Family planning and abortion service availability and utilisation during the COVID-19 pandemic in Ghana

The effect of COVID-19 has manifested both in the capacity of healthcare systems to provide services as well as create a good balance between pandemic management and maintenance of essential health services. Earlier studies in Ghana during the pandemic reported low patronage of family planning (FP) services but a sudden spike in emergency contraceptive pill utilization. This paper seeks to assess health service availability and readiness, client needs for, and utilization of FP and abortion services during the COVID-19 pandemic period in Ghana. This study was a panel study with two-time data collection points six to nine months apart. Both quantitative and qualitative approaches were used. A one-time survey was used to assess SRH service utilization by 997 clients. Qualitative data involved a total of 24 Focus Group Discussions (FGDs), 128 In-depth Interviews (IDIs) with female clients and their male partners, and 32 IDIs with healthcare practitioners in the four selected facilities. Also, the WHO Service Availability, Readiness and Assessment tool was completed for the health facilities at baseline and endline. Descriptive statistics and thematic analysis were conducted for quantitative and qualitative data respectively. Age of clients and their male partners participating in IDIs ranged between 18 and 50 years (mean = 33.2 years) while participants for community FGDs ranged between 16 and 56 years (mean = 32.0 years). The majority (68%) of clients visiting the health facility for SRH care sought FP services while 5% sought abortion/post-abortion care of which 71% needed post-abortion care. Attendance data showed sensitivity to the occurrence of the different waves of COVID-19. Family planning and abortion services were generally available but witnessed some short-lived disruption. Healthcare managers reported financial stress which led to innovations in procurement of PPEs and hand sanitizers. Telemedicine facilities did not provide SRH care. Fear of stigma was a major barrier to access to abortion care. The relatively low COVID-19 infection rates in Ghana preceded by the national COVID-19 preparedness strategy may explain the low impact on disruption of FP and abortion services. Development of SRH specific guidelines and strengthening telemedicine facilities to include SRH care may reduce future disruption. Since 2020 most countries around the world were hit by COVID-19 infection with many deaths recorded. Measures to control the pandemic while sustaining existing services stressed health systems. Earlier studies in Ghana during the pandemic reported impact on health services. Yet, we do not know how the COVID-19 pandemic impacted the health system’s readiness and availability to provide family planning and abortion services, and client utilization, at different levels of care in public health facilities in Ghana. This study involved a survey of clients accessing care at all sexual and reproductive health units in the 4 selected hospitals. We also had in-depth interviews with 128 women and their male partners, 32 interviews with healthcare providers and 24 groups of community members to elicit their needs for sexual and reproductive health services, utilization, and perspectives on care provided at the time. We found that there was some disruption of family planning and abortion services, especially for surgical abortion methods which were suspended during the lockdown and period thereafter. However, service provision was fully restored in all facilities by the follow-up period. Fear of COVID-19 infection and stigma were barriers to accessing care even after lockdown was ended. We recorded innovative measures such as self-production of personal protective equipment and institution of telemedicine facilities. Client utilization data showed patterns related to waves of infection in Ghana. Thus, we believe that the minimal disruptions observed was due to the relatively low infection rates in Ghana.