Sexual and reproductive disparities by formal and informal urban residence in Kinshasa before, during, and after the COVID-19 pandemic

The Coronavirus Disease 2019 (COVID-19) pandemic threatened progress in sexual and reproductive health (SRH) across sub-Saharan Africa, with urban communities in informal settlements (slum neighborhoods) particularly at risk. In Kinshasa, disruptions to family planning and contraceptive services were noted at the beginning of the COVID-19 pandemic but rebounded after lockdown restrictions were eased. However, there has been limited research on differential post-pandemic trends in SRH outcomes between slum and non-slum residents. This study uses longitudinal data from four rounds of the Performance Monitoring for Action (PMA) survey in Kinshasa, Democratic Republic of Congo (DRC) to examine how SRH outcomes shifted across slum and non-slum neighborhoods from 2019 to 2024. We utilized mixed-effects logistic regression models to examine the influence of slum vs. non-slum neighborhood status on the odds of contraceptive and pregnancy outcomes over time. Prior to the onset of the COVID-19 pandemic, seven in ten women (70.4%) were living in a slum neighborhood. Among all women, the odds of reporting one’s current or last pregnancy being unintended increased significantly from 2019/2020 to 2021/2022 (OR = 3.8) and 2024 (OR = 11.6), highlighting that pregnancies occurring during and after the pandemic were more likely to be unintended. We found no evidence of diverging trends in SRH outcomes by slum status over time. However, slum residence was significantly associated with higher need for contraception, lower contraceptive use among those in need, greater provider-dependent method use, and unintended pregnancy, before, during and after the pandemic. COVID-19 did not significantly widen reproductive health disparities between slum and non-slum residents in Kinshasa, but the analysis shows sustained inequities in contraceptive need, contraceptive coverage, and unintended pregnancy, before, during and after the pandemic. Addressing these disparities, particularly during times of budget cuts to family planning and reproductive health, requires targeted investments in counseling and contraceptive access. The COVID-19 pandemic led to disruptions in health services that threatened the ability of women in Sub-Saharan Africa to seek sexual and reproductive healthcare, such as family planning services. Those who live in informal settlements (slum neighborhoods) may be particularly harmed by disruptions related to COVID-19. In this study, we used data from the Performance Monitoring for Action (PMA) Program in Kinshasa, DRC to examine changes over time in measures of reproductive health among women living in formal non-slum and slum communities. Before the pandemic, women in slum communities were less likely to be using family planning when trying to avoid pregnancy and more likely to report their pregnancies as unintended. The need for family planning to avoid pregnancy and the reporting of unintended pregnancies during and in the year after the pandemic increased for all women, with no differential trends between slum and non-slum dwellers. As a result, inequities women in slum communities faced before the pandemic​ persisted during and after the pandemic. As such, the research highlights ongoing challenges in ensuring equal access to family planning and reproductive health services in Kinshasa.