@article {Karpbmjsrh-2020-200944, author = {Celia Karp and Shannon N Wood and Georges Guiella and Peter Gichangi and Suzanne O Bell and Philip Anglewicz and Elizabeth Larson and Linnea Zimmerman and Caroline Moreau}, title = {Contraceptive dynamics during COVID-19 in sub-Saharan Africa: longitudinal evidence from Burkina Faso and Kenya}, elocation-id = {bmjsrh-2020-200944}, year = {2021}, doi = {10.1136/bmjsrh-2020-200944}, publisher = {British Medical Journal Publishing Group}, abstract = {Introduction Evidence from health emergencies suggests COVID-19 will disrupt women{\textquoteright}s sexual and reproductive health (SRH). In sub-Saharan Africa, which experiences the highest rates of unintended pregnancy and unsafe abortion globally, COVID-19 is projected to slow recent progress toward universal access to contraceptive services.Methods We used longitudinal data collected from women at risk of unintended pregnancy in Burkina Faso (n=1186) and Kenya (n=2784) before (November 2019{\textendash}February 2020) and during (May{\textendash}July 2020) COVID-19 to quantify contraceptive dynamics during COVID-19; examine sociodemographic factors and COVID-19 experiences related to contraceptive dynamics; and assess COVID-19-related reasons for contraceptive non-use. Bivariate and multivariate logistic regressions were used to examine correlates of contraceptive dynamics amid COVID-19.Results Most women did not change their contraceptive status during COVID-19 (68.6\% in Burkina Faso and 81.6\% in Kenya) and those who did were more likely to adopt a method (25.4\% and 13.1\%, respectively) than to discontinue (6.0\% and 5.3\%, respectively). Most women who switched contraceptives were using methods as or more effective than their pre-pandemic contraception. Economic instability related to COVID-19 was associated with increased contraceptive protection in Burkina Faso but not in Kenya. Altogether, 14.4\% of non-contraceptive users in Kenya and 3.8\% in Burkina Faso identified COVID-19-related reasons for non-use.Conclusions The vast majority of women at risk of unintended pregnancy did not change their contraceptive status during COVID-19, and more women adopted than discontinued methods. A minority of women reported COVID-19-related reasons for non-use, underscoring the importance of expanding safe modes of service delivery during health crises.}, issn = {2515-1991}, URL = {https://srh.bmj.com/content/early/2021/02/11/bmjsrh-2020-200944}, eprint = {https://srh.bmj.com/content/early/2021/02/11/bmjsrh-2020-200944.full.pdf}, journal = {BMJ Sexual \& Reproductive Health} }