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

Report on Sexual and Reproductive Health Services and Sustainable Development Goals

1.0 Participant Demographics and Relevance to SDGs

This report analyzes data from multiple participant groups to assess the status of sexual and reproductive health (SRH) services, aligning with key Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), and SDG 5 (Gender Equality).

1.1 Client Survey Participants

• Total Respondents: 990
• Age Range: 15 to 47 years
• Gender Distribution: 99.5% female, highlighting the study’s direct relevance to SDG 5 by focusing on health outcomes for women and girls.
• Education Level: 0 to 19 years of formal education, indicating a diverse sample relevant to understanding the intersection of SDG 4 and health literacy.
• Relationship Status: 65.3% cohabiting with partners.
• Health Status: Approximately 10% tested for COVID-19, and 7% were pregnant, underscoring the immediate health needs pertinent to SDG 3.

1.2 Healthcare Worker Participants

• Total Interviewed: 16 (13 female, 3 male)
• Role: All held management positions, providing a strategic perspective on health system resilience, a core component of SDG 3.

1.3 In-Depth Interview (IDI) and Focus Group Discussion (FGD) Participants

A combined total of 134 individuals participated in qualitative data collection, with characteristics reinforcing the study’s focus on key SDG-related demographics.

1. IDI Participants (66): Included 30 men and 36 women, ensuring a gender-balanced perspective crucial for SDG 5. The majority had completed high school and were engaged in income-generating activities, linking health outcomes to SDG 8 (Decent Work and Economic Growth).
2. FGD Participants (68): Included community members and adolescents (age 16-56), whose engagement is vital for inclusive progress towards SDG 10 (Reduced Inequalities).

2.0 SRH Service Utilization and Progress Towards SDG 3 and SDG 5

Analysis of SRH service utilization provides a direct measure of progress towards SDG Target 3.7 (universal access to SRH services) and SDG Target 5.6 (universal access to SRH and reproductive rights).

2.1 Primary Reasons for Health Centre Visits

• Contraceptive/Family Planning: 68% of clients sought these services, indicating a strong demand that aligns with the objectives of SDG 3.7.
• Gender-Based Violence (GBV): A significant finding was that no clients sought care for GBV, revealing a critical gap in service provision that directly undermines the achievement of SDG 5.
• STI Screening: 41% of clients reported being screened for STIs, showing partial progress in comprehensive SRH care under SDG 3.

2.2 Abortion and Post-Abortion Care (PAC)

• The majority (71%) of clients seeking abortion care required PAC, primarily for incomplete abortion (81%) and haemorrhage (78%). This highlights the necessity of safe and comprehensive abortion services to meet SDG 3.7 and reduce maternal mortality.
• Provider perspectives indicated that while abortion care was considered essential, demand remained low. Medical abortion was prioritized during lockdown periods.

2.3 Contraceptive Use and Sexual Risk Behaviours

• Qualitative data confirmed a sustained need for contraception for birth spacing.
• Survey data revealed low protection usage during sexual activity (14% for oral sex, 13.8% for anal/vaginal sex), indicating a persistent challenge for public health education and disease prevention efforts under SDG 3.

3.0 Health System Resilience and Service Availability During the Pandemic

The study assessed the resilience of the health system in maintaining essential services, a critical factor for achieving SDG Target 3.8 (Universal Health Coverage).

3.1 Client Attendance and Service Disruption

• Client attendance at health facilities fluctuated, with notable declines observed in July 2021 and July 2022. This demonstrates the vulnerability of health service utilization during a crisis, posing a risk to sustained progress on SDG 3.
• Despite fluctuations, most facilities (three of four) reported normal functioning at baseline, and all facilities reported normal functioning at endline, indicating a degree of system resilience.
• SRH services were officially maintained and strengthened, with special provisions made for COVID-19 positive mothers, reflecting a commitment to SDG 3 and SDG 5.

3.2 Access to Essential Medicines and Financial Stability

• There was no reported shortage of essential SRH medicines, a positive indicator for SDG 3.8.
• However, facilities reported significant financial distress due to the high cost of PPEs and reduced income from lower attendance. This financial strain threatens the long-term sustainability of health services and the achievement of the SDGs.

4.0 Specific Service Readiness: Family Planning and Abortion Care

4.1 Family Planning (FP) Services

• Three of four facilities reported no disruption to FP services. Staffing for FP units increased by endline, supporting the infrastructure needed for SDG 3.7.
• Commodity Gaps: A significant challenge was the lack of a full stock of reproductive health commodities. No facility had female condoms or vaginal rings, and only half had male condoms at endline. This gap directly hinders the ability to provide comprehensive choices as envisioned by SDG 3.7 and SDG 5.6.

4.2 Abortion Services

• Safe abortion services were largely undisrupted in three of four facilities.
• Improvements were noted in facility infrastructure, such as the availability of reception desks and separate rooms for abortion service clients, which enhances the quality of care and supports progress towards SDG 3.
• A persistent gap was the lack of separate waiting rooms for adolescents, highlighting an area for improvement to ensure equitable access under SDG 10.

5.0 Barriers and Mitigating Factors for Achieving Health-Related SDGs

5.1 Barriers to SRH Service Utilization

The primary barrier to accessing SRH services, which impedes progress on SDG 3 and SDG 10, was the fear of COVID-19 infection. Movement restrictions also posed a challenge.

5.2 Innovations and Mitigating Actions

Healthcare managers implemented key innovations that demonstrate a commitment to SDG 17 (Partnerships for the Goals) and building resilient systems.

1. Local Production of PPEs: Facilities used internally generated funds and volunteer support to produce hand sanitizers and face masks, overcoming supply chain disruptions.
2. Expansion of Telemedicine: Three facilities already had telemedicine, and the fourth established it by endline, using technology to maintain access to care and advance SDG 3.
3. Task Shifting: Facilities reallocated staff to ensure continuity of care, demonstrating adaptability in resource management.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article primarily addresses issues related to two Sustainable Development Goals:

• SDG 3: Good Health and Well-being: The article’s central theme is the provision and utilization of Sexual and Reproductive Health (SRH) services, including family planning, abortion care, and screening for Sexually Transmitted Infections (STIs). It also examines the resilience and readiness of the healthcare system in the face of a global health crisis (COVID-19), discussing service availability, access to essential medicines, and the impact on healthcare workers.
• SDG 5: Gender Equality: The issues discussed are intrinsically linked to gender equality. The focus on SRH services like contraception and safe abortion care is crucial for women’s empowerment, bodily autonomy, and reproductive rights. The article explicitly mentions screening for Gender-Based Violence (GBV) and highlights that the survey respondents were predominantly female (99.5%), underscoring the gendered nature of SRH services.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, the following specific SDG targets can be identified:

1. Target 3.7: “By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.”
   • Explanation: The article extensively details the utilization of contraceptive/family planning services (68% of clients), the availability of various contraceptive methods, the provision of safe abortion and post-abortion care, and STI screening. This directly relates to ensuring access to a range of SRH services.
2. Target 5.6: “Ensure universal access to sexual and reproductive health and reproductive rights…”
   • Explanation: This target is closely linked to 3.7 but with a specific focus on rights from a gender equality perspective. The article’s discussion on the availability of family planning, contraception choices, and safe abortion services directly addresses the components necessary for women to exercise their reproductive rights.
3. Target 5.2: “Eliminate all forms of violence against all women and girls…”
   • Explanation: The article mentions that health facilities were screening clients for Gender-Based Violence (GBV). It states, “About 18% were screened for GBV,” which is a direct action aimed at identifying and addressing violence against women, aligning with this target.
4. Target 3.d: “Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks.”
   • Explanation: The article assesses the impact of the COVID-19 pandemic on the healthcare system. It discusses service availability and readiness, disruptions, the impact on human resources (“reduction in staff strength”), the availability of essential medicines and PPEs, and mitigating actions taken by facilities, such as the “introduction or expansion of Telemedicine.” This analysis is a direct evaluation of the health system’s capacity to manage a global health risk.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article provides several quantitative and qualitative data points that can serve as indicators to measure progress:

• For Targets 3.7 and 5.6 (Access to SRH):
  • Proportion of clients seeking specific SRH services: The article states that “68% of clients visited the health centre for contraceptive/family planning services.”
  • Availability of contraceptive methods: The text details the stock of various methods, noting that all facilities had items like “combined estrogen progesterone oral contraceptive pill, progestin only contraceptive pill… implant and copper IUDs,” while noting stock-outs of others like “female condoms.”
  • Utilization of abortion services: Figure 2 shows the “Client utilisation of abortion services over the study period,” providing a direct measure of service use.
  • Proportion of clients screened for STIs: The article specifies that “41% of clients reported being screened for STIs during their visit.”
• For Target 5.2 (Eliminating Violence Against Women):
  • Proportion of clients screened for GBV: The article provides the specific figure that “18% were screened for GBV.”
  • Service uptake for GBV: It is noted that “none interviewed sought care for Gender Based Violence (GBV),” which serves as an indicator of service utilization (or lack thereof).
• For Target 3.d (Health System Readiness):
  • Service continuity: The article reports that “three of four [facilities] were functioning as normal during baseline” and “all health facilities reported normal functioning” at endline.
  • Availability of essential supplies: It is mentioned that there was “no shortage of essential medicines and medical supplies,” although challenges with PPEs and financing were reported.
  • Human resource capacity: The article indicates changes in staffing for family planning units, with the median number of staff increasing from three at baseline to six at endline.
  • Adoption of innovative health solutions: The article notes that by endline, all four facilities had established telemedicine services to mitigate the pandemic’s impact.

4. Summary Table of SDGs, Targets, and Indicators

Source: reproductive-health-journal.biomedcentral.com