Unmet contraceptive needs and unintended pregnancies among adolescent girls amid COVID-19 in sub-Saharan Africa and the importance of accurate, reliable and real-time data

Background

Contraception, also known as birth control, is used to prevent pregnancy.¹ Condoms (both male and female), diaphragms, cervical cups, birth control patches, pills, injections, rings and implants are some of the birth control methods or birth control devices that can be used.²

The COVID-19 pandemic has created numerous challenges on a global and national level. One of the problems caused by the pandemic is the inability to obtain contraceptives and devices due to a supply chain disruption.³ Additionally, in 2020, the Indian government decided to restrict the export of 26 pharmaceutical ingredients and drugs, including the hormone progesterone, used in contraceptive pills and intrauterine devices (IUDs). Also, Karex Bhd, Malaysia’s largest condom manufacturer, which makes one in five condoms worldwide, was forced to close in March 2020. As a result, lockdowns and border closures are impacting the global distribution of IUDs, contraceptives, pills, condoms and other devices.^1,4

In addition, the restrictions imposed by COVID-19 led to an unmet need for contraceptives among young people. Pandemics such as COVID-19 in sub-Saharan Africa (SSA) have a significant negative impact on issues such as reproductive health among young girls, as resources dedicated to reproductive health can be diverted to combating COVID-19.⁵ As such, there is a strong concern at SSA that there may be unwarranted or extreme sexual activity in adolescents that could result in teenage pregnancy.⁶ For example, it was discovered that thousands of schoolgirls in Kenya became pregnant during the lockdown.⁵ The Gauteng Health Department said in the latest report on teenage pregnancies amid COVID-19 in one of South Africa’s provinces, Gauteng, the records show that there were more than 23,000 teenage pregnancies involving 934 girls aged 10 to 14 years between April 2020 and March 2021 at birth.⁷ There are also concerns that adolescent girls may be exposed to transactional sex with adults, leading to increased sexual abuse and human immunodeficiency virus (HIV) transmission.⁸

Such a situation undermines progress made in sexual and reproductive health and HIV response in SSA⁶ as it leads to an increase in sexual violence against women and girls, which can result in unwanted pregnancies. According to the Envoy of the United Nations Human Rights Office (2020), strict lockdown rules have meant women and girls have had limited access to social protection, threatening their sexual health and reproductive (SHR) rights. Disrupted public health has led to a 10% annual decline in SHR services and access in low- and middle-income countries, particularly among girls and women.⁹ This current situation may jeopardize the ability of SSA countries to achieve the 2030 Sustainable Development Goals (SDGs).

Reaching sustainable development goals

The United Nations Sustainable Development Goals (SDGs), launched in September 2015, serve as a guide for countries to set goals that will benefit the health of citizens by 2030. Goal 3 of the SDGs is to ensure healthy lives and promote well-being for all people of all ages.¹⁰ Target 3.3 of the SDGs aims to eradicate acquired immune deficiency syndrome (AIDS) epidemics. AIDS is now the leading cause of death among African youth and HIV is the leading cause of death among women of childbearing age worldwide.¹¹ This letter hypothesizes that, among other things, this important goal could not be achieved under the prevailing current circumstances.

Need for accurate, reliable and real-time data

However, it is unclear how much COVID-19 restrictions have impacted teenage pregnancy and related complications in sub-Saharan Africa during COVID-19 due to a lack of real-time or recent data. Furthermore, no association has been established between teenage pregnancies and contraceptive use during COVID-19 pandemic. According to the latest statistics¹² there were 106,408 live births to mothers aged 10-19 in South Africa in 2019. Although marked as recent, these births may not have taken place during lockdown. They may have occurred in 2019 and were reported between January and February of the following year.¹³ It’s even hard to say how many pregnancies end in miscarriage, stillbirth or abortion, says Katharine Hall, a researcher at the University of Cape Town’s Children’s Institute.⁷ Accordingly, in the absence of real-time data monitoring health-oriented behavior and contraceptive use among adolescents, may be difficult to track the SDG goal 3 and objectively report on achievement.

Researchers often rely on data from live births. Statistics South Africa, for example, compiles and publishes annual live birth data using the Home Office’s national birth registration system.¹⁴ Due to the lack of real-time data, demographic processes such as fertility and its direct determinants such as contraceptive use are becoming increasingly difficult to understand. Accurate, reliable, real-time data on contraceptive use during a pandemic is critical to the development of social, economic and health policies that allow government to develop interventional health programs and control the rise in teenage pregnancy in sub-Saharan Africa.

Traditional data sources such as regular surveys and censuses have proven insufficient to understand adolescent health behaviors, although they remain the only sources. The concern is that surveys are not being conducted in a timely manner to monitor trends and changes in population dynamics and health behaviors. Put simply, disasters like the COVID-19 pandemic have shown that traditional data sources are insufficient to capture and understand changes in behavior over a short period of time, making it difficult to understand the reality of the situation.

Main concerns

The key questions that need to be asked and are the main concerns are: if teenage pregnancy rates remain relatively high, what is the level of contraceptive use among adolescents in Africa? How effective has COVID-19 disrupted young people’s access to contraception? Has COVID-19 contributed to an increase in teenage pregnancies or even an increase in abortions due to unmet contraceptive needs caused by lack of access to reproductive healthcare and unwanted pregnancies? How well is the District Health System (DHS) able to answer these questions by providing data to help understand the postulated questions about contraceptive use? Has there been a decrease in contraceptive use during COVID-19? If so, what factors might have contributed: lack of access to healthcare facilities or changing health behaviors leading to sexually transmitted diseases, teenage pregnancy, and related complications?

Conclusion

The concerns and questions raised in this post may indicate a lack of understanding of critical health issues related to adolescent pregnancy in sub-Saharan Africa. Data sources for this important concern may need to be strengthened to track sexual behavior, potential child abuse, teenage pregnancy and other complications that may arise due to barriers to contraceptive access during a pandemic.

Data availability

No data are associated with this article.