Early Effects of the COVID-19 Pandemic on Family Planning Utilisation and Termination of Pregnancy Services in Gauteng, South Africa: March–April 2020

Background: Experiences from infectious outbreaks globally, such as Ebola and severe acute respiratory syndrome (SARS), highlight the challenges of government to maintain essential healthcare services, guarantee healthcare access and at the same time shift resources to contain and mitigate the crisis. The declaration of the State of Disaster in South Africa due to the COVID 19 pandemic (on the 15th of March) and the subsequent imposition of a total national lockdown on all usual activities were anticipated to have both direct and indirect negative consequences on healthcare utilisation including reproductive healthcare services. Objective: The objective of this study is to describe the effect of the COVID-19 pandemic on family planning and termination of pregnancy services utilisation immediately following the lockdown in Gauteng Province. Methods: We analysed the administrative data on clinical services utilisation during the previous two years, including five weeks following the enforcement of the lockdown in South Africa, from the District Health Information System database over the period 1 April 2018–30 April 2020. Results: Primary healthcare utilisation headcounts across the province declined by nearly 500,000 visits following the lockdown period. Family planning utilisation patterns which are demand-driven declined during the two months preceding the COVID-19 pandemic and further declined during the lockdown. Switching contraceptive methods to those with less effectiveness were noted as a trend over the previous two years. Year on year comparisons from April 2018 to April 2020 indicated a consistent decline in the use of injectable methods and increased use of oral contraceptive pills. Conclusion: This review highlights the importance of monitoring the utilisation of routine healthcare services during the outbreak situations to ensure that service provision is not compromised. Women of reproductive age must be able to exercise their reproductive choices to prevent unintended pregnancies and to reduce their risk of mortality as a result of diminished access to reproductive healthcare services.