Health Provider Perceptions of Contraceptive Availability in Jamaica during the COVID-19 Pandemic Pubblico
Catbay, Denise (Spring 2023)
Abstract
Background: The COVID-19 pandemic impacted all aspects of health service delivery, especially sexual reproductive health services. COVID-19 restrictions affected patients’ access to and clinics’ provision of family planning services. More than two and half years after the first case of COVID-19 in Jamaica, the effects of the pandemic on contraceptive availability can still be seen.
Goal: The goal of this research project is to identify the contraceptive methods that were available at public health centers in three regions in Jamaica, determine whether there were any disruptions or circumstances that impacted health providers’ provision of contraceptive methods, and analyze health provider perceptions of contraceptive availability during the pandemic.
Methods: The study applied a retrospective cross-sectional convergent mixed-methods descriptive study design. The project analyzed quantitative surveys and qualitative in-depth interviews with HIV and family planning healthcare providers at 14 health centers in 3 regions in Jamaica. For the 48 surveys, the project used STATA to analyze univariable and bivariate relationships with descriptive statistics and Fisher’s exact tests. For the 23 interviews, the project conducted thematic analysis with MAXQDA.
Results: The majority of healthcare providers reported no change in the availability of contraceptive methods during the COVID-19 pandemic. The same types of methods were available before, during, and at the peak of the pandemic. The methods perceived to be more available were male condoms, injectables, and oral contraceptives. The methods perceived to be less available were female condoms, IUDs, implants, and emergency contraception. Staffing issues negatively affected the availability of long-acting reversible contraception. Changes in contraceptive availability were associated with perceptions of recent stockouts and on-time deliveries. Qualitative results showed a variety of challenges that health personnel faced including contraceptive stockouts, staff shortages, and a lack of trained staff for IUDs.
Discussion: Despite challenges with stockouts and staff shortages, there was overall availability of contraceptives at health centers in Jamaica during the pandemic. Though contraceptives were available, COVID-19 restrictions prevented patients from accessing available family planning services. More research is needed to understand the accessibility of family planning services during the pandemic from the patient perspective.
Table of Contents
Chapter 1: Introduction 1
Chapter 2: Literature Review 6
Contraception as the Cornerstone of Family Planning 6
Understanding Modern Methods of Contraception 7
Unmet Need for Family Planning 8
Jamaica in Focus 9
Contraceptive Use in Jamaica 10
Challenges to Contraceptive Availability around the World 11
Challenges to Contraceptive Availability in Jamaica 14
The Impact of COVID-19 on Contraceptive Availability 16
Jamaican Health System Response to COVID-19 18
COVID-19 Impact on Contraceptive Availability in Jamaica 19
Chapter 3.1: Methods 20
Research Partners and Support 20
Study Design 21
Setting 21
Sampling and Recruitment 22
Data Collection 25
Study Instruments 26
Data Cleaning 28
Data Analysis 29
Institutional Review Boards and Ethical Considerations 31
Chapter 3.2: Results 33
Quantitative Results 33
Qualitative Results 48
Chapter 4.1: Discussion 57
Issues with the Supply of Contraceptives and Stockouts 57
Contraceptive Services were Restricted due to Workforce Capacity 60
Resilience of the Jamaican Health System to Ensure Contraceptive Availability 62
Application of the AAAQ Framework 64
Research Limitations 65
Chapter 4.2: Public Health Implications & Recommendations 68
Conclusion 70
References 72
Appendix A. Survey Questionnaire 81
Appendix B. In-Depth Interview Guide 85
About this Master's Thesis
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