Facilitators and Barriers to Sexual and Reproductive in the Midst of the COVID-19 Pandemic: An Evaluation of Clinics in Jamaica Restricted; Files Only

Abstract

The COVID-19 pandemic has disrupted health systems across the globe, including sexual

and reproductive services. The extent of these impacts has yet to be understood,

especially in Jamaica. Therefore, this thesis sought to explore provider perspective on

sexual and reproductive care before and during COVID-19. More specifically, this

research used a mixed-methods approach to answer the question: What are the barriers

and facilitators to service delivery of sexual and reproductive healthcare in two Jamaican

regions as a response to COVID-19? Interviews and surveys were administered to 66

participants at 7 sites to identify the challenges and adaptations to specific services like

STI testing and treatment, family planning education, and contraceptive access. The data

found themes of: an existing integrated model of care, prior existing challenges,

exacerbated and unique challenges due to COVID-19, and adaptations and resilience in

the face of the pandemic. Jamaican healthcare providers are aware of the community’s

needs, even before the introduction of COVID-19. Because of this and the strong existing

model of integrated HIV and sexual and reproductive care, health staff was able to

respond to added barriers with ingenuity and resilience. The findings from this thesis

align with similar other COVID-19 related research, but allows for unique insight into

provider perspective.

Table of Contents

Chapter 1: Introduction…………………………………………………………………1

Chapter 2: Literature Review…………………………………………………….……..7

Sexual and Reproductive Health and Essential Component of Care…………...…7

Health Systems of Jamaica……………………………………………………..…7

Sexual and Reproductive Care and HIV/AIDS Services in Jamaica………..…….9

Sexual and Reproductive Health Service Delivery in Jamaica…………………..10

Barriers to Sexual and Reproductive Healthcare Access in Jamaica…………….12

Challenges to SRH Service Delivery and Health Systems during COVID-19…..13

Sexual and Reproductive Research in Jamaica………………………………..…15

Research Contribution………………………………………………………...…16

Chapter 3: Methods…………………………………………………………….………17

Study Design and Recruitment………………………………………………..…17

Setting……………………………………………………………………………18

Procedures……………………………………………………………………..…20

Instruments……………………………………………………………………….21

Data Analysis…………………………………………………………………….22

Ethical Considerations………………………………………………………...…23

Chapter 4: Results………………………………………………………………..….…24

Participant Demographics……………………………………………..…………24

Specialized Services: How Clinics Have Served Their Community…….………27

Pre-COVID-19 Barriers to Care: Systemic Challenges…………………….……29

COVID-19 Specific Challenges: The Introduction of Unique Barriers……….…32

Adaptations to Strengthen the SRH Care Continuum…………………..………..38

Chapter 5: Discussion and Public Health Implications………………………………45

Discussion………………………………………………………………..………45

Strengths and Limitations………………………………………………..………49

Future Research and Public Health Implications…………………………...……51

Chapter 6: Conclusion…………………………………………….……………..……..54

References……………………………………………………………………..…………55

Appendix A………………………………………………………………………………62

Appendix B……………………………………………………………………..……..…66

Figure 1……………………………………………………………………………..…..…5

Figure 2……………………………………………………………………………..……..6

Figure 3………………………………………………………………………………..…19

Figure 4………………………………………………………………………………..…38

Table 1………………………………………………………………………………...…19

Table 2………………………………………………………………………………...…24

Table 3………………………………………………………………………………..….26

Table 4………………………………………………………………………………...…38

Table 5………………………………………………………………………………..….39

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Education Health Sciences, Public Health
Stichwort	Sexual Health
Committee Chair / Thesis Advisor	Subasri Narasimhan, Emory University

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