The Impact of the 2018-2020 Ebola Epidemic in DR Congo on Access to Family Planning and Post Abortion Care Services, a Mixed Methods Analysis Open Access

Snyder, Allison (Summer 2020)

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Objective: This study aims to evaluate the impact of the 2018-2020 Ebola epidemic in DRC on access to and utilization of sexual and reproductive health services, with a focus on family planning (FP) and post abortion care services (PAC).

Design: Mixed methods study, including an analysis of primary qualitative data (key informant interviews (KII) and focus group discussions (FGD)) from care providers and women community members in North Kivu DRC, plus an analysis of secondary program data from CARE International’s SAFPAC initiative.

Methods: 10 KII and 12 FGD were conducted with 130 total participants. Data were analyzed in MAXQDA and major themes were identified. Secondary program data containing monthly totals of women who utilized FP and/or PAC services at identified SAFPAC supported health facilities in 3 health zones in North Kivu, DRC (Butembo, Kayna and Lubero) from 2017 through 2020 were analyzed to identify trends.

Results: FGD and KII feedback indicated that FP and PAC use dropped significantly during the EVD epidemic in the health zones in question. However, SAFPAC initiative health facility data on FP and PAC use indicated that use of the services remained relatively stable, with slight drops in FP use and a more significant drop of PAC use in Butembo, the health zone hardest-hit by the EVD epidemic. Interview and discussion participants shared that fear and rumors were the main drivers of decisions around seeking SRH care during the epidemic.

Conclusion: A mixed methods approach to this topic is extremely valuable in order to understand the nuance and complexity of the challenge. Overall, SRH services continued through the course of the EVD epidemic, with only slight reductions in numbers of women accessing the services via the SAFPAC initiative. One of the most important findings regarding mitigation planning/techniques to ensure continued access to SRH services in epidemic settings is to involve local organizations and leaders in community outreach and sensitization efforts.

Table of Contents

Table of Contents



Chapter I: Introduction

Introduction and Rationale

Problem Statement

Purpose Statement

Research Questions

Significance Statement

Definition of Terms


Chapter II: Review of the Literature

Introduction to the Literature

Learning from Past Experiences

DRC Context

The latest EVD outbreak in DRC, and its impact on SRH

Summary of current problem and study relevance

Chapter III: Contribution of the Student

Chapter IV: Journal Article Manuscript

Title Page for Manuscript





Access to and utilization of family planning (FP) services during the EVD epidemic

Access to and utilization of post abortion care (PAC) during the EVD epidemic

Interruptions in the availability of SRH services during the EVD epidemic

Drivers of women's decisions to seek SRH services

Possible long-term impacts of the EVD on SRH

Proposed mitigation techniques


Key findings





Tables and Figures

Table 1

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Chapter V: Public Health Implications


I.     Qualitative Analysis Code Book

II.   Key Informant Interview Questions:

III.  Focus Group Discussion Questions:

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