Distribution of FP &amp; RH services in Bangladesh during "Lockdown" period: Shock assessment of COVID-19,
Creators: name: Md. Irfan Hossain
name: Bajracharya, Ashish
name: Sigma Ainul
name: Ubaidur Rob
name: Hossain, Sharif
Publisher: name: Gates Open Research
Year: 2023

description: <b>Background</b><br> To contain community transmission of COVID-19, Bangladesh instituted a nationwide “holiday” which media described as a "lockdown", initially for 10 days, from March 26th to April 4th, 2020, then extended successively through May 30th. During the “lockdown”, public and private offices remained closed, people were asked to practice social distancing and stay at home, public transport was limited and advice was given to avoid it (all of these activities were forbidden with the exception of emergency services). Many organizations widely documented the impact of the pandemic and its mitigation measures on social, economic, and financial aspects of life. However, disruptions to reproductive health (RH) &amp; family planning (FP) services got less attention. This study intends to assess the potential shocks of COVID-19 and its related mitigation measures on RH &amp; FP services in Bangladesh, examining national trends by utilizing publicly available routine service statistics.<br> <br> <b>Main question/Hypothesis</b><br> This study was performed to answer how RH &amp; FP services got disrupted during the imposing "lockdown" and post-“lockdown” period. Furthermore, this study explored district (2<sup>nd</sup> large administration boundary) level variations of these disruptions to advocate the government to take necessary actions to face any other wave of COVID-19 or another pandemic for providing seamless RH &amp; FP services. Also, the study collated mitigation measures from various anecdotal sources.<br> <br> <b>Methodology</b><br> Routine monthly service statistics for 2019 and 2020 from the Directorate General of Family Planning (DGFP)’s website of Bangladesh’s Ministry of Health and Family Welfare (MoHFW) were examined to determine ante-natal care (ANC), institutional delivery, and post-natal care (PNC) service trends. Statistics from the Directorate General of Health Service (DGHS) were not included because of non-availability.<br> For the RH part, the following services were considered– first 4 ANC services, first 4 PNC services, normal delivery, C-section delivery, and active management of 3rd stage of labor (AMTSL) services. Also, for the FP side, distribution &amp; provisions of short-acting methods (pill, condoms, injectables), long-acting and reversible contraceptives (intrauterine devices IUD, implants), and permanent methods (tubectomy &amp; non-scalpel vasectomy) were considered.<br> As this secondary analysis (trend) is based upon publicly available data so no ethical review of this study was needed. To ensure any decline in services observed in 2020 was not a result of a seasonal trend, data from each month of 2020 were compared with the same months in 2019, with differences expressed as relative percentage differences. Trends in changes for these services within individual districts were also examined to illustrate geographic trends in the country’s RH &amp; FP services disruptions.<br> <br> <b>Results</b><br> The findings showed that ANC and PNC visits declined in March 2020. Compared to 2019 services statistics, ANC and PNC services declined to 40% in April 2020 immediately following the lockdown. In December 2020, except for the 1<sup>st</sup> ANC visit; 2<sup>nd</sup> , 3<sup>rd</sup> , and 4<sup>th</sup> ANC visits were still 10% less than in 2019 whereas PNC services were found to be 15% less.<br> Between February and April 2020, when “lockdown” was under enforcement, fully half (32 of 64 total) of Bangladesh’s districts experienced immediate reductions in 1<sup>st</sup> ANC services, as much as 40% - while declines as great as 60% in these services occurred in 29 districts.<br> All forms of institutional delivery services were 15–20% lower in April 2020, compared to 2019. Major disruptions in institutional delivery occurred in Dhaka for both normal delivery (42%) and c-section (41%).<br> All family planning (FP) methods, except the pill, showed decreases ranging from 30% to 100% in April 2020 (compared to 2019), indicating disruptions immediately after the lockdown started. Trends improved in May and June, indicating recovery towards pre-lockdown levels, then plateaued in July–November and fell slightly in December.<br> In 20 districts, distribution declined as much as 40% for the oral pill (comparing February vs. April 2020). Although these districts had improved in July 2020, when data were compared to February 2020, seven districts had continued reductions of as much as 40%, while a certain district continued overall reductions of up to 60%.<br> <br> <b>Knowledge contribution</b><br> Clear disruptions in RH &amp; FP services following COVID-19 and its resultant lockdowns are evident in Bangladesh. Recommendations to help restore RH services to normal levels include: Develop targeted interventions that rebuild trust between communities and the health system, especially frontline healthcare providers, amid fears and stigma related to COVID-19. Monitor and routinely analyze facility service statistics to support MoHFW’s identification of low-performing and slowly recovering districts, where targeted actions can help restore levels of service. Develop standard operating procedures for maternal health service continuation during COVID-19, and preparedness plans for potential future emergencies—including similar pandemic scenarios or potential future waves of COVID-19; such plans should include clear instructions for community outreach in addition to facility and health worker readiness, considering all appropriate safety measures Incentivize healthcare providers for their continued services during the pandemic Ensuring service providers and facilities have appropriate safety equipment and measures such as PPE and logistics plans for emergency settings to improve providers’ confidence in their own health and safety. Dedicated research, such as structured surveys and in-depth interviews with pregnant mothers and service providers For the FP services – Resume outreach (door-to-door services) by providers with FP methods, employing appropriate COVID-19 protection measures, for sustained FP access Interventions targeted to investments in human resources, and to improve the quality of FP service provision during pandemics like COVID-19. Monitor and routinely analyze facility service statistics. Dedicated research.