The impact of the COVID-19 pandemic on sexual and reproductive health performance indicators at public health care facilities in Ekurhuleni Health District, South Africa: An interrupted time series analysis

Abstract

<i>Background</i>: The COVID-19 pandemic disrupted essential health services globally, including sexual and reproductive health (SRH).<i>Aim</i>: This study examines the impact of lockdown measures on sexual and reproductive health services in Ekurhuleni Health District, South Africa.<i>Methods</i>: An interrupted time series design was utilised to analyse the impact of COVID-19 restrictions on SRH indicators in the Ekurhuleni Health District, Gauteng Province, South Africa. Monthly data (January 2018 to December 2023) from the web-District Health Information System were used. Indicators included primary health utilisation (PHC), couple-year protection (CYP), antenatal care visits (ANC), maternal mortality ratio (MMR), medical male circumcision (MC), male urethritis syndrome (MUS), female and male condom distributions, and cervical cancer screening. Descriptive statistics and segmented linear regression models were conducted using Stata version 17.<i>Results</i>: PHC utilisation declined significantly during the COVID-19 lockdown (Coef: -0.3%, 95% CI: -0.4 to -0.2) with gradual recovery after the lockdown. ANC first visits before 20 weeks decreased by 5.7% during lockdown (Coef: -5.7%, 95%CI: - 2.8 to -8.5). Cervical cancer screening coverage significantly declined during lockdown with no recovery afterwards (Coef: -29.4%, 95% CI: -37.4 to -21.3). In contrast to these declining trends, the CYP rate remained stable and increased significantly by 18.2% during lockdown (Coef: 18.2%, 95% CI: 3.4 to 32.9). MUS declined by 3.3% during the lockdown period (Coef: -3.3%, 95% CI: -5.7 to -1.0).<i>Conclusion</i>: This study revealed a remarkable impact of the COVID-19 lockdown on sexual and reproductive health services indicators. While primary health care utilisation experienced a moderate decline and gradual recovery, other indicators, such as ANC, cervical cancer, and MUS, showed persistent negative disruptions.