2026/01/01 by C N Marona · 1 voice
Medicine · #COVID-19 Impact on Reproduction #Global Maternal and Child Health #Reproductive Health and Contraception
paper · doi:10.17037/pubs.04680216
openalex publication_date 2026/01/01 · openalex created_date 2026/02/27 · openalex updated_date 2026/07/01
Aim: The aim of this research is to understand how women of reproductive age in the Western Cape, South Africa navigated the health system during the COVID-19 pandemic to obtain their contraceptive methods, what the health system was able to accommodate, and what was learned regarding the delivery of contraceptive services. Research Questions: 1. What were the experiences of women trying to obtain contraceptive supplies in Western Cape, South Africa during COVID-19? 2. How did pressures on the health system and lockdowns, as well as perceived risk, both of COVID-19 and of unplanned pregnancy, affect access to services and choice of contraceptive methods? 3. What are the lessons learned and opportunities for improving the health system regarding contraceptive access and care that emerged from COVID-19 in South Africa and how are these being applied and sustained? Methodology: A qualitative approach was used to address the research questions. The study performed a secondary analysis of focus group discussions (FGDs) with 24 women of reproductive age. These FGDs focused on multiple points of women’s health journeys specific to their contraceptive choices through the first and second year of the COVID-19 pandemic. Communities with key health burdens and challenges were identified and participants were recruited from public health clinics in these communities for a second phase of the research. This step of the study involved a second set of FGDs with 24 women of reproductive age in the Western Cape to understand their post-COVID health journeys and pathways to access contraceptives. These combined phases of this research are designed to identify the challenges associated with Research Question 2 (RQ2) and map out the experiences associated with Research Question 1 (RQ1). Additionally, the study includes key informant interviews with Department of Health employees, who are policy makers and service providers, such as nurses. The goal of these interviews was to understand what lessons were learned from COVID-19 and how these lessons have been applied to strengthen the health system, linking to Research Question 3 (RQ3). To map women’s journeys and understand barriers, challenges, opportunities, and outliers from their perspectives and at the health system level, the FGDs and interviews were recorded and transcribed, then analyzed using the Levesque Conceptualization of Access Framework. Results: The findings reveal significant disruptions in contraceptive access for women of reproductive age in the Western Cape during and after the COVID-19 pandemic. The pandemic exacerbated pre-existing structural barriers, including transport limitations, economic instability, and overburdened healthcare facilities. Women’s experiences were shaped by intersecting factors such as affordability, provider interactions, and systemic trust deficits. Many reported difficulties in maintaining continuity of contraceptive use due to stockouts and restricted clinic hours, while others adapted by shifting to alternative access points, such as pharmacies or informal networks. The study’s application of the Levesque framework highlighted how perceptions of healthcare quality, personal agency, and social norms influenced health-seeking behaviours. Despite challenges, resilience was evident as women and healthcare providers navigated evolving constraints, demonstrating adaptive strategies to ensure contraceptive continuity. Conclusion: This study underscores the need for equitable, user-centred contraceptive service delivery, particularly during public health crises. Women’s lived experiences revealed critical gaps in trust, affordability, and accessibility, reinforcing the importance of integrating communitybased and digital health innovations to mitigate future disruptions. While the Levesque framework provided a useful lens to analyse access barriers, its limitations became apparent in capturing the dynamic, real-time decision-making processes and the influences on contraceptive access. The model’s structured approach may oversimplify the fluidity of women's experiences, particularly in crisis settings where barriers and facilitators shift rapidly. Despite these constraints, findings align with the global literature on health inequities, emphasizing the role of systemic reforms in addressing barriers beyond service availability. The study contributes to broader discussions on reproductive health resilience, highlighting the necessity of sustained policy efforts to strengthen health systems. Future initiatives should prioritize participatory approaches that amplify women’s voices, ensuring contraceptive access is both adaptable and inclusive amid evolving healthcare challenges.