Disruption and recovery of family planning, contraception and other sexual and reproductive health services in Brazil with COVID-19 pandemic: a mixed methods approach

Background Limited scientific evidence is available on the impact of COVID-19 on Sexual and Reproductive Health (SRH). Some data shows that severe disruptions in SRH services expose women to preventable health risks. This study has the objective to provide a better understanding of the impact of COVID-19 on family planning and contraception among other SRH services and strengthen policies and services to be more responsive to community needs. Methods A mixed quantitative and qualitative methods were used to assess SRH service availability and readiness, and clients' and providers' perceptions in some Brazilian COVID-19-affected areas. Interviews were performed at baseline and 6-9 months later. It was conducted in three cities from the S & atilde;o Paulo state, Campinas, Jundiai, and Santos. The health facility level involved five questionnaires for assessment of infrastructure availability and readiness to provide SRH services and a qualitative survey to elicit health services providers perspectives. The qualitative in-depth interviews (IDI) with the participants and Focus Group Discussion (FGD) with women and partners were conducted using a semi-structured interview, recorded and transcribed. A thematic content analysis was then performed. Results The settings studied had different characteristics of geographic size, population, and organisation of health services that influenced the way they faced COVID-19. During the baseline interview, the population mentioned fear of seeking health support in the PHU; however, this situation was still observed in Santos in the end-line interview. Antenatal and post-partum care was offered to the population; however, other demands, such as contraception were not. In the interviews, contraception services were considered a priority. The different speeches and behaviours of the government leaders caused discredit to the health measures recommended by the WHO. There is a need for alignment among health managers at municipal, state, and federal levels. Conclusions The municipal administration played a key role in the fight against COVID-19 together with the coordinators of the health services. Contraception was not considered a priority during the pandemic. However, participants reported they should be considered essential services in future pandemics. The PHU readiness offered antenatal and post-partum care, while other population needs were not prioritized.