Impact of Ebola and COVID-19 pandemic on patterns in uptake of short-acting and long-acting contraceptive methods in Sierra Leone: a country-wide observational study

BackgroundThe Ebola epidemic and COVID-19 pandemic disrupted essential healthcare services globally, including family planning, but the extent of disruptions in Sierra Leone is largely unknown. This study aimed to evaluates the impact of these crises on the uptake of contraceptive methods--short-acting contraceptives (SAC) and long-acting reversible contraceptives (LARC)-- among adolescent girls and women ages 10-45 years in Sierra Leone from 2013 to 2022. MethodsWe conducted a retrospective, cross-sectional study using aggregated DHIS2 data from adolescent girls and women aged 10-45 years. We describe and visualize the trends in the uptake of SAC and LARC before Ebola (March 2013 to April 2014), during Ebola (May 2014 to February 2016), after Ebola and before COVID-19 (March 2016 to February 2020), and during COVID-19 (March 2020 to February 2022). Proportional shifts and age-specific patterns were assessed to identify changes in contraceptive preferences. ResultsDuring the Ebola outbreak (2014-2016), SAC uptake declined temporarily while LARC uptake modestly increased. A recovery in SAC uptake followed during the inter-epidemic period (2016-2019). Conversely, the COVID-19 pandemic (2020-2022) saw an initial spike in SAC uptake, which subsequently returned to pre-pandemic levels. In contrast, LARC uptake consistently increased throughout both pandemics and the post-pandemic period. Notably, a proportional shift toward LARC methods was observed. Trends across age groups were variable, with adolescents demonstrating resilience in their use of contraceptives during the COVID-19 pandemic. ConclusionLARC services demonstrated remarkable stability during health emergencies, underscoring the resilience of long-term methods and the adaptability of women in making informed choices about their reproductive health amidst disruptions. These findings highlight the importance of strengthening healthcare systems to ensure continued access to reliable contraceptive options, particularly during crises.