In this half, after a quick overview on demographic background of respondents, the principle extracted themes will likely be mentioned.
Demographic background of respondents
A complete of 67 qualitative interviews had been carried out in Bangladesh within the districts of Dhaka, Cumilla, Cox’s Bazar, and Barishal. Among the 39 girls interviewed, 13 of them lived in cities and 26 girls had been in semi-urban and rural areas. Also, 18 girls had been 21 to 30 years previous, and the remainder (n = 11) had been 16 to twenty years of age. Most girls (n = 15) had secondary faculty schooling, and 29 girls had been homemakers or home employees. In Iran, of the 15 service suppliers, 8 people had been working in city areas and 6 in rural areas of three provinces: Fars, Tehran, and Sistan and Baluchestan. All service suppliers had been girls. We interviewed 20 girls in Iran: 14 lived in city and 6 in rural areas. Most of respondents in Iran aged between 21 and 30 years, and three had been under between 18–20 years previous. Most of those individuals had greater than secondary faculty schooling. Besides, 16 girls had been homemaker. Only 2 girls had used abortion providers throughout the COVID-19 pandemic. In the Netherlands, about half of the 11 service suppliers who had been interviewed labored concerned within the provision of contraception providers, whereas the remainder had been in control of abortion care or referral providers. Almost all of those service suppliers had been girls. On the opposite hand, 4 girls had been interviewed on this nation, and all of them had used abortion providers throughout the COVID-19 pandemic. Three of them lived in city areas and one lived in a semi-urban space. These girls aged between 21 and 40 years, and all of them had been employed within the Netherlands [36].
The important extracted themes
Table 3 reveals that primarily based on interviews evaluation, information will be organized in eleven subthemes positioned in three important themes. 1) challenges to accessing FP providers (discount of referrals; disruption of entry to providers; rising costs and unavailability of some contraceptives; inadequate information; worries amongst employees); 2) measures taken in clinics or well being facilities to enhance entry to FP providers (time extension and go to scheduling; phone, on-line, and door-to-door providers; help of media); and three) suggestions supplied by the individuals to advertise the standard of and entry to FP and abortion providers in future crises (well being facility enhancements; free, on-line, and nearer providers; ongoing trainings and consciousness campaigns) [36].
Challenges
The discovering of this examine revealed that each service customers (girls) and repair suppliers confronted completely different challenges in accessing and offering household planning providers, respectively. These challenges will be divided into 5 classes as following:
Reduction of referrals
The findings revealed a discount in referrals to FP facilities within the 3 nations. According to 2 service suppliers: “Consultation time elevated on account of hygienic measures taken, however problem was find out how to get sufferers to the GP follow; individuals didn’t request care” (SP, NL). [36]. “Although well being facilities attempt to talk with their shoppers by cellphone or on-line, not all of the shoppers have a phone line, cell phone, or web connection. These are sometimes from the decrease socioeconomic courses and are at higher danger of unintended pregnancies” (SP, IR). [36].
Disruption of entry to providers
According to the experiences of service suppliers within the Netherlands, overseas girls had extra challenges. Furthermore, girls throughout the border couldn’t go away their house nation to come back to the Dutch clinic or had been scared passing on account of border checkpoints. Women with out enough medical insurance who had been unable to depart the Netherlands and return to their house nations on account of COVID-19 restrictions had entry issues due to monetary obstacles. Another drawback, talked about by many respondents in Bangladesh, was the disruption of the transportation system. Most of the service suppliers in Bangladesh skilled lengthy strolling distances to achieve their clinic, on account of lack of transportation and the extreme restrictions on shifting between neighborhoods areas [36].
It needs to be talked about that in Iran, challenges in entry to FPs had been linked not solely to the COVID-19 pandemic however had been the termination of free contraceptives for all teams of girls, which was talked about as one of the necessary challenges for respondents in Iran:“Cancellation of free contraceptives has created many challenges, particularly for households who can’t afford to pay for contraception. Some girls have been pressured to make use of conventional strategies on account of their incapacity to acquire contraceptives. This will increase the chance of unintended pregnancies. I’ve seen a number of unintended pregnancies throughout this era, and a few have been attempting to have abortions” (SP, IR) [36]. “I do know some girls who’re unable to afford contraceptives. Some of them are reluctant to have intercourse with their husbands for worry of being pregnant, which has precipitated issues of their relationship with their husbands” (SP, IR) [36]. “I used to get the contraceptives totally free from the well being middle, however now it’s tough for me to entry contraceptives as a result of there isn’t a pharmacy in our village and I’ve to make use of the withdrawal methodology” (W, IR) [36].
Rising costs and unavailability of some contraceptives
Rising costs of contraceptives, particularly condoms, was an issue cited by many respondents in Iran and Bangladesh. Furthermore, the unavailability of some strategies made some girls each in Iran and Bangladesh step again from trendy contraceptives and use the withdrawal methodology: “During the COVID-19 pandemic, financial stress has elevated. My husband is a laborer, and if I need to purchase an everyday condom pack, we’ve to pay appreciable a part of our earnings for it. So I selected to make use of the withdrawal contraceptive methodology as an alternative of the condom. It elevated my stress about unintended being pregnant” (W, IR) [36]. “I used to have cyclofem injection, however throughout COVID-19 pandemic, [access to] this ampule has decreased and I’ve to obtain medroxyprogesterone injection (quarterly). This change has precipitated a variety of psychological rigidity for me” (W, IR) [36].
Insufficient information
Lack of enough information about sexual and reproductive well being points throughout the COVID-19 pandemic, particularly about being pregnant dangers throughout this era, constituted one such concern primarily amongst respondents in Iran and Bangladesh:“I didn’t intend to grow to be pregnant, however with the onset of COVID-19, I started to really feel confused about what would occur to me and the fetus if I used to be pregnant” (W, IR) [36].“A subject hardly mentioned, even on social media, is whether or not or not we should always have intercourse throughout the COVID-19 pandemic. I’ve tried to not have intercourse as a result of I’ve been afraid of COVID-19 in addition to unintended being pregnant” (W, IR) [36].
Worries amongst employees
Staff scarcity was an issue which created stress on the present well being care employees in Bangladesh: “
There was not sufficient human sources or not even sufficient service suppliers within the clinics to offer service” (SP, B). Furthermore, service suppliers in each Bangladesh and the Netherlands reported difficulties in organizational and security duties and a scarcity of administration steering and supervision on the availability of providers. Partly on account of inadequate sources, implementing private safety gear (PPE) protocols was tough, inflicting a discount in service provision and the chance of contracting COVID-19 at work:
“
At the start of COVID-19, it was robust to offer providers as there was not sufficient well being measurement. As an instance, there was only one PPE for 10 docs, and so they needed to alternate it amongst themselves and so breach the COVID-19 protocols” (SP, B) [36]. “There are different GPs who’re very reluctant (to see sufferers). And that’s partly on account of private worry, like how do you estimate the chance. We could also be a bit extra light-hearted (in our follow) about this” (SP, NL) [36]. Furthermore, some employees had been frightened as a result of some shoppers would ignore the well being protocols by some shopper: “Sometimes we couldn’t maintain bodily distance as service seekers weren’t conscious of the pandemic or weren’t sufficient involved about sustaining well being measures of sanitization or utilizing masks and different safety gear” (SP, B) [36].
Measures
Time extension and go to scheduling
The extension of service time was a method employed within the 3 nations. Scheduling shopper visits was one other technique in Iran and Bangladesh to extend entry to FPs in a protected setting: “I needed to go for injection. So I referred to as the well being middle and so they appointed a time for me. Then on that particular day, I obtained the FP service with none hesitation” (W, B); “Most of the pharmacies had been open throughout lockdown so menstrual regulation kits had been obtainable to assist girls keep away from unintended pregnancies” (W, B) [36].
Telephone, on-line, and door-to-door providers
Telephone and on-line consultations and dealing from house had been amongst measures which had been taken by some service offers within the 3 nations: “
In reality, it is a nationwide guideline, and we offer free counseling throughout workplace hours to individuals who want counseling providers regarding contraceptive use and abortion” (SP, IR [36]. “Once the condom broke throughout intercourse, and I used to be very frightened about getting pregnant. Upon my cellphone name to the well being middle, they gave full directions on emergency contraception and, happily, no being pregnant occurred” (W, IR) [36].
Although the supply of on-line providers by well being facilities was not frequent in Iran earlier than COVID-19 pandemic, a few of them tried to offer on-line recommendation throughout the pandemic due to the shut relationship of the employees with shoppers: “I’ve been working within the well being middle of this village for greater than 20 years, and I’ve household relationship with some shoppers. Indeed, I do know a few of these girls, for instance, the much less educated girls or girls who’re in high-risk teams by way of being pregnant or those that could face extra issues. So throughout the COVID, I might contact them by way of WhatsApp or Telegram and provides them the required recommendation” (SP, IR) [36].
Support of media
The Netherlands and Bangladesh made changes in (social) media, together with using a nationwide e-newsletter for GPs to emphasise the continuation of contraception and abortion care and the necessity to increase shoppers’ consciousness. Onlin changes had been utilized each to tell the general public in regards to the continuation of providers and COVID-19 measures and to triage sufferers. Preparing roadmaps, organizing conferences, and prioritizing acute care providers had been emphasised on this context [36].
Recommendations
One of the principle components of this examine was to seek out out the respondents’ views on methods to enhance household planning providers, particularly in occasions of disaster. The suggestions of respondents can divided into three important classes:
Health facility enhancements
Some service suppliers within the Netherlands advisable {that a} handbook about contraception, abortion, and menstrual regulation in addition to job division between completely different service suppliers and disaster administration needs to be obtainable throughout crises. In addition, some service suppliers in Bangladesh suggested collaboration between the federal government and non-government organizations to keep away from replication of applications and providers. Also, to enhance entry to providers, they advisable that versatile service hours be adopted and even the opening hours of the facilities enhance when shopper demand is excessive. In case of additional service hours, they highlighted that extra service suppliers needs to be recruited rapidly [36].
Several respondents within the 3 nations emphasised higher communication and pleasant disposition of service suppliers. They talked about that such communication with shoppers will encourage a wider vary of individuals to go to well being facilities and obtain the required providers. Consequently, well being facilities will higher monitor the inhabitants below protection in all conditions, particularly in emergencies. One girl acknowledged, “Service suppliers needs to be effectively skilled so {that a} snug and pleasant setting could possibly be ensured for ladies” (W, B). Furthermore, since some girls and repair suppliers in Bangladesh had transportation issues, they believed enchancment of the transportation system is important to make sure the provision of service suppliers at clinics and ladies’s entry to FPs [36].
Free, on-line, and nearer providers
Some service suppliers advisable the availability of free or inexpensive contraceptives for all girls, significantly for migrants, and the inclusion of contraception within the fundamental medical insurance. Most respondents in Bangladesh advisable that on-line counselling needs to be in place to have the ability to give follow-up care to girls at house. Several respondents referred to as for the continued provision of on-line and phone consultations after COVID-19: “Free counseling on-line and offline needs to be devoted for all married and single girls, particularly those that are extra weak and marginalized” (W, B). The must restart free entry to FPs was incessantly raised by respondents in Iran: “
It is healthier to have contraceptives obtainable, as previously, freed from cost to all individuals, particularly for {couples} who’re much less literate or come from decrease financial courses. Besides, it needs to be borne in thoughts that in occasions of disaster, similar to the current, some individuals face financial issues. Hence, they might refuse to buy a contraceptive. Thus, it’s higher, not less than in these circumstances, that the gadget be obtainable to everybody totally free” (SP, I) [36].
Most of the responding girls in Bangladesh urged enhancing the accessibility of door-to-door providers or one-stop service for ladies who’re unable to depart the home: “Some girls are unable to depart house in occasions of disaster due to a particular illness, their small youngster, a sick member of the family, and the like. Therefore, it’s best to establish such individuals and supply them with contraceptives at their place” (W, B) [36].
Ongoing trainings and consciousness campaigns
Education about FP and reproductive well being and the way to deal with issues in occasions of disaster needs to be one of many main academic agendas of the ministry of well being of a rustic: “Now that fertility development insurance policies have been adopted in Iran, FP schooling shouldn’t be underestimated or uncared for. Both earlier than and throughout the disaster, individuals ought to obtain schooling concerning contraceptives, reproductive well being in occasions of disaster such because the COVID-19 outbreak, being pregnant dangers, being pregnant preservation, and extra” (SP, I) [36].
In addition, media will be deployed to enhance individuals’s consciousness: “Official media can play an necessary function in occasions of disaster. Unfortunately, FP points haven’t obtained a lot consideration from the nationwide media, which might present the required coaching and data” (SP, I). In the three nations, the net and offline approaches of data sharing platforms will be mixed to enhance individuals’s information about and entry to FPs. Information needs to be delivered in straightforward and clear language. There needs to be a steadiness between digital and conventional modes of data sharing and schooling on contraception and abortion. Furthermore, some respondents within the 3 nations confused the necessity to prepare outreach campaigns and conferences, together with extra male members to create consciousness and spotlight the significance of contraceptive provision, reproductive well being, and FP [36].