Background: Although hindrances to the sexual and reproductive health of women are expected because of COVID-19, the actual effect of the pandemic on contraceptive use and unintended pregnancy risk in women, particularly in sub-Saharan Africa, remains largely unknown. We aimed to examine population-level changes in the need for and use of contraception by women during the COVID-19 pandemic, determine if these changes differed by sociodemographic characteristics, and compare observed changes during the COVID-19 pandemic with trends in the 2 preceding years. Methods: In this study, we used four rounds of Performance Monitoring for Action (PMA) population-based survey data collected in four geographies: two at the country level (Burkina Faso and Kenya) and two at the subnational level (Kinshasa, Democratic Republic of the Congo and Lagos, Nigeria). These geographies were selected for this study as they completed surveys immediately before the onset of COVID-19 and implemented a follow-up specific to COVID-19. The first round comprised the baseline PMA panel survey implemented between November, 2019, and February, 2020 (referred to as baseline). The second round comprised telephone-based follow-up surveys between May 28 and July 20, 2020 (referred to as COVID-19 follow-up). The third and fourth rounds comprised two previous cross-sectional survey rounds implemented in the same geographies between 2017 and 2019. Findings: Our analyses were restricted to 7245 women in union (married or living with a partner, as if married) who were interviewed at baseline and COVID-19 follow-up. The proportion of women in need of contraception significantly increased in Lagos only, by 5·81 percentage points (from 74·5% to 80·3%). Contraceptive use among women in need increased significantly in the two rural geographies, with a 17·37 percentage point increase in rural Burkina Faso (30·7% to 48·1%) and a 7·35 percentage point increase in rural Kenya (71·6% to 78·9%). These overall trends mask several distinct patterns by sociodemographic group. Specifically, there was an increase in the need for contraception among nulliparous women across all geographies investigated. Interpretation: Our findings do not support the anticipated deleterious effect of COVID-19 on access to and use of contraceptive services by women in the earliest stages of the pandemic. Although these results are largely encouraging, we warn that these trends might not be sustainable throughout prolonged economic hardship and service disruptions. Funding: Bill & Melinda Gates Foundation. Translation: For the French translation of the abstract see Supplementary Materials section.
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