Abstract
Introduction
The COVID-19 pandemic significantly disrupted global health systems, and sexual and reproductive health (SRH) were among the services often receiving less priority compared to other urgent health needs. Anticipated disruptions included limited access to contraception, abortion care, sexually transmitted infections (STI) prevention, and gender-based violence (GBV) support, particularly in low- and middle-income countries. This study aimed to assess the availability, readiness, and recovery of SRH services during and after the pandemic across nine countries.
Methods
This repeated cross-sectional, mixed-methods study was implemented in collaboration with national Ministries of Health across nine countries: Brazil, Burkina Faso, China, England, Ghana, Italy, Kenya, Pakistan, and Thailand. Data were collected from health facilities and SRH clients at two time points: during peak COVID-19 transmission and post-pandemic. Standardized facility assessments and client interviews were analyzed using multilevel logistic regression models. Qualitative data were collected through in-depth interviews and focus group discussions in selected countries to explore service disruptions, health system adaptations, and psychosocial impacts. Thematic analysis identified context-specific challenges and coping strategies.
Results
Of 4,346 clients interviewed, 2,292 from seven countries were included in the final analysis. Post-pandemic improvements were modest, with gains in STI testing and GBV response training. Family planning and abortion services showed minimal recovery. Systemic vulnerabilities such as outpatient closures, staff shortages, and supply chain failures contributed to service disruptions. Facilities adopted resilience strategies including telemedicine, task
shifting, and triaging. Qualitative findings revealed emotional strain among healthcare providers, stigma, and informal coping mechanisms, underscoring the need for integrated mental health support and flexible service delivery
models.
Conclusion
The pandemic exposed critical weaknesses in SRH service delivery but also highlighted opportunities for strengthening health system resilience.
The COVID-19 pandemic significantly disrupted global health systems, and sexual and reproductive health (SRH) were among the services often receiving less priority compared to other urgent health needs. Anticipated disruptions included limited access to contraception, abortion care, sexually transmitted infections (STI) prevention, and gender-based violence (GBV) support, particularly in low- and middle-income countries. This study aimed to assess the availability, readiness, and recovery of SRH services during and after the pandemic across nine countries.
Methods
This repeated cross-sectional, mixed-methods study was implemented in collaboration with national Ministries of Health across nine countries: Brazil, Burkina Faso, China, England, Ghana, Italy, Kenya, Pakistan, and Thailand. Data were collected from health facilities and SRH clients at two time points: during peak COVID-19 transmission and post-pandemic. Standardized facility assessments and client interviews were analyzed using multilevel logistic regression models. Qualitative data were collected through in-depth interviews and focus group discussions in selected countries to explore service disruptions, health system adaptations, and psychosocial impacts. Thematic analysis identified context-specific challenges and coping strategies.
Results
Of 4,346 clients interviewed, 2,292 from seven countries were included in the final analysis. Post-pandemic improvements were modest, with gains in STI testing and GBV response training. Family planning and abortion services showed minimal recovery. Systemic vulnerabilities such as outpatient closures, staff shortages, and supply chain failures contributed to service disruptions. Facilities adopted resilience strategies including telemedicine, task
shifting, and triaging. Qualitative findings revealed emotional strain among healthcare providers, stigma, and informal coping mechanisms, underscoring the need for integrated mental health support and flexible service delivery
models.
Conclusion
The pandemic exposed critical weaknesses in SRH service delivery but also highlighted opportunities for strengthening health system resilience.
| Original language | English |
|---|---|
| Article number | 233 |
| Number of pages | 13 |
| Journal | Reproductive Health |
| Volume | 22 |
| DOIs | |
| Publication status | Published - 20 Nov 2025 |
Keywords
- Sexual and reproductive health
- COVID-19 pandemic
- Health systems resilience
- Service disruption
- Mixed-methods
- Multi-country study