Assessing the impact of COVID-19 on access to family planning and HIV services among women in Lilongwe, Malawi.

Following its declaration as a pandemic, COVID-19 spread extensively, affecting millions globally. Concerns emerged that it could have a detrimental impact on sexual and reproductive health services. Specifically, these worries centred on the potential disruption of family planning and HIV-related care. We conducted a mixed methods study to understand the impact of the pandemic and its associated measures on access to FP and HIV services among women in a peri-urban area of Lilongwe, Malawi. We used descriptive statistics to assess what proportion of eligible women accessed FP/HIV services and understand experiences and challenges faced. 400 women responded to a questionnaire, and 30 of them completed in-depth interviews. We used frameworks by Peters (2008) and; Ensor and Cooper (2004) to analyse qualitative data. The mean age of the study participants was 30 years, with less than a third aged 18-25. Of the 269 who tried to access FP services, 254 (94.4%) received it, and 248 (92.2%) received their preferred method. Only 2 (6.1%) out of 33 women living with HIV reported difficulties in obtaining ART. For HIV Testing & Counselling (HTC) services, 97.0% (n = 293) of the 302 women who wanted the service attempted to access them, and 99.0% (n = 290) of the 293 were successful. The most commonly reported challenges were: being sent away if they did not have a mask, being sent away if the maximum number of clients per day had been reached, and higher fares for the few who used minibus. Overall, access to FP and HIV services was sustained. Women, however, faced some challenges while accessing the services, which were more pronounced among FP clients compared to ART clients. Our findings emphasize the need to implement strategies that will minimize challenges to health care access during pandemics, to ensure gains in FP and HIV services are sustained.