Fertility and Contraceptive Dynamics amidst COVID-19: Who is at Greatest Risk for Unintended Pregnancy among a Cohort of Adolescents and Young Adults in Nairobi, Kenya?
Loading...
Date
2023
Authors
Wood, Shannon N
Byrne, Meagan E
Thiongo, Mary
Devoto, Bianca
Wamue-Ngare, Grace
Decker, Michele R
Gichangi, Peter
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ
Abstract
Objectives Among youth in Nairobi, we (1) characterised
fertility and contraceptive use dynamics by gender; (2)
estimated pregnancy prevalence over the pandemic; and
(3) assessed factors associated with unintended pandemic
pregnancy for young women.
Design Longitudinal analyses use cohort data collected
at three timepoints prior to and during the COVID-19
pandemic: June to August 2019 (pre-pandemic), August to
October 2020 (12-month follow-up) and April to May 2021
(18-month follow-up).
Setting Nairobi, Kenya.
Participants At initial cohort recruitment, eligible youth
were aged 15–24 years, unmarried and residing in
Nairobi for at least 1 year. Within-timepoint analyses were
restricted to participants with survey data per round; trend
and prospective analyses were restricted to those with
complete data at all three timepoints (n=586 young men,
n=589 young women).
Primary and secondary outcome measures Primary
outcomes comprised fertility and contraceptive use
for both genders, and pregnancy for young women.
Unintended pandemic pregnancy (assessed at 18-month
follow-up) was defined as a current or past 6-month
pregnancy with intent to delay pregnancy for more than 1
year at 2020 survey.
Results While fertility intentions remained stable,
contraceptive dynamics varied by gender—young men
both adopted and discontinued coital-dependent methods,
whereas young women adopted coital-dependent or shortacting methods at 12-month follow-up (2020). Current
pregnancy was highest at 2020 (4.8%), and approximately
2% at 2019 and 2021. Unintended pandemic pregnancy
prevalence was 6.1%, with increased odds for young
women recently married (adjusted OR (aOR)=3.79; 95%
confidence interval (CI) 1.83–7.86); recent contraceptive
use was protective against unintended pandemic
pregnancy (aOR=0.23; 95% CI 0.11–0.47).
Conclusions Current pregnancy in Nairobi was highest at
the height of the COVID-19 pandemic (2020), and subsided
to pre-pandemic levels by 2021 data collection; however,
requires further monitoring. New marriages posed
considerable risk for unintended pandemic pregnancy.
Contraceptive use remains a crucial preventive strategy
to averting unintended pregnancy, particularly for married
young women.
Description
Article
Keywords
Citation
Wood, S. N., Byrne, M. E., Thiongo, M., Devoto, B., Wamue-Ngare, G., Decker, M. R., & Gichangi, P. (2023). Fertility and contraceptive dynamics amidst COVID-19: who is at greatest risk for unintended pregnancy among a cohort of adolescents and young adults in Nairobi, Kenya?. BMJ open, 13(5), e068689.