Wood, Shannon NByrne, Meagan EThiongo, MaryDevoto, BiancaWamue-Ngare, GraceDecker, Michele RGichangi, Peter2023-07-192023-07-192023Wood, 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.http://dx.doi.org/10.1136/bmjopen-2022-068689http://ir-library.ku.ac.ke/handle/123456789/26327ArticleObjectives 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.enArticle