The Government of Uganda has put in place public health emergency directives during the COVID-19 pandemic and partially lifted the travel ban for pregnant women and people living with HIV/AIDS. However, access to essential SRH services such as contraceptives and other family planning packages like condoms, access to ARVs and menstrual health materials by young people have not been prioritized during the lockdown [14].
In this study, we found lack of access to information and services of SRH among the youths during this lockdown (Table 2). These findings further demonstrate the inadequate access to the information and services among youths worldwide [16]. It is reported that less than 10% of adolescent women access health facilities and information about family planning in 70 developing countries despite the momentum in implementing SRH in most countries [27].
With global health emergencies, there is a total reversal of priorities and, as a result, the availability, accessibility and affordability of SRH services has become challenging [16]. During the pandemic, lack of resources may reduce access to SRH and increase maternal and childhood mortality rates [16]. The inadequate access to the information and services among youths was reported in Kenya, Zambia [28], Swaziland [29], and Uganda [30] while studying the attitudes of health professionals to adolescent SRH issues concerning provision of services. Particularly in Uganda, two major surveys conducted among university students indicated that young people had limited access to sexual and reproductive health services and HIV/AIDS-related programmes despite their engagement in high-risk sexual behaviours
[31-32]. The West Africa’s large, multi-country Ebola Virus Disease (EVD) outbreak of 2014-2016 tells us that there were significant impacts on SRH, particularly in the early stages of that outbreak, largely related to health facility closures [33]. In Sierra Leone one study estimated that there were an additional 3600 maternal deaths, neonatal deaths and stillbirths related to the decrease in health service utilization during the EVD outbreak [34]. Another study from Guinea found a decrease of 51% in Family Planning (FP) visits during the outbreak [35]. There is significant unmet need for information, education, and services for sexual and reproductive health for married and unmarried young people [36].
The finding from this study reports that family planning was being used during lockdown among which modern methods uptake was 44.2%. We found that condoms were the most modern contraceptive method used followed by emergency pills and IUD during the COVID-19 lockdown by Ugandan youths. These results are similar to the one found in Lao People’s Democratic Republic where preventive measures that youth used were condoms, oral pills and emergency pills [37] and also similar to a study done in suburban Shanghai, whereby a youth-friendly intervention program providing information, skills, and services to promote safe sex behaviour (contraception and condom use) compared with a control group [38].
Lack of transport was the commonest (68.7%) of the limiting factor to access SRH services and information during the lockdown followed by distance from home and were to get the services (55.2%), cost of services (42.2%) and curfew (39.1%). The high percentage of no transport as the commonest limiting factors to access the SRH in our study can be explained by the status of lockdown during the study period which was limiting access to private cars and taxis in order to avoid the spread of the COVID-19 in the community as one of the measures implemented by the Ugandan Government. This finding may also imply that the lockdown may have affected more youth from poorer household with no private means of transport. During the lockdown, fewer economic activities were allowed in the country in addition to a curfew between 7 pm to 6am. Having no transport means, a curfew and the high cost of services during the study period meant that most of the participants were unable to access SRH services. In Lao People’s Democratic Republic, geographical accessibility was one of the barriers to access SRH among youths [37] but in Rwanda geographical accessibility of SRH services was not seen to be a negative factor influencing access among young people [39].
Our results show that cohabiting was associated with an increased need for sexual and reproductive health services. Cohabiting, being unemployed and the resultant extreme poverty have been highlighted as factors behind the spike in pregnancy during the Ebola outbreak, with girls reportedly having sex in exchange for water, food or other forms of financial protection [40].
Our study revealed that STIs were among the commonest (40.4%) sexual and reproductive health related problems faced during the lockdown. This was followed by unwanted pregnancy (32.4%) and sexual abuses (32.4%). Each year, there are over six million unintended pregnancies among adolescents, most of whom do not have access to modern contraceptive methods [41]. In 2008, over 1.2 million unintended pregnancies occurred in Uganda and these accounted for more than half of 2.2 million pregnancies in the country [42]. The Uganda Demographic Health Survey of 2016 points to over 25% teenage pregnancies, among sexually active young people by the age of 16 years, and the unmet family planning need in the country stands at 28% [9]. Studies have shown the importance of SRH services in the prevention of unwanted pregnancies, unsafe abortion, reducing maternal and child mortality as well as reducing poverty and empowering women [43].
Although this study was essential during the lockdown, it had several limitations.
As virtual snowball sampling method was used, the survey was respondent driven; hence it cannot be taken as a representation for general population. The study was limited to youths who have smartphones with internet connectivity and have an understanding of English. Those with no smartphones and internet connectivity were locked out especially the rural population and any other would be participant unable to access the online form. This study only included the educated Ugandan youths, so it cannot be generalizable to the whole youth population.