Qualitative component
Four FGDs were conducted at baseline (December 2021to February 2022). For endline, 2 FGDs were done (June 2022 to August 2022). IDIs with 6 providers, 20 female clients, and 19 male clients were conducted at baseline. For endline, IDIs with 3 providers, 20 female clients, and 17 male clients were conducted. Mean-age of the clients were 26.8 and 26.7 years for baseline and endline, respectively. While mean-age of the providers were 45.3 and 47.3 years for baseline and endline, respectively (Table 1).
Contraception services
Healthcare providers’ perception
Providers perceived that clients expressed more interest in birth control. Furthermore, they switched to a longer-lasting form of birth control.
“More needs (contraception) would be among students and children younger than 20 years. Moreover, I noticed more concern in postpartum women during pandemic. Previously, if you give advice, sometimes they might not want to use contraception. But now, everyone is more concerned……Because they don’t want to get pregnant during the pandemic.” ………………Provider3kkhb.
“They (the clients) wanted to use birth control for a longer time. It turned out that they didn’t want to come to the hospital often. From injectables, they switched to implants.” ………………Provider3kkhb.
There was no shortage of contraceptive supply.
Providers of both facilities postponed appointments for non-urgent clients or advised them to receive services from a hospital nearby. For those who came, all clients had to be screened for COVID-19 before receiving service. During COVID-19 pandemic, postpartum women were provided with contraception options before their discharge, and nurses in the postpartum ward underwent training to counsel and facilitate the insertion of contraceptive implants promptly.
“During the first wave of outbreak, we called to postpone appointments for 2 weeks because we didn’t know what the situation was at that time…… And if anyone was convenient to go to the nearby hospitals, we recommended them to do so.” ………………Provider3kkub
“We’re responsible for providing the initial training. Before the pandemic, we didn’t carry out implant insertions in the ward, correct? We’re planning to educate the nurses on assisting the doctors in this process. The doctors will handle the actual procedure, and our role is to support them. Additionally, I’ve created a QR code to share information about postpartum care and different birth control methods.” ………………Provider3kkub
Telemedicine services via mobile phone was used as an innovation as a result of adapting to the pandemic to decrease in-person visit and promote social distancing policy. Timing for visit was individualized.
“We made a call instead. Normally after giving birth, we schedule a checkup at 6 weeks, right? But we called around 5 weeks instead. If they had problems, we advised them to come to the hospital within a week. But if they didn’t, we asked them to come within 3 months after delivery. We also provided contraception before discharge for those who expressed interest.” ………………Provider3kkub
For those who received online-visit and required medication, home-deliver medicine was also provided.
“During that time, there was a service for delivering medicine to patient’s home. …. sending medicines by logistics.” ………………Provider3kkub
During the six-month data collection period, we could not specify the date for post-COVID-19 pandemic (endline). During this period, no differences were observed in either the number of visits or contraceptive methods as well as the pattern of services for COVID-19.
Clients’ perspective
The following information was obtained from two hospitals. There might be some differences in the contextual issues between these two hospitals.
There were three types of decision in choosing a birth control method, depending on the family context, including women themselves, women decided together with their partners or women made decisions together with their boyfriends and mothers. Both male and female clients intended to delay pregnancy due to two main reasons, fear of COVID-19 infection to the newborn and financial reason. Women stated that they opted for extended-acting methods because it reduced the frequency of hospital visits.
“I still don’t want to get pregnant during COVID. …. I’m afraid of getting infected. I’m afraid I’ll get COVID. Then the child will be abnormal.” ……………F5kkhe_5
There were four main sources of birth control information including the hospital’s Line App, the internet, healthcare providers, and from others such as friend.
“Listen to advice from friends who got the implant before. So, I chose to use it as well” ……………..F7kkhe
Service at the family planning unit was convenient and fast. No need to sit and wait in line. The hospital had a strict COVID-19 prevention system.
“The service was good and it’s open and not crowded. And it was very convenient. And the doctor was okay.” …………………M3kkue_3
Clients were aware of the risk of COVID-19 infection when coming to the hospital because it was crowded.
“There is a risk because the number of people using the service is still quite large.” ……………..F7kkhe_7
Some respondents perceived barriers including inconvenience of parking, postponement of appointments, overcrowded and long queues in hospital. Registration through the online system makes it convenient to not have to wait in line at the medical records unit, hence considered as facilitator.
“It’s crowded. You might have to line up for a long time and wait for a long time. Even in the COVID-19 pandemic period, there were still a lot of people using the service” ……….F1kkhb
Issues with no difference include knowledge about COVID-19, services from providers, and barriers during getting services. Issues with difference include anxiety and concern declined between the baseline and endline, likely attributable to increased COVID-19 vaccination rates and familiarity with the ongoing pandemic.
Detection, treatment and prevention of sexually transmitted infections
Healthcare providers’ perception
During COVID-19 pandemic, there has been a decrease in people seeking services regarding STI.
“In the early days of the pandemic, it decreased a lot. Patients were worried about the pandemic situation. They were afraid of coming to the hospital and getting infected. The next thing was that their children or grandchildren didn’t want them to come. Or they were unable to come due to the lockdown policy” …………….Provider1kkub
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Availability of STI testing, care, and treatment during COVID-19 pandemic – including health promotion and partner notification
There was no interruption to this service. Used more telephone for notification of examination results was employed to sustain the service.
“We also provided telemedicine services in some cases where it was not necessary to come. Or we delivered medicine to patient home to prevent the patients from flowing in from high-risk areas.” …………….Provider1kkub
If the individual receiving telemedicine requires medication, the hospital also offers a service for delivering medicines to their home.
“When it started, it was as if the patients were decreased. Patients were afraid. And we ourselves were afraid too. We had measures. That was, for non-emergency patients, we would deliver medicine to them at home.” ………………Provider3kkhb
No differences were observed. Providers were continuously trained in knowledge about COVID-19 prevention and screening before examining every client.
Clients’ perspective
There was no clear information on the impact of pandemic on STI.
Barriers to accessing services involve societal stigmatization of individuals with HIV, branding them as morally questionable, naïve, or promiscuous, leading to feelings of shame and reluctance to seek assistance. For facilitators, factor that promote service utilization include the convenience of available services.
“Yes (when I had a sexually transmitted infection) and I didn’t dare to tell my friends, I was embarrassed and didn’t know where to go. Didn’t go for treatment.” ……………F4kkhb
“Now it’s as if it’s been managed to prevent crowding. I feel like it’s better than before pandemic. According to my feelings, when I arrived, I could register. I don’t have to sit and wait, sometimes for an hour or two” ……………F9kkub
Some clients mentioned that they were experiencing stress and facing financial difficulties.
“I feel overwhelmed as my financial resources fall short to cover my expenses.” ……………….F3kkue_3
No difference was observed.
There was limitation for some themes since information retrieved from the interview of the clients who came for other SRH services.
The Centre for COVID-19 Situation Administration (CCSA) was established by the Royal Thai government to update COVID-19 pandemic situation as well as new government policy and intervention to reduce fake news.
Quantitative component
The overall survey included 893 participants, as outlined in Table 2, with participants exhibiting certain characteristics. On average, the participants were 25.8 ± 6.7 years old. Half of the participants were in a cohabiting arrangement. About two-thirds of the participants had undergone a COVID-19 test, but only a small proportion of them tested positive. The primary reasons for participant visits were contraception (68.5%), followed by postnatal care (18.4%), and STI services (9.7%).
Contraception/family planning
Out of the 875 individuals involved in the study, 16.5% were provided with counseling on contraception, while 72.6% received both counseling and contraception (Table 3). Contraceptive implants were the preferred method among women, chosen by 45.8% of clients.
The facility lacked standardized national guidelines. The number of clients at the endline was slightly higher than at the baseline. Certain contraception options, such as the female condom, emergency pill, cycle beads, and vaginal ring, were not in stock. However, both male and female sterilization services were offered at both facilities. Providers did not receive any training on contraceptive methods or adolescent and reproductive health from the baseline to endline period (Table 4).
STI services
During the study period, 94 individuals sought STI services. Only 18.8% reported using condoms in their most recent vaginal or anal intercourse. Approximately half of all women underwent STI testing (excluding HIV), with HPV being the most prevalent diagnosis. The services considered most crucial by participants were condom accessibility (44.7%), STI testing (39.4%), and communication with their sexual partner about STIs (28.7%). Notably, 38 participants accessed STI services during the lockdown associated with the COVID-19 pandemic, but they generally found the convenience of receiving these services to be easy or very easy (Table 5).
Both facilities offered HIV counseling and testing services, along with the provision of condoms. Vaccination against HBV and HPV was administered at least in one of the facilities. The target population for these services was limited to adults. All medications, except for spectinomycin, were accessible Table 6 showed that the incidence of cases appeared to be similar during the two measurement periods.
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