Effects of COVID-19 lockdowns on unintended pregnancies among adolescent girls and young women in low- and middle-income countries: a scoping review

Abstract

Background: The response to the COVID-19 pandemic involved various lockdown measures, including school closures, which significantly impacted young populations, particularly in low-and middle-income countries (LMICs). Given the well-known protective effect of regular school attendance on sexual and reproductive health and rights (SRHR), reports of disrupted education, compromised SRHR, and an increase in unintended pregnancies among adolescent girls and young women (AGYW 10-24 years) have caused major concerns. We conducted a scoping review to compile the available evidence of the impact of COVID-19 lockdown measures on unintended pregnancies among AGYW aged 10-24 in LMICs.

Methods: The scoping review followed the five-stage framework by Arksey and O´Malley. A systematic search on two comprehensive databases, using search terms related to COVID-19 and unintended pregnancies, was conducted along with grey literature searches of articles in English language published between 2019 and 2024. The systematic review software Covidence was used for publication screening, selection and data extraction.

Results: After deduplication, 241 publications were screened, and 72 full-text publications were assessed for eligibility. 13 publications from the database searches, citation searching and grey literature, were included. The scoping review included seven studies that applied quantitative methods, four that used qualitative approaches and the remaining two mixed methods. Five out of 13 publications were set in Uganda, two in Kenya and two in Nigeria, while six other countries were represented once. All included studies reported increases in pregnancies among AGYW during the COVID-19 period. School dropout among girls following a pregnancy was reported to have increased. Factors associated with unintended pregnancy were school closures, limited access to SRHR services including contraceptives, and increasing sexual encounters.

Conclusion: School closures and other lockdown measures during the COVID-19 pandemic led to an increase in unintended pregnancies among AGYW in LMICs. The long-term consequences for these young individuals, their communities and to the broader society are still to be measured and available evidence is limited, few studies have applied robust study designs, and several relied on small sample sizes. Further research is needed to build a stronger evidence base for health and socio-economic impacts of school closures and lockdowns among young people.

Keywords: Adolescent girls; COVID-19; Lockdown; Low- and middle-income countries; School closures; Sexual and reproductive health and rights; Unintended pregnancies; Young women.

Fig. 1

Flow Diagram Selection of Publications. This figure shows a flow diagram detailing the publication selection process

Fig. 2

Visualization of country distribution of included studies. This figure shows a visualization of the distribution of the frequency of countries among the included studies