The Democratic Republic of the Congo has high rates of maternal mortality, fertility and rapid population growth. To address these challenges, increasing access to and uptake of contraceptives have been priorities in recent years.

In early 2014, the first National multisectoral strategic plan for family planning was adopted to increase modern contraceptive use from 6.5% in 2013 to at least 19.0% in 2020. Community-based family planning and contraceptive services were identified as key components of strategies to facilitate increased uptake. By 2018, the modern contraceptive prevalence rate for married women reached 17.6% nationally.

The first case of COVID-19 was documented in the Democratic Republic of the Congo in early March 2020. Shortly after, public health and social measures were enforced including stay-at-home orders, discouragement of the use of non-essential health services and the closing of schools and international borders. Health facility use declined as health workers fell ill, facilities reduced service offerings and were seen as potential points of COVID-19 transmission.

In Kinshasa, where most COVID-19 cases were concentrated, contraceptive uptake was not affected in the period from May-July 2020. From July 2020, pandemic-related supply chain disruptions caused an increase in stock-outs of modern contraceptives in health facilities. However, the number of clients accepting oral and injectable contraceptives in Kinshasa began an upward trend from mid-2020, though injectable contraceptives continued to be distributed at higher rates than oral contraceptives. There was an overall increase in oral and injectable contraceptive distribution from 2020 to 2021.

During the COVID-19 pandemic, national policy actions worked in concert with community-based efforts to maintain access to injectable contraceptives. With the onset of the pandemic, the ministry of Health accelerated several key actions, including provisional approval of self-injection of DMPA-SC to be offered at health facilities and by trained community health workers (CHWs). The Ministry of Health and its partners prioritized the training of trainers in the administration of DMPA-SC in the community and training clients on self-injection of DMPA-SC (15). Videos and online materials were used to reach providers outside Kinshasa, who went on to lead training for colleagues at lower levels of the health system.

Overall, both community- and health facility-based distribution of DMPA-SC in Kinshasa trended upwards from 2019-2021, although fluctuations occurred each year. While training for increased community distribution during COVID-19 in Kinshasa was largely successful, drops in distribution tended to coincide with pandemic-related events, such as supply chain ruptures and the closure of schools and universities, which affected the continuity of distribution by advanced nursing students.

Nationally, the total number of doses of DMPA-SC supplied increased from about 416 500 doses in 2017 to over 1.7 million in 2020.

• A fear of self-injection pushed some DMPA-SC clients to return to health centres to access contraceptive services. 

• Inadequate financial and moral support for community distribution agents resulted in low motivation of some health workers.

• No central data repository existed for DMPA-SC activities, and reporting was inconsistent between distribution sites.

• Delays in the release of funds, especially for the integration of family planning activities into pandemic response plans, caused delays in activity scale-up and implementation.

• Lack of coordination and regulation of intervention activities between the government and other partners.