Effects of terrorism-related attacks and family planning interventions on the uptake of modern contraceptives in Burkina Faso: a nationwide interrupted time-series analysis (2013–2023)

Objective To investigate the effect of terrorism-related attacks on modern contraceptive uptake and to assess the effects of recent family planning (FP) interventions in Burkina Faso. Design Nationwide longitudinal study using a multiple interrupted time-series analysis. Setting Public primary healthcare centres and district hospitals in Burkina Faso, from January 2013 to December 2023. Data sources Monthly data on new FP users were drawn from Burkina Faso’s National Health Information System, covering 132 months. Data on terrorist attacks were extracted from the Armed Conflict Location and Event Data Project. Exposures The main exposure was the occurrence of terrorist attacks at the commune-month level. Secondary exposures were the 2020 FP user-fee exemption policy and national family planning weeks (NFPWs). Primary and secondary outcome measures The primary outcome was the monthly count of new FP users used as an indicator of modern contraceptive uptake. Secondary measures were predicted gains and losses in visits by new FP users associated with terrorist attacks, user-fee removal and NFPWs. Results The monthly number of visits by new FP users decreased by 13% (95% CI 11% to 15%) in the month of and following a terrorist attack. NFPWs were associated with a 152% increase in new users (95% CI 147% to 156%), while the 2020 FP fee exemption policy was associated with a 22% immediate increase (95% CI 18% to 25%). Predicted gains were greater for NFPWs (+4 31 846 new users) than for the free FP policy (+3 52 006). Terrorist attacks were associated with a predicted loss of 133 688 new users since January 2013. Conclusion Terrorist attacks were associated with reduced modern contraceptive uptake in Burkina Faso, likely through disruptions in both service supply and access. Combining user-fee removal with active outreach strategies such as NFPWs may help sustain reproductive health service coverage in settings affected by protracted insecurity.