Factors associated with contraceptive use among reproductive-age women during a pandemic: Evidence from a small developing state.

The COVID-19 pandemic disrupted access to sexual and reproductive health services, including contraception, highlighting the need to understand contraceptive use to strengthen health-system resilience in small developing states. This study examined factors associated with contraceptive use among reproductive-age women during the early phase of the pandemic in Barbados. A cross-sectional online survey was conducted in 2020 among adults aged 18 years and older, with analysis restricted to non-pregnant women aged 18-49 years. Contraceptive use was assessed in relation to sociodemographic characteristics, relationship status, and psychosocial distress measured using the Hospital Anxiety and Depression Scale. Multiple imputation was used to address missing data, and sensitivity analyses compared imputed and complete-case models. Among 1,094 women, 34.2% (n = 333) reported current contraceptive use, while 36.5% reported moderate-to-severe anxiety and 39.0% reported clinically significant distress. In multivariable analyses, tertiary education (OR 1.68; 95% CI 1.24 - 2.28), being partnered but not cohabiting (OR 1.57; 95% CI 1.10 - 2.22), and being married or cohabiting (OR 2.49; 95% CI 1.65 - 3.77) were associated with higher odds of contraceptive use. Anxiety symptoms showed a weak positive association, while increasing age was associated with slightly lower odds. Findings were consistent across sensitivity analyses. These results underscore the importance of maintaining access to sexual and reproductive health services and integrating mental health support into emergency preparedness strategies.