Contraceptive use and pregnancy planning in Britain during the first year of the COVID-19 pandemic: findings from a large, quasi-representative survey (Natsal-COVID)

Abstract

BackgroundContraceptive services were significantly disrupted during the COVID-19 pandemic in Britain. We investigated contraception-related health inequalities in the first year of the pandemic.MethodsNatsal-COVID Wave 2 surveyed 6658 adults aged 18–59 years between March and April 2021, using quotas and weighting to achieve quasi-representativeness. Our analysis included sexually active participants aged 18–44 years, described as female at birth. We analysed contraception use, contraceptive switching due to the pandemic, contraceptive service access, and pregnancy plannedness.ResultsOf 1488 participants, 1619 were at risk of unplanned pregnancy, of whom 54.1% (51.0%–57.1%) reported routinely using effective contraception in the past year. Among all participants, 14.3% (12.5%–16.3%) reported switching or stopping contraception due to the pandemic. 3.2% (2.0%–5.1%) of those using effective methods pre-pandemic switched to less effective methods, while 3.8% (2.5%–5.9%) stopped. 29.3% (26.9%–31.8%) of at-risk participants reported seeking contraceptive services, of whom 16.4% (13.0%–20.4%) reported difficulty accessing services. Clinic closures and cancelled appointments were commonly reported pandemic-related reasons for difficulty accessing services. This unmet need was associated with younger age, diverse sexual identities and anxiety symptoms. Of 199 pregnancies, 6.6% (3.9%–11.1%) scored as ‘unplanned’; less planning was associated with younger age, lower social grade and unemployment.ConclusionsJust under a third of participants sought contraceptive services during the pandemic and most were successful, indicating resilience and adaptability of service delivery. However, one in six reported an unmet need due to the pandemic. COVID-induced inequalities in service access potentially exacerbated existing reproductive health inequalities. These should be addressed in the post-pandemic period and beyond.

A consensus statement on perinatal mental health during the COVID-19 pandemic and recommendations for post-pandemic recovery and re-build

“…Access to essential reproductive services such as contraception and abortion ( 37 , 38 ), ensuring high levels of relational care are prioritised in healthcare service and delivery ( 28 , 31 ), and redoubling efforts to ensure that perinatal and infant mental health are given the parity of esteem of physical health concerns ( 39 ) are recommended for retention in line with other calls for prioritisation of specialist women's mental healthcare ( 40 – 42 ). Communication of health messaging to families should continue to be clear, concise, and consistent, and the option for remote care provision should be maintained ( 32 , 33 ).…”

“…Recommendations for immediate action were suggested under aspects of care to retain, reintroduce, and to remove. Maintaining access to essential reproductive and perinatal health services ( 37 , 38 ), ensuring quality healthcare delivery ( 28 , 31 , 33 ), and giving perinatal mental health parity of esteem with physical health concerns ( 39 ), as well as providing specialist, tailored services for perinatal women ( 40 – 42 ), are recommended for retention as we recover and re-build services after the pandemic. Remote care should be retained ( 32 , 33 ) but not at the expense of face-to-face consultation ( 24 , 25 , 35 ), nor should it be the dominant provision.…”

Influence of the COVID-19 pandemic on births and induced abortions in Southern Sweden: a register-based study

“…Overall, the measures of abortions in themselves may not give precise clarity on what the health needs of the population may be, potentially capturing competing effects which differ across age groups as well as markers of inequality. 24 The pandemic's prolonged stressors on societies with variants of the virus emerging leading to new waves of outbreaks, restrictions and uncertainty of the future, 25 may have had an impact on reproductive decisions in a longer perspective compared with previous pandemics. As such, future studies might further assess the pandemic, as well as different public health policies' influence on pregnancy decisions.…”