The pandemic’s impact on access to contraception and pregnancy intentions

A recent cohort study found an increase in unplanned pregnancies during the pandemic, as well as decreased access to contraception during this time.

Access to contraception in the United Kingdom (UK) has become significantly more challenging during the COVID-19 pandemic, along with unplanned pregnancies which have almost doubled compared to before the lockdown.

These are the two major findings of a national prospective cohort study in the journal BMG Sexual & Reproductive Health.1

The study examined female participants in the UK who became pregnant between May 24 and December 31, 2020. Although the official date of the first UK lockdown was March 23, 2020, the investigators used April 1, 2020, as the lockdown date due to potential restrictions in the month the women conceived.

Among the 9,784  women recruited, mostly through social media, 42.0% conceived pre-lockdown and 58.0% conceived post-lockdown.

The proportion of women reporting difficulties accessing contraception was much higher in those who conceived post-lockdown: 6.5% vs 0.6% pre-lockdown (P < 0.001). This trend rose from March to September 2020.

After accounting for confounders, women were 9 times more likely to report difficulty accessing contraception after lockdown: adjusted odds ratio (aOR) 8.96; 95% confidence interval (CI): 5.89 to 13.63 (P < 0.001).

There was also a significant difference in the levels of pregnancy planning, with higher proportions of unplanned and ambivalent pregnancies post-lockdown: 2.1% and 20.5%, respectively, vs. 1.3% and 16.1%, respectively, pre-lockdown.

Conversely, there was a lower proportion of planned pregnancies in the post-lockdown group: 77.4% vs. 82.5% (P<0.001).

After adjusting for confounders, women who conceived after lockdown were still significantly less likely to have a planned pregnancy: aOR 0.88; 95% CI: 0.79 to 0.98 (P = 0.025).

The study authors do not have information on why women found it harder to access contraception during the COVID-19 pandemic. However, a recent online study from Scotland2, also in BMG Sexual & Reproductive Health, reported numerous factors, including a lack of clarity about the legitimacy of trying to access sexual and reproductive health (SRH) services during a pandemic; uncertainty about which SRH services are still available; limited general practitioner (GP) appointments; challenges to contraceptive prescribing; and closure of usual points of access to free condoms within community settings.

In the UK, the Faculty of Sexual & Reproductive Healthcare acted promptly to provide guidance to healthcare professionals and commissioners to ensure that high standards of SRH care could be maintained throughout the duration of the pandemic, according to the current authors.

The UK also significantly shifted to telemedicine, along with remote prescription for the progestogen-only-pill and combined contraceptive pill for up to 1 year compared to the normal 3- to 6-month prescription period.

Moreover, in England, Scotland, and Wales, abortion regulations were changed to permit medical termination of pregnancy at home supported by telemedicine.

The study authors noted that an increase in unplanned pregnancies further exerts pressures on already burdened abortion and maternity services. Unplanned births are also linked to negative social and economic outcomes for both parents and their children.

“Better planning and resources, and communication with women about service availability, are required to ensure that access to essential services such as these are not disrupted in any future pandemics,” concluded the authors.

References:

1. Balachandren N, Barrett G, Stephenson, J, et al. Impact of the SARS-CoV-2 pandemic on access to contraception and pregnancy intentions: a national prospective cohort study of the UK population. BMJ Sex Reprod Health. 2021;0:1-6. doi:10.1136/bmjsrh-2021-201164

2. Lewis R, Blake C, Shimonovich M. Disrupted prevention: condom and contraception access and use among young adults during the initial months of the COVID-19 pandemic. An online survey. BMJ Sex Reprod Health. 2021;47:269-276. doi:10.1136/bmjsrh-2020-200975