# Contraceptive and sexual health services during the COVID-19 pandemic and recovery: a mixed-methods study in England

## TL;DR

This study examines how contraceptive and sexual health services in England adapted during the pandemic, showing that remote options helped maintain access despite challenges.

## Contribution

The study provides new insights into how SRH services in England adapted to the pandemic through remote care innovations and maintained service continuity.

## Key findings

- Sexual health and contraceptive services continued during the pandemic but faced challenges like reduced patient choice and delays.
- Remote services like postal self-sampling and telemedicine were expanded and retained due to their popularity and effectiveness.
- Despite disruptions, services returned to near-normal operations by the second data collection phase.

## Abstract

Sexual and reproductive health (SRH) is essential for public health. COVID-19 led to major disruptions in the provision of essential services including SRH services. Within the context of a multi-country project, this study aimed to explore individual and service-level impacts on contraceptive and sexual health services during the COVID-19 pandemic and recovery phase in England.

A longitudinal, mixed-methods design was implemented, collecting data in two phases, approximately 9 months apart (November 2021 and July 2022). The study comprised in-depth interviews with staff (n = 4) and clients (n = 20) of a sexual health and contraceptive clinical service in the Southeast of England. Over the same timeframe, a quantitative service availability and readiness assessment (SARA) was completed, based on World Health Organization validated tools.

Sexual health and contraceptive services continued to operate throughout the pandemic, however measures taken to prevent COVID-19 transmission and staff capacity issues (due to staff redeployment, staff sickness) impacted on patient choice (e.g. how the service could be accessed, methods of contraception available) and patient experience (e.g. delays in accessing healthcare). Despite disruptions, staff described how in-person provision remained available almost continuously for urgent/vulnerable cases. SARA data confirmed service availability, and qualitative data indicate how this was managed. For example, postal home self-sampling for STIs/HIV was expanded and contraceptive counselling by telephone was introduced to reduce clinic visits, and was retained due to popularity. At Time 2, services were running close to normal.

COVID-19 disrupted sexual health and contraceptive services in England. Compared to pre-pandemic, more elements of these services were delivered remotely. Readiness to adapt was aided by the pre-pandemic direction-of-travel towards greater use of digital and telemedicine services. Innovations require robust evaluation to ensure optimisation for public health benefit both in the pandemic and post-pandemic context.

COVID-19 led to huge demands on health services around the world. It caused major disruptions to sexual and reproductive health (SRH) services, the delivery of which was adapted to enable service continuity. This study was part of a global project which aimed to explore the impact of COVID-19 on SRH services. The study took place in the Southeast of England; in this paper we focused on a sexual health and contraception service. We carried out interviews and administered questionnaires at two different times, 9 months apart. We spoke to people who used this service and healthcare professionals. The service continued to run throughout COVID-19 and most people interviewed experienced minimal barriers to care. However, COVID-19 impacted the delivery, availability, and quality of services. Measures taken to prevent COVID-19 transmission and staffing issues impacted on patient choice and experience. At Time 2, services were running close to normal. However, other health service delivery and public health issues (such as mpox) impacted how the service was run. The pandemic occurred at a time when the service was already offering (or close to offering) remote elements of care. This meant that the service was able to rapidly expand remote services early on in the pandemic, such as STI home self-sampling kits. Delays in access to sexual health and contraceptive care can have serious individual and public health impacts, and our findings illustrate how these services can flexibly adapt in order to maintain continuity of these essential services during health emergencies.