By Dr Neerujah Balachandren and Dr Jennifer Hall

One year into the pandemic, the U.N. Sexual and Reproductive Health Agency (UNFPA) estimated 12 million women in low and middle-income countries may have been unable to access family planning services. ¹ It has been estimated that as many as 1.4 million unplanned pregnancies may have occurred before women were able to resume access to family planning services again.¹

In this paper, Balachandren et al., undertook a prospective nationwide survey of 9784 pregnant women to understand the impact of the COVID-19 pandemic on women’s access to contraception and on the levels of unplanned pregnancy in the UK.² They showed that pregnant women were nine times more likely to report difficulty in accessing contraception in the months before they became pregnant if they conceived during or after the first national lockdown of late March 2020. Using the London Measure of Unplanned Pregnancy (LMUP) to assess the degree of intention of the pregnancy³, Balachandren and team also reported at least a doubling in the proportion of unplanned pregnancies.

In March 2020, the UK Government implemented a national lockdown which stipulated severe restrictions on social contact⁴. Staff redeployment and sickness led to some SRH clinics being closed and face-to-face appointments being reduced.⁵ The Faculty of Sexual & Reproductive Health acted rapidly to provide guidance to healthcare professionals and commissioners to ensure that high standards in SRH care could be maintained throughout the duration of the COVID-19 pandemic.⁶ Despite these measures, this study found a steep increase in the proportion of women reporting difficulty accessing contraception particularly between March and April 2020.

Unplanned pregnancies have huge implications on social and economic outcomes for parents and their children.  The overall annual cost of unplanned pregnancies in England, including those ending in births or abortions, was previously estimated at £193 million⁷ and is likely more than that now.  There were 210,860 abortions reported in England and Wales in 2020; the highest since records began. Most abortions in 2020 were medical (85% – an increase of 12 percentage points on 2019) and 88% were performed before 10 weeks of gestation, increasing from 81% in 2019. Both these changes were likely facilitated by temporary measures in England and Wales to approve the provision of medical abortion at home rather than the usual requirement of attendance at a health facility.⁸ Early findings suggest that this approach is safe, acceptable, effective and increases access to care⁹ supporting the case for this to become a permanent change.

The UK’s response to COVID-19 is currently under scrutiny. It is paramount that we reflect on both the successes and lessons learnt to better inform future responses to national emergencies. Decisions regarding essential services such as sexual health and reproductive service (SRH) during future national emergencies must be underpinned by knowledge and scientific evidence. This study provides reliable information about the impact of the pandemic on access to contraception and levels of unplanned pregnancy and recommends that 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.

References:

1. United Nations Population Fund. Impact of COVID-19 on Family Planning: What we know one year into the pandemic. 2021; Available from: https://www.unfpa.org/sites/default/files/resource-pdf/COVID_Impact_FP_V5.pdf.
2. Balachandren, N., Barrett, G., Stephenson, J., Yasmin, E., Mavrelos, D., Davies, M., David, A. and Hall, J. , The impact of the SARS-CoV-2 pandemic on access to contraception and pregnancy intentions: a national prospective cohort study of the UK population. BMJ Sexual and Reproductive Health.
3. Barrett, G., S.C. Smith, and K. Wellings, Conceptualisation, development, and evaluation of a measure of unplanned pregnancy. J Epidemiol Community Health, 2004. 58(5): p. 426-33.
4. Prime Minister’s Office 10 Downing Street. Prime Minister’s statement on coronavirus (COVID-19): 23 March 2020. 2020; Available from: https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-23-march-2020.
5. Faculty of Sexual and Reproductive Health (FSRH). FSRH COVID-19 SRH Service Survey. 2020; Available from: https://www.fsrh.org/documents/covid-19-fsrh-survey-interim-results-07-may-2020/.
6. Faculty of Sexual and Reproductive Health (FSRH). Essential Services in Sexual and Reproductive Healthcare. 2020; Available from: www.fsrh-position-essential-srh-services-during-covid19-24-march-2020%20(1).pdf.
7. Montouchet, C. and J. Trussell, Unintended pregnancies in England in 2010: costs to the National Health Service (NHS). Contraception, 2013. 87(2): p. 149-153.
8. DHSC, Abortion statistics, England and Wales: 2020. 2021: London, UK.
9. Aiken, A., et al., Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study. BJOG, 2021. 128(9): p. 1464-1474.

Read more: Impact of the SARS-CoV-2 pandemic on access to contraception and pregnancy intentions: a national prospective cohort study of the UK population

Dr Neerujah Balachandren is a Senior Registrar in Obstetrics and Gynaecology and a Clinical Research Fellow in the Reproductive Medicine Unit at UCLH. She is also in the final year of her MD at UCL, where she is conducting research on reproductive health and fertility.

Dr Jennifer Hall is an Associate Clinical Professor in the Sexual and Reproductive Health Research Team at the UCL EGA Institute of Women’s Health. Her research focuses on how women avoid or plan for pregnancy and the consequences of this for pregnancy outcomes and health service delivery.