By Malcolm Moffat, Tanha Begum, Emer Cullen & Judith Rankin
When the COVID-19 pandemic began almost four years ago, few of us could have predicted the profound and enduring impact that the events of 2020 and 2021 would have on all our lives. Not least among those impacts were the effects that lockdown restrictions had on our social interactions – of both the platonic and the more intimate kind. Previous research has identified significant shifts in sexual behaviours during the pandemic, with an increase in reports of ‘non-partnered’ sex involving virtual activities, masturbation, and sex toy use. However, in the same national cohort, almost two thirds of respondents reported some form of partnered sexual activity in the four months following the instigation of the first national lockdown in March 2020, including 14.5% of people not in a steady relationship and 8.1% of people in a non-cohabiting relationship. Although sexual experiences changed during the early weeks and months of COVID-19, the need for safe and effective contraception care persisted.
In our study, published this month in BMJ Sexual and Reproductive Health, we used the English Prescribing Dataset (EPD), a national NHS record of all prescriptions issued in primary care in England, to examine changes and trends in contraceptive prescribing during the first year of the pandemic. We extracted prescription records for four contraceptive methods (the contraceptive injection, emergency hormonal contraception (EHC), the progestogen-only pill (POP) and the combined oral contraceptive pill (COC)) for all of England during March 2020-February 2021 (the first full year of the pandemic) and March 2019-February 2020 (the full year preceding it). We explored variation in contraception prescribing across the four English regions (the North of England, the South of England, the Midlands and East of England and London), and briefly considered the impact of area-level deprivation on prescribing rates across clinical commissioning group (CCG) areas in the North East of England.
The results were concerning. There was a significant reduction in the number of contraception prescriptions issued across England and in all four English regions during the first year of the pandemic compared to the equivalent pre-pandemic period, and decreases were greater during the lockdown months. There was an 8.41% decrease in the number of COC prescriptions issued during the first year of the pandemic, with more significant decreases observed in the number of prescriptions issued for the contraceptive injection (14.89% decrease) and EHC (18.17%). These decreases were only partially mitigated by an increase in the number of POP prescriptions issued during March 2020-February 2021 (5.15% increase). In the North East and North Cumbria, we did not find any compelling evidence of an association between area-level deprivation and changes in contraceptive prescribing rates.
No area of UK healthcare escaped the effects of the COVID-19 pandemic, and this analysis confirms that contraception care was no exception. Although it was beyond the scope of this study to consider the downstream consequences of reduced contraception use, other research has reported a significant increase in the proportion of UK pregnancies that were described as unplanned post-lockdown. Qualitative evidence has identified the barriers that patients faced in accessing SRH services during the height of the pandemic, and the distress that they experienced when their reproductive health needs were not adequately met. Healthcare professionals, too, have reflected on how provider organisations responded to the challenges wrought by the pandemic, and on the possible implications for marginalised population groups that already suffer pernicious reproductive health inequalities. In amongst the challenges, however, the pandemic presented valuable opportunities to do things differently – to expand telemedicine care in SRH services, and to improve postnatal contraception provision in maternity settings, to give just two examples. Making sense of what went well and what went badly during the worst days of the pandemic, the good and the bad, can help us to develop improved and more responsive services that better meet the needs of the populations we serve.
In reality, contraception care in the UK faced significant challenges even before the COVID-19 pandemic – cuts to the public health grant, which funds sexual and reproductive health services in England, saw significant reductions to services during the period 2012-2019, reflected in fewer sites providing SRH care, reduced opening hours, cuts to staff numbers, and reduced provision of long-acting reversible contraception (LARC) in particular. In the authors’ home city of Newcastle upon Tyne, the contract for SRH provision will shortly pass from the local NHS Foundation Trust to a private provider, sparking concerns among members of the public as well as partners in the wider health and care system about the impact that this move will have on care and outcomes. As we look to the future, and consider the implications of the current study as well as the wider literature around SRH provision during the pandemic, three questions stand out – what were the consequences of changes to SRH provision during the COVID-19 pandemic, and how do we respond to those challenges now; how do we ensure that the positive innovations brought about by the pandemic are integrated into routine care, and evaluated to capture their impact; and what can we do to champion and highlight the value of comprehensive SRH services, not only to ensure that they are sufficiently robust to withstand the effects of future crisis situations, but also to guarantee that they properly meet the population health needs of our patients and communities at all times?
About the Authors
Dr Malcolm Moffat is an honorary consultant in public health and NIHR Doctoral Fellow based at the Population Health Sciences Institute at Newcastle University.
Tanha Begum is a pharmacist based in Newcastle upon Tyne.
Dr Emer Cullen is a specialty registrar in public health, based in the North East of England.
Prof Judith Rankin is professor of maternal and child health based at the Population Health Sciences Institute at Newcastle University.