Understanding the impact of COVID-19 on women's access to and experiences of contraceptive services in England: a qualitative study

Lauren McMillan; Erica Gadsby; Rebecca Howell; Michael Ussher; Kate Hunt; Allison Ford

doi:10.1136/bmjsrh-2023-202206

Understanding the impact of COVID-19 on women's access to and experiences of contraceptive services in England: a qualitative study

BMJ Sex Reprod Health. 2024 Mar 19:bmjsrh-2023-202206. doi: 10.1136/bmjsrh-2023-202206. Online ahead of print.

Authors

Lauren McMillan¹, Erica Gadsby², Rebecca Howell², Michael Ussher^{2

3}, Kate Hunt², Allison Ford²

Affiliations

¹ Institute for Social Marketing and Health, University of Stirling, Stirling, UK lauren.mcmillan@stir.ac.uk.
² Institute for Social Marketing and Health, University of Stirling, Stirling, UK.
³ Population Health Research Institute, St George's University of London, London, UK.

PMID: 38503471
DOI: 10.1136/bmjsrh-2023-202206

Abstract

Background: The COVID-19 pandemic response prompted rapid changes to how contraceptive services were delivered in England. Our aim was to examine women's experiences of accessing contraceptive services since March 2020 and to understand any inequalities of access.

Methods: We conducted telephone interviews with 31 women aged 17-54 years who had accessed contraceptive services in England since March 2020. The sample was skewed to include participants with lower educational attainment and higher deprivation. Interview transcripts were thematically analysed using inductive and deductive approaches.

Results: Few differences were found regarding educational attainment. Participants using contraceptive injections (all living in areas in the most deprived quintile) reported the greatest access challenges. Some switched method or stopped using contraception as a result. More general barriers reported by participants included service closures, unclear booking processes, and lack of appointment availability. Many participants welcomed the flexibility and convenience of remote contraceptive services. However, telephone appointments posed challenges for those at school or living with parents, and some described them as rushed and inconducive to asking questions or raising concerns. Those accessing contraception for the first time or nearing menopause felt they were unable to access sufficient support and guidance during the pandemic. Some participants voiced concerns around the lasting effects of COVID-19 on appointment availability and inadequate service delivery.

Conclusions: Women's experiences of accessing contraceptive services in England since March 2020 are diverse. While remote services were suitable for some, COVID-19 restrictions unequally impacted women depending on their method of contraception and life stage.

Keywords: COVID-19; Health Policy; Health Services Accessibility; Health Services Research; contraception behavior; qualitative research.