Initial Impacts of COVID-19 on Sexual and Reproductive Health Service Use and Unmet Need in Britain: Findings from a Large, Quasi-Representative Survey (Natsal-COVID)

Abstract

Background: The COVID-19 pandemic has affected sexual and reproductive health (SRH) service use and unmet need, but the impact is unknown. Methods: 6,654 participants (18-59y) completed a web-panel survey (July-August 2020) 4-months after initial lockdown in Britain (March 2020). Quota-based sampling and weighting enabled a quasi-representative population sample. We estimated reported SRH service use and unsuccessful use, and calculated age-adjusted odds ratios (aOR) among sexually-experienced (≥1sexual partner/lifetime;n=3,065) and sexually-active (≥1sexual partner/past year;n=2,752) participants (18-44y). F Findings: 9·1% and 2·7% of sexually-active men and women reported new sexual partners in the four months from March 2020, of whom 80·6% also reported condomless sex. 20·8% of sexually-experienced participants reported using SRH services during this timeframe. 9·7% reported being unable to use a service, though most (76·4%) also reported an instance of successful use. STI-related (4·8% of sexually-active participants) and contraceptive services (14·8% of sexually-experienced women) were most commonly used, with use highest among young people. Sexually-active participants reporting condomless sex with new partner(s) since lockdown (n=99) were particularly likely to report using STI-related services (aOR, men: 23.8(95%CI 11.6-48.9), women: 10.5(3.94-28.2)) and, amongst men, inability to access (aOR 13.3(5.39-32.9)). Among those reporting STI testing, 64·4% accessed remotely (telephone/video/online). 2.4% of women (25-59y) reported cervical screening, compared to an estimated 6% under normal circumstances. Interpretation: Many participants accessed SRH care during the initial lockdown, but young people and those reporting sexual risk behaviours reported difficulties. Services may need to address a backlog of need. Funding: Natsal (Wellcome/ESRC/NIHR), MRC/CSO, and UCL COVID-19 Rapid Response Fund. Declaration of Interest: None to declare. Ethical Approval: We obtained ethics approval from University of Glasgow MVLS College Ethics Committee (reference 20019174) and London School of Hygiene and Tropical Medicine Research Ethics committee (reference 22565). An anonymised dataset will be deposited with the UK Data Service.