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O05.2 A mixed-method investigation into challenges in accessing sexual and reproductive health (SRH) services in Britain during the COVID-19 pandemic (Natsal-COVID)
  1. D Reid1,
  2. E Dema1,
  3. R Boso Perez2,
  4. K Maxwell2,
  5. C Tanton3,
  6. C Bonell3,
  7. S Clifton1,4,
  8. P Sonnenberg1,
  9. C Mercer1,
  10. J Gibbs1,
  11. N Field1,
  12. K Mitchell2
  1. 1Institute for Global Health, Centre for Population Research in Sexual Health and HIV, University College London, London, UK
  2. 2MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  3. 3Faculty of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Health and Biomedical Surveys Team, NatCen Social Research, London, UK


Background COVID-19 restrictions led to widespread disruption of SRH services in Britain following the first national lockdown (23/3/2020). One-in-ten people who tried to access SRH services during reported being unable to do so (Natsal-COVID). We used mixed-methods research to quantify unmet need and explore its context and impact.

Methods 6,657 participants aged 18–59 years completed a web-panel survey (29/07–10/08/20). Quota-based sampling and weighting enabled a quasi-representative population sample to be achieved. Quantitative analysis focused on participants’ challenges accessing contraception and STI-related services since lockdown. We conducted 23 in-depth interviews with participants, 15 who reported not receiving an SRH service and eight who discussed this in a different topic interview.

Results Reasons for not receiving STI-related (n=103) or contraception services (n=144) despite need included that appointments were unavailable (STI-related services: 28.6% (95%CI:19.5–39.8)/Contraception services 36.3% (28.1% – 45.4%)), were cancelled (22.8% (14.9%- 33.3%)/23.9% (16.8%-32.8%) or services were closed (21.2% (13.7%-31.4)/26.1% (19.1%-34.5%). Discomfort with using online/telephone services was more common amongst those not receiving STI-related services 26.0% (17.4%-36.9%) than for contraception services 6.7% (3.4%-12.8%).

Interviewees described how some services were unavailable, while others were disrupted. Many were offered and received alternatives to in-person service (e.g. telephone/online) and some had to use different contraceptive methods. Most understood attempts to limit SARS-CoV-2 transmission and found alternatives convenient, though others saw them as inferior due to interaction limitations. Tenacity was required to access some services. Several participants described how they had avoided or deprioritised their own needs. Fears of contracting COVID-19 and of judgement for having sex against restrictions deterred help-seeking.

Conclusion While some people were unable to access an anticipated service, many were offered alternatives with varied consequences. Services may need to adapt further to improve access by offering efficient face-to-face and remote provision while emphasising lack of judgement and validating help seeking.

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