A study conducted by researchers from University College London (UCL) and University College London Hospital (UCLH) assessed changes in women’s self-reported access to contraception and how it was impacted by COVID-19 in the U.K.
A Closer Look at the Study
The study, published in BMJ Sexual and Reproductive Health, analyzed data from 9,784 women, who are all participants of the ongoing Contraception and Pregnancy Study (CAP-COVID) based at UCL and UCLH. Of these women, 4,114 conceived before lockdown and the remaining 5,670 conceived post-lockdown. Women were nine times more likely to experience problems getting contraception during the first lockdown, the researchers wrote. This led to almost double the proportion of unplanned pregnancies—1.3% pre-lockdown compared to 2.1% post-lockdown. After lockdown, the proportion of women who reported difficulties accessing contraception rose from 0.6% to 6.5%. Senior author Dr. Jennifer Hall, from UCL Institute for Women’s Health, said it was important to carry out the study to be able to assess the impact of the pandemic on aspects of health other than the number of COVID-19 cases and deaths. “The effect of lockdown, staff illness, and redeployment on access to essential services, including contraception and termination, could otherwise have been missed,” Dr. Hall explains. “Understanding whether there was an effect on access to services is important for planning how to respond to future challenges in order to maintain provision and prevent unwanted pregnancies and births.” While the researchers weren’t surprised that it was harder to access contraception, they were surprised at just how much harder it was, especially given the changes that had been put in place. During the pandemic, the U.K. and many other countries recognized the need to continue the provision of contraception, and implemented new practices and policies accordingly, such as a shift to telemedicine and remote prescription for the contraceptive pill for up to a year instead of the usual 3-6 months. “A doubling in the number of unplanned pregnancies was more than we expected, especially because this was a study of pregnant women so people who had terminated a pregnancy did not take part,” Dr. Hall adds.
The Importance of Access to Contraception
Access to contraception is important because it helps improve the health and well-being of women, decreases global maternal mortality, and increases female engagement in the workforce and financial self-sufficiency, says Sandy Dorcelus, DO, an OB/GYN physician at NYU Langone Hospital—Long Island. “Approximately 50% of pregnancies are unintended and supporting family planning programs help address this issue,” Dr. Dorcelus adds. “Access to contraception allows women the ability to decide when to have children, the number of children they would like to have, and healthy, satisfying sex lives.” The COVID-19 pandemic aside, many obstacles prevent people from easily accessing contraception in the U.S. “The cost of contraception and insurance coverage can be barriers,” says Dr. Dorcelus. She also points to misperceptions and a lack of knowledge surrounding contraception safety and use. Dr. Hall believes there are examples of good practices in the U.K., including changing guidelines to allow more contraception to be available without prescription or repeated reviews and for medical termination to be accessible from home. However, she notes that despite this, access to contraception was still much more difficult during lockdowns and resulted in an increase in unplanned pregnancies.
Consequences of Unplanned Pregnancy
According to the Guttmacher Institute, access to contraception is estimated to help decrease the rate of unintended pregnancies by 68% in low to middle-income countries. Unplanned pregnancy can put an individual in the extremely difficult position of having to decide whether to give the baby up for adoption, or have an abortion, or carry the baby to term. This can have an impact on their mental and physical health, may impact their family and their finances, and has implications for health services. “Each one represents a missed opportunity to prepare for pregnancy, for example by taking folic acid and reaching a healthy weight,” says Dr. Hall. “We know that unplanned pregnancies have poorer outcomes for mum and baby, including babies being born early and mums experiencing postnatal depression—and this is preventable.” Dr. Hall and her team hope their findings show the need to balance the immediate health care requirements that are directly related to the COVID-19 pandemic with the need to provide ongoing access to essential services, like contraception. Other people may have their opinions, but it’s important to do what’s best for you.
