MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
Institute of Population Health, University of Liverpool, Liverpool, UK.
BMJ Sex Reprod Health. 2023 Oct;49(4):260-273. doi: 10.1136/bmjsrh-2022-201763. Epub 2023 Mar 23.
Contraceptive services were significantly disrupted during the COVID-19 pandemic in Britain. We investigated contraception-related health inequalities in the first year of the pandemic.
Natsal-COVID Wave 2 surveyed 6658 adults aged 18-59 years between March and April 2021, using quotas and weighting to achieve quasi-representativeness. Our analysis included sexually active participants aged 18-44 years, described as female at birth. We analysed contraception use, contraceptive switching due to the pandemic, contraceptive service access, and pregnancy plannedness.
Of 1488 participants, 1619 were at risk of unplanned pregnancy, of whom 54.1% (51.0%-57.1%) reported routinely using effective contraception in the past year. Among all participants, 14.3% (12.5%-16.3%) reported switching or stopping contraception due to the pandemic. 3.2% (2.0%-5.1%) of those using effective methods pre-pandemic switched to less effective methods, while 3.8% (2.5%-5.9%) stopped. 29.3% (26.9%-31.8%) of at-risk participants reported seeking contraceptive services, of whom 16.4% (13.0%-20.4%) reported difficulty accessing services. Clinic closures and cancelled appointments were commonly reported pandemic-related reasons for difficulty accessing services. This unmet need was associated with younger age, diverse sexual identities and anxiety symptoms. Of 199 pregnancies, 6.6% (3.9%-11.1%) scored as 'unplanned'; less planning was associated with younger age, lower social grade and unemployment.
Just under a third of participants sought contraceptive services during the pandemic and most were successful, indicating resilience and adaptability of service delivery. However, one in six reported an unmet need due to the pandemic. COVID-induced inequalities in service access potentially exacerbated existing reproductive health inequalities. These should be addressed in the post-pandemic period and beyond.
在英国 COVID-19 大流行期间，避孕服务受到了严重影响。我们调查了大流行第一年与避孕相关的健康不平等现象。
Natsal-COVID 波 2 调查了 2021 年 3 月至 4 月期间 6658 名 18-59 岁的成年人，使用配额和加权来实现准代表性。我们的分析包括年龄在 18-44 岁之间、出生时为女性的有性行为的参与者。我们分析了避孕措施的使用、因大流行而改变避孕措施、获得避孕服务的情况以及怀孕的计划性。
在 1488 名参与者中，有 1619 名有意外怀孕的风险，其中 54.1%（51.0%-57.1%）报告在过去一年中常规使用有效避孕措施。在所有参与者中，有 14.3%（12.5%-16.3%）因大流行而改变或停止避孕措施。在大流行前使用有效方法的人中，有 3.2%（2.0%-5.1%）转而使用效果较差的方法，而有 3.8%（2.5%-5.9%）停止使用。有风险的参与者中有 29.3%（26.9%-31.8%）报告寻求避孕服务，其中 16.4%（13.0%-20.4%）报告难以获得服务。诊所关闭和预约取消是常见的与大流行相关的难以获得服务的原因。这种未满足的需求与年龄较小、性认同多样化和焦虑症状有关。在 199 例妊娠中，有 6.6%（3.9%-11.1%）被评为“意外”；计划较少与年龄较小、社会等级较低和失业有关。
在大流行期间，近三分之一的参与者寻求避孕服务，大多数人都成功了，这表明服务提供具有弹性和适应性。然而，有六分之一的人报告因大流行而存在未满足的需求。服务获取方面的 COVID 引起的不平等现象可能加剧了现有的生殖健康不平等现象。这些问题应在大流行后时期及以后得到解决。
