Contraceptive use and pregnancy planning in Britain during the first year of the COVID-19 pandemic: findings from a large, quasi-representative survey (Natsal-COVID) (preprint)

Background Reproductive health services were significantly disrupted during the COVID-19 pandemic in Britain. We investigated contraception-related health inequalities in the first year of the pandemic. Methods Natsal-COVID Wave 2 surveyed 6,658 adults aged 18-59 between March-April 2021, using quotas and weighting to achieve quasi-representativeness. Our analysis included sexually active participants aged 18-44, described as female at birth. We analysed contraception use and switching, contraceptive service access, and pregnancy plannedness in the year from March 2020. Findings Amongst all participants (n=1,488), 14.3% (12.5%-16.3%) reported switching or stopping contraception due to the pandemic. Of participants at risk of unplanned pregnancy (n=1,169), 54.1% (51.0%-57.1%) reported routinely using effective contraception in the past year. 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. Stopping/switching was more likely amongst participants of younger age, non-white ethnicity, and lower social grade. 29.3% of at-risk participants (26.9%-31.8%) reported trying to access contraceptive services; of whom 16.4% (13.0%-20.4%) reported their needs went unmet. Unmet need was associated with younger age, diverse sexual identities and anxiety symptoms. Of 199 pregnancies, 6.6% (3.9%-11.1%) were scored as 'unplanned'; less planning was associated with younger age, lower social grade and unemployment. Interpretation Although many participants reported accessing contraceptive services during the pandemic, one-in-six of these reported an unmet need. Inequalities in unmet need and risk of unplanned pregnancy - related to age, ethnicity, social disadvantage and mental health - potentially exacerbated existing reproductive health inequalities. These should be addressed in the post-pandemic period and beyond.

How did the COVID-19 pandemic affect access to condoms, chlamydia and HIV testing, and cervical cancer screening at a population level in Britain? (Natsal-COVID) (preprint)

Objectives: To investigate how differential access to key interventions to reduce sexually transmitted infections (STI), HIV, and their sequelae changed during the COVID-19 pandemic. Methods: British participants (18-59y) completed a cross-sectional web survey one year (March to April 2021) after the initial lockdown in Britain. Quota-based sampling and weighting resulted in a quasi-representative population sample. We compared Natsal-COVID data with Natsal-3, a household-based probability sample cross-sectional survey (16-74y) conducted in 2010-12. Reported unmet need for condoms because of the pandemic and uptake of chlamydia testing/HIV testing/cervical cancer screening were analysed among sexually-experienced participants (18-44y) (n=2869, Natsal-COVID; n=8551, Natsal-3). Odds ratios adjusted for age (aOR) and other potential confounders (AOR) describe associations with demographic and behavioural factors. Results: In 2021, 6.9% of women and 16.2% of men reported unmet need for condoms because of the pandemic. This was more likely among participants: aged 18-24 years, of Black or Black British ethnicity, and reporting same-sex sex (past five years) or one or more new relationships (past year). Chlamydia and HIV testing were more commonly reported by younger participants, those reporting condomless sex with new sexual partners, and men reporting same-sex partners; a very similar distribution to 10 years previously (Natsal-3). However, there were differences during the pandemic, including stronger associations with chlamydia testing for men reporting same-sex partners; with HIV testing for women reporting new sexual partners; and with cervical screening among smokers. Conclusions: Our study suggests differential access to key primary and secondary STI/HIV prevention interventions continued during the first year of the COVID-19 pandemic. However, the available evidence does not suggest substantial changes in inequalities in since 2010-12. While the pandemic might not have exacerbated inequalities in access to primary and secondary prevention, it is clear that large inequalities persisted, typically among those at greatest STI/HIV risk.