Contraceptive and sexual health services during the COVID-19 pandemic and recovery: a mixed-methods study in England

Background: Sexual and reproductive health (SRH) is essential for public health. COVID-19 led to major disruptions in the provision of essential services including SRH services. Within the context of a multi-country project, this study aimed to explore individual and service-level impacts on contraceptive and sexual health services during the COVID-19 pandemic and recovery phase in England. Methods: A longitudinal, mixed-methods design was implemented, collecting data in two phases, approximately 9 months apart (November 2021 and July 2022). The study comprised in-depth interviews with staff (n = 4) and clients (n = 20) of a sexual health and contraceptive clinical service in the Southeast of England. Over the same timeframe, a quantitative service availability and readiness assessment (SARA) was completed, based on World Health Organization validated tools. Results: Sexual health and contraceptive services continued to operate throughout the pandemic, however measures taken to prevent COVID-19 transmission and staff capacity issues (due to staff redeployment, staff sickness) impacted on patient choice (e.g. how the service could be accessed, methods of contraception available) and patient experience (e.g. delays in accessing healthcare). Despite disruptions, staff described how in-person provision remained available almost continuously for urgent/vulnerable cases. SARA data confirmed service availability, and qualitative data indicate how this was managed. For example, postal home self-sampling for STIs/HIV was expanded and contraceptive counselling by telephone was introduced to reduce clinic visits, and was retained due to popularity. At Time 2, services were running close to normal. Conclusions: COVID-19 disrupted sexual health and contraceptive services in England. Compared to pre-pandemic, more elements of these services were delivered remotely. Readiness to adapt was aided by the pre-pandemic direction-of-travel towards greater use of digital and telemedicine services. Innovations require robust evaluation to ensure optimisation for public health benefit both in the pandemic and post-pandemic context.