Evaluation of contraceptive provision during SARS-CoV-2 lockdown in the United Kingdom: online survey using social media platforms

Conference:

SAPC ASM 2021 - virtual

Talk Code:

3D.1

Presenter:

Richard Ma

Twitter:

@Richard_GP

Co-authors:

Kimberly Foley, Sonia Saxena

Author institutions:

Imperial College London

Problem

UK government introduced non-pharmaceutical intervention (“lockdown”) to reduce community transmission of SARS-CoV-2 in March 2020. Health services responded by limiting face-to-face contacts; general practices changed to using total triaging and remote consultations. Contraceptive services, including provision of long acting reversible contraception (LARC) was deemed “low priority” by BMA and RCGP. Given the potential for reduced access to contraception, we conducted a rapid evaluation of contraceptive access in the UK during lockdown.

Approach

Using Qualtrics software, we designed an online survey that asked about contraceptive access, contraceptive use, and preferences before and after the lockdown, with an option for free text comment. After piloting with a patient and public involvement group, we promoted this survey on social media platforms for two weeks from 27th May 2020, targeting cisgender women between ages of 16 and 54 years from all over the UK. We used Microsoft Excel for descriptive analysis of quantitative data and Nivo to organise free text data for thematic analysis.

Findings

Out of 352 visits to the survey site, 214 were cisgender women who consented and completed the survey. We received responses from all UK regions and age groups between 16 to 54 years; modal age was 16 to 18 (n=70, 33%), greatest from South East (31, 15%) and least from Northern Ireland (6, 3%).83% (178/214) were using contraception at the time; 64% (113/178) obtained before lockdown, 37% after lockdown. 38 (17%) were not using contraception at the time. 40% to 60% were concerned about getting their next supply during lockdown; most common reason was perception that GP/contraception clinic was closed or not offering appointments.59 free text responses to the “comments” section were categorised into themes. Respondents reported not knowing how and where to obtain contraception after lockdown and assumed their clinic/GP surgery were shut or not offering face-to-face appointments and LARC fittings. Providers adapted however by offering remote consultations for assessments and issued prescriptions by mail or electronically to nominated pharmacies; this was useful for respondents staying away from their usual residence.Some purchased contraception from online pharmacies or switched methods. One respondent had to travel further for LARC because her local GP was not offering it. Some complained it was unfair blood tests and immunisations were offered but not LARC (injections and implants).While a temporary method to their preferred choice was acceptable to some, this was not for those who relied on it for non-contraceptive benefits such as manging heavy menstrual bleeding and acne.

Consequences

The survey highlighted the need for better information and signposting to obtain free contraception during lockdown. We reported variations in availability and access to contraceptive services across the UK, especially so for LARC because of the restrictions in face-to-face contacts and procedures.

Submitted by:

Richard Ma

Funding acknowledgement:

RM is funded by National Institute for Health Research (NIHR) Doctoral Research Fellowship (NIHR-DRF-2017-10-181). This publication presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. SS receives grants from The Daily Mile Foundation and holds core and programme grant funding from the NIHR School for Public Health Research (SPHR grant reference number PD-SPH-2015). This article presents independent research commissioned by the National Institute for Health Research (NIHR) under the Applied Research Collaboration (ARC) programme for North West London. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the abstract.