IS COVID-19 YET ANOTHER BARRIER TO CONTRACEPTIVE ACCESS?

Following on from World Contraceptive Day 2021 this last weekend, we’re revisiting the concerns raised in our 2020 MAGNIFI around women’s access to contraceptives in the UK and beyond. Alongside revisiting the stock issues that were prevalent at the start of 2020, we look at how the COVID-19 pandemic has limited women’s access to sexual health and reproductive services even further, along with some of the ways that organisations are responding to this issue.

A growing crisis

Around the globe, concerns have been raised that the pandemic will disrupt access to family planning services, ultimately leading to unwanted pregnancies, and increased maternal risk.

In the UK, a report¹ was produced by NHS Digital investigating the use of sexual and reproductive health (SRH) services between April and September of 2020. The data revealed the following trends:

1. There was a 35% decrease in the total number of contacts with SRH services*

2. There was a 3% decrease in uptake of long-acting reversible contraceptives (LARCs) – e.g., contraceptive implants, intrauterine devices (IUDs) and injectables*

3. There was a 53% fall in the number of emergency contraceptive items provided by SRH services*

As described by the United Nations sexual and reproductive health agency (UNFPA), similar trends are thought to be occurring across the globe, with an estimated 12 million women experiencing interruptions in their access to contraception within the first year of the pandemic, potentially leading to a many as 1.4 million unintended pregnancies.²

The pandemic has seen already limited contraceptive services take a further hit

As we described in our previous MAGNIFI, when the COVID-19 pandemic hit in March 2020, a variety of products associated with women’s health, including both hormonal contraceptives and hormone replacement therapy (HRT) were subject to a myriad of stock issues.

In addition to the existing barriers such as Brexit-related stock uncertainty and an increased demand for the products, the global supply chain for these products was now experiencing the challenges seen across the world, with social distancing, self-isolation and country specific restrictions all adding to delays in manufacture and delivery.³

A multifaceted issue

Alongside these disruptions to the supply chain, the added pressure on health services to cope with the virus and the restrictions placed on the general public further disrupted the ability of both men and women to access appropriate forms of contraceptive.

In the UK, in the initial months of the pandemic, when fears of the NHS being overwhelmed were all too real, there was a push to increase the number of HCPs available to treat COVID-19 patients. Recently retired doctors returned to work,⁴ final year medicine and nursing students started their careers early⁵ and HCPs were redeployed to ICUs from other specialities.^6,7 This reallocation of the workforce, combined with the closing of drop-in centres meant that there were fewer points of access for sexual health services available to those who needed them.

Along with a reduction in the services available, at this time ‘the new normal’ was creating a lot of confusion and interruption for the general public. In a survey of girls and women in the UK between the ages of 14 and 21, carried out by Plan International UK in May 2020,⁸ it was found that 10% of young women surveyed had not been able to access their usual forms of contraception. Some of the common reasons given included:

• Full or partial closure of their usual place of access

• Confusion as to whether access to contraception was considered an ‘essential’ reason for travel

• Fears of family members finding out that they were using contraception due to more time spent at home

When you combine the reduction in available services and limitations on travel triggered by the pandemic with the fact that sexual health services are currently fragmented in the UK between the NHS England, clinical commissioning groups (CCGs) and local authorities,⁹ it’s no surprise that women are unsure where to access contraceptives

What can we do to improve the situation?

A greater responsibility for pharmacists

So far, one of the biggest moves made to combat this issue was the approval of two over-the-counter contraceptive pills by the MHRA.¹⁰ The medications available are two brands containing a form of synthetic progesterone, commonly referred to as the ‘mini-pill’, and will be the first of their kind to be approved in the UK for provision without a prescription, after a consultation with a pharmacist.

Although a prescription will still be required for the combined pill (containing both artificial oestrogen and progesterone) due to the increased health risks, this is still a step forward in simplifying women’s access to contraceptives. This strategy also moves some responsibility away from doctors and onto pharmacists – could this be something we see applied in more therapeutic areas going forward?

Access to advice is a necessity

However, making forms of contraception more readily available won’t fully solve the problem. A woman’s journey with contraception isn’t always simple, with many trying several methods before finding one that they are happy with. Meaning that alongside the ability to access the contraceptive itself, it is essential that women also have access to an HCP who can guide them through this process.

Lately, with the conversation around the negative side-effects of hormonal birth control becoming less taboo¹¹ and the rise in ‘Femtech’ meaning a greater awareness around the option of digital contraceptive apps, women are increasingly questioning the options available to them.¹² If a big change in contraceptive trends is on the horizon, then there needs to be professional advice available.

A more comprehensive solution

To really improve women’s access to contraception, you have to look at the bigger picture and address what is currently lacking in the provision of sexual health services.

That is why organisations like The Faculty of Sexual and Reproductive Healthcare (FSRH) and The All Party Parliamentary Group on Sexual and Reproductive Health in the UK are campaigning for an overhaul of the way these services are run.^9,13 They believe that returning the responsibility for the provision of sexual and reproductive health services back to NHS England, will improve accountability for the standard of services delivered and allow for a more holistic view of sexual and reproductive health, leading to a smoother patient journey for women.

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