Current Projects

Background:

The Covid-19 pandemic led to significant changes in how NHS services are delivered and used. Within primary care, changes included use of digital triage, rapid expansion of remote consultation, the suspension of routine care, and electronic prescribing. In turn, the pandemic impacted on women’s contraceptive choices and access. Before the pandemic, strategies to increase long-acting reversible contraceptive (LARC) prescribing led to increased uptake of this highly effective method. Data for LARC prescribing in England 2020/21, however, indicated substantial declines in both GP prescribing and LARC access via specialist sexual and reproductive health (SRH) services compared with the previous year. This decrease was accompanied by declines in contraception-related contacts with SRH services and declines in prescribing of short-acting hormonal contraceptives and contraceptive injections. During Covid-19, the Faculty of Sexual and Reproductive Healthcare deemed it essential that women be able to access contraception. However, depending on the methods, women may have been asked to switch to another method temporarily, and some services for LARC removal and insertion were stopped or delayed. A change from face-to-face to routine online provision further changed GPs’ prescribing.

There is a need to understand current attitudes and experiences regarding access to various forms of contraception in the ongoing Covid-19 pandemic and shifting landscape of service delivery. Research suggests that women were uncertain where or how to access contraception during the pandemic. Young people also reported uncertainty about whether access to SRH care was an ‘essential’ need during the pandemic, inconsistencies with previous advice, and greater barriers in navigating the system. Increased remote service provision allowed continued access to some contraception methods. While this was important in meeting some challenges of the pandemic, it may have unintentionally widened health inequalities. Stakeholders charged with implementing future SRH provision will therefore need detailed understanding of the longer-term impacts of the Covid-19 pandemic and implications for contraception services provision.

Aims:

• To examine women’s experiences (and barriers and facilitators) of accessing contraception services since the start of the pandemic, both for new users of contraception and those with prior experience, and to understand any inequalities of access.
• To explore how the Covid-19 pandemic and resultant changes in the landscape of service provision has impacted on women’s attitudes, preferences and decision-making behaviour around contraception.
• To develop recommendations for maximising contraception uptake, including access, delivery and communication needs (with a focus on LARC).

Methods:

We will conduct individual in-depth interviews with ∼30 women in England who have accessed contraception services since the start of the pandemic (March 2020). Participants will be recruited from the general public through a GDPR compliant market research agency which operates a research panel with UK adults (aged 16+). Participants will be purposively sampled. In the interviews we will explore women’s experiences of accessing contraception including: any perceived changes in services availability or access since the start of the pandemic; barriers and facilitators to accessing contraception; perceptions of different contraception methods including LARC, short-acting hormonal contraceptives, and non-hormonal contraception such as condoms and contraception/period tracker apps; what influences women’s preferences; and perceptions of new modes of access such as digital and pharmacy provision. pathways) are likely to be important influences on women’s decision making behaviour.

A semi-structured topic guide will be informed by the Theoretical Domains Framework (TDF), which defines 14 domains of influence on health behaviour. The topic guide will also be informed by two online PPI consultation groups to allow vital input from women and provide a preliminary understanding of the main issues from their perspective.

Data will be managed using NVivo to facilitate robust, structured, deductive and inductive thematic analysis.

Principal Investigator

Allison Ford

Co-Investigators:

Prof Kate Hunt, Prof Michael Ussher, Dr Erica Gadsby

Reserach Team:

Lauren McMillan

Image credit: Sarahmirk, CC BY-SA 4.0 <;, via Wikimedia Commons

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