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)

BackgroundReproductive 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. MethodsNatsal-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. FindingsAmongst 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. InterpretationAlthough 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. FundingWellcome Trust, The Economic and Social Research Council, The National Institute for Health Research, Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, and UCL Coronavirus Response Fund. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIThe COVID-19 pandemic likely impacted reproductive outcomes in diverse ways; such impacts may have been unequally distributed. C_LIO_LIPrevious studies reported adaptations to health service delivery and difficulties experienced in accessing reproductive health services, with switching and stopping of contraceptive methods and potentially greater risk of unplanned pregnancy. C_LI What this study addsO_LIWe examined differences in contraceptive use and pregnancy planning in a sample of women, trans and non-binary people able to become pregnant who were quasi-representative of the British general population. C_LIO_LIWe found that key markers of inequality and vulnerability, related to age, ethnicity, social disadvantage and mental health, were associated with increased contraceptive method switching, unmet need of contraceptive services and less-planned pregnancies. C_LI How this study might affect research, practice or policyO_LIOngoing efforts to ease the health impacts of the pandemic should aim to improve equality of access to contraceptive services. C_LI