Reduced access to contraception during the COVID-19 pandemic led to a 61.5% rise in the proportion of unplanned pregnancies in the UK

Pregnancy test

Unplanned pregnancies nearly doubled during the first COVID-19 lockdown in the UK, a major national prospective cohort study has found.

The study, published in BMJ Sexual and Reproductive Health, is the first to assess changes in women’s self-reported access to contraception as a consequence of the COVID-19 pandemic in the UK. 

The researchers from University College London (UCL) and University College London Hospital (UCLH) analysed data from 9784 female participants of the ongoing COVID-19 Contraception and Pregnancy Study (CAP-COVID), who were pregnant between 24 May and 31 December 2020. Those with a last menstrual period (LMP) date before 1 April 2020 were classified as having conceived ‘pre-lockdown’ and those with an LMP on/after 1 April 2020 were classified as ‘post-lockdown’.

Of the 9784 women, 4114 conceived pre-lockdown and 5670 conceived post-lockdown.

There was an increase in the proportion of unplanned pregnancies, from 1.3% pre-lockdown to 2.1% post-lockdown; a 61.5% rise. The researchers believe this is an under-estimate, and unplanned pregnancies may have at least doubled, as the sample was unlikely to have captured the women who were not planning to continue their pregnancy.

Overall, the research team found women were nine times more likely to have difficulties in accessing contraception during the first lockdown; rising from 0.6% pre-lockdown to 6.5% post-lockdown, and this was suggested to be a key factor behind the rise in unplanned pregnancies.

Telemedicine

Senior author Dr Jennifer Hall (UCL Institute for Women’s Health) said: ‘During the COVID-19 pandemic, many countries, including the UK, recognised the need for continuing contraception provision and implemented new practices and policies to deliver this

‘The UK saw a significant shift to telemedicine along with remote prescription for progestogen-only pill and combined oral contraceptive pill for up to a year compared to the usual 3–6 months, and many maternity services also worked to improve the postnatal contraception provision available in hospital.

‘However, we found that despite the introduction of new policies and practices by contraception and abortion service providers during the first lockdown, women continued to report ongoing difficulties in accessing contraception, leading to a significant rise in the proportion of unplanned pregnancies.’

First author Dr Neerujah Balachandren from the reproductive medicine unit at UCLH, added: ‘Prior research has pointed to several factors which may explain why it was harder to access to contraception during the COVID-19 pandemic. 

‘These include a lack of clarity about the legitimacy of trying to access sexual and reproductive health services (SRH) during a pandemic, uncertainty about which SRH services are still available, limited GP appointments, challenges to contraceptive prescribing, and closure of usual points of access to free condoms within community settings.’

The authors suggest that a rise in unplanned pregnancies will increase pressures on already stretched abortion and maternity services. Data released earlier this month show that there were 210,860 abortions reported in England and Wales in 2020—the highest since records began.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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