Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences

Bosó Pérez, R. , Reid, D., Maxwell, K. J., Gibbs, J., Dema, E., Bonell, C., Mercer, C. H., Sonnenberg, P., Field, N. and Mitchell, K. R. (2023) Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences. BMJ Sexual and Reproductive Health, 49, pp. 12-20. (doi: 10.1136/bmjsrh-2021-201413) (PMID:35444001) (PMCID:PMC9062459)

Abstract

Introduction: Access to quality sexual and reproductive health (SRH) services remains imperative even during a pandemic. Our objective was to understand experiences of delayed or unsuccessful access to SRH services in Britain during the early stages of the COVID-19 pandemic. Methods: In October and November 2020 we conducted semi-structured telephone interviews with 14 women and six men reporting an unmet need for SRH services in the Natsal-COVID survey, a large-scale quasi-representative web-panel survey of sexual health and behaviour during COVID-19 (n=6654). We purposively sampled eligible participants using sociodemographic quotas. Inductive thematic analysis was used to explore service access and quality and to identify lessons for future SRH service delivery. Results: Twenty participants discussed experiences spanning 10 SRH services including contraception and antenatal/maternity care. Participants reported hesitancy and self-censorship of need. Accessing telemedicine and ‘socially-distanced’ services required tenacity. Challenges included navigating changing information and procedures; perceptions of gatekeepers as obstructing access; and inflexible appointment systems. Concerns about reconfigured services included reduced privacy; decreased quality of interactions with professionals; reduced informal support; and fewer preventive SRH practices. However, some participants also described more streamlined services and staff efforts to compensate for disruptions. Many viewed positively the ongoing blending of telemedicine with in-person care. Conclusion: The COVID-19 pandemic impacted access and quality of SRH services. Participants’ accounts revealed self-censorship of need, difficulty navigating shifting service configurations and perceived quality reductions. Telemedicine offers potential if intelligently combined with in-person care. We offer initial evidence-based recommendations for promoting an equitable restoration and future adaption of services.

• Item Type: Articles
• Additional Information: Natsal is a collaboration between University College London (UCL), the London School of Hygiene and Tropical Medicine (LSHTM), the University of Glasgow, Örebro University Hospital, and NatCen Social Research. The Natsal Resource, which is supported by a grant from the Wellcome Trust (212931/Z/18/Z) with contributions from the Economic and Social Research Council (ESRC) and National Institute for Health Research (NIHR), supports the Natsal-COVID study in addition to funding from the UCL COVID-19 Rapid Response Fund and the MRC/CSO Social and Public Health Sciences Unit (Core funding, MC_UU_00022/3; SPHSU18). DR was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England. We acknowledge members of the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections (BBSTI) Steering Committee in securing funding for this NIHR HPRU: Professor Caroline Sabin (HPRU Director), Dr John Saunders (PHE Lead), Professor Catherine Mercer, Dr Hamish Mohammed, Professor Greta Rait, Dr Ruth Simmons, Professor William Rosenberg, Dr Tamyo Mbisa, Professor Rosalind Raine, Dr Sema Mandal, Dr Rosamund Yu, Dr Samreen Ijaz, Dr Fabiana Lorencatto, Dr Rachel Hunter, Dr Kirsty Foster and Dr Mamooma Tahir.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bosó Pérez, Raquel and Mitchell, Professor Kirstin and Maxwell, Dr Karen
• Authors: Bosó Pérez, R., Reid, D., Maxwell, K. J., Gibbs, J., Dema, E., Bonell, C., Mercer, C. H., Sonnenberg, P., Field, N., and Mitchell, K. R.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: BMJ Sexual and Reproductive Health
• Publisher: BMJ Publishing Group
• ISSN: 2515-1991
• ISSN (Online): 2515-2009
• Published Online: 20 April 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in BMJ Sexual and Reproductive Health 49: 12-20
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
304823	1	Relationships and health	Kirstin Mitchell	Medical Research Council (MRC)	MC_UU_00022/3	HW - MRC/CSO Social and Public Health Sciences Unit
304823	1	Relationships and health	Kirstin Mitchell	Chief Scientist Office (CSO)	SPHSU18	HW - MRC/CSO Social and Public Health Sciences Unit