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

Abstract

Objectives: 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 COVID-19 pandemic. Design: Semi-structured qualitative follow-up interviews were conducted in October-November 2020 (six months after the first UK lockdown) with participants of Natsal-COVID, a quasi-representative web-panel survey of sexual health and behaviour during COVID-19 (n=6654). Inductive thematic analysis was used to identify lessons for future SRH service access and quality. Setting: Telephone interviews with participants from the general population. Participants: 14 women and 6 men (24-47-years-old) reporting unmet need for SRH services and agreeing to recontact (n=311) were selected for interview using socio-demographic quotas. Results: Participant experiences spanned ten different SRH services, including contraception and antenatal/maternity services. At interview, ten participants still experienced unmet need. Participants reported hesitancy and self-censorship of need. Accessing services required tenacity. Challenges included navigating inconsistent information and changing 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 due to lone attendance; and fewer routine physical checks. However, participants also described examples of more streamlined services and staff efforts to compensate for disruptions. Many viewed the blending of telemedicine with in-person care as a positive development. Conclusion: COVID-19 impacted access and quality of SRH services. The accounts of those who struggled to access services revealed self-censorship of need, difficulty navigating shifting service configurations, and perceived reduction in quality due to a socially-distanced service model. Telemedicine offers potential for greater efficiency if blended intelligently with in-person care. We offer some initial data-based recommendations for promoting equitable access and quality in restoration and future adaption of SRH services.