Background The COVID-19 pandemic and lockdown responses presented changes in delivery of reproductive health services. To explore the population-level effects, we examined patterns of contraceptive method use, service access and pregnancy planning in the year following the first UK lockdown.

Methods Survey wave 2 of Natsal-COVID was conducted in March-April 2021, one year after the first lockdown. We selected participants who were described as female at birth, aged 18–44 years and reported sex with a man in the past year. We examined differences in outcomes by age and markers of vulnerability, inequality and mental ill-health. We calculated proportions who stopped using contraception or switched method and estimated age-adjusted odds ratios (aOR) of unmet need for contraceptive services. Amongst participants who became pregnant, we calculated age-adjusted differences in mean London Measure of Unplanned Pregnancy scores (LMUP; range 0–12) to examine ‘plannedness’ of pregnancies.

Results Of 1,488 eligible participants, 1,169 (78.0%) were at risk of unplanned pregnancies (neither pregnant, trying to get pregnant, nor unable to get pregnant). Of 629 (52.4%) at-risk participants who reported using a more effective contraceptive method pre-lockdown, 17.2% reported subsequently stopping or switching method. 441 (33.3%) participants reported trying to access contraceptive services; 74 (16.4%) of these reported facing barriers. Young participants (18–24 years) were most likely to report switching method (23.5%, (15.2, 34.5); vs 13.4% overall), trying to access contraceptive services (38.4%; (32.2, 45.0); vs 28.4% overall) and facing barriers (OR: 2.87 (1.36, 6.06)). Participants who faced barriers were more likely to report higher alcohol intake than before the pandemic (aOR: 2.62; 95%CI: 1.27, 5.42), no educational qualifications (aOR: 2.12; (0.75, 6.00)), and symptoms of anxiety (aOR: 1.98; (1.16, 3.36)) or depression (aOR: 1.67; (0.97, 2.85)). 199 participants (13.6%) reported a pregnancy in the last year. Pregnancies reported by young people were more likely to have a lower ‘plannedness’ score (LMUP difference between aged 18–24 and over 24: -2.95; (-3.91, -1.99)). Lower scores were reported in pregnancies to participants in the lowest socioeconomic grades (adjusted difference: -1.36; (-2.49, -0.22)), along with those who became unemployed (adjusted difference: -1.37; (-2.98, 0.25)).

Discussion While most women continued their usual method of contraception and most trying to access contraceptive services succeeded, young people and participants reporting markers of vulnerability were more likely to have difficulties accessing services and less planned pregnancies. Sexual health services preparing for future crises may need to further take into account the needs of young people and vulnerable women.