With many people unable to access their regular form of contraception, experts advise how to adapt, which new methods are available, and how accessibility might change post-pandemic
The coronavirus has put the UK’s health service under unprecedented strain. Those on the frontline of the crisis are still pleading with the government for more PPE, while other vital services have been thrown into disarray. With GPs cutting face-to-face contact with patients, urgent appointments have been cancelled or postponed.
One service particularly affected is sexual health, which – according to experts – has been “rolled back” by decades amid the pandemic. As well as cancelled cervical screenings, many women have been unable to access their regular form of contraception, as clinics are forced to close or run a skeleton service.
It doesn’t help that the government’s messaging on sexual health has been confusing – to say the least. The UK announced changes to abortion regulations as soon as the lockdown was announced in March, only to reverse the decision a few hours later. The government then changed its mind again, announcing that women can take two abortion pills at home – those in Northern Ireland, however, must still take one at the clinic, and the deadline has long passed for implementing the full abortion services that were promised last year.
As well as being in the middle of a pandemic, Valentina Milanova, the founder of sustainable tampon brand Daye, tells Dazed that “the country is also in the middle of a sexual health crisis, and contraceptive services are the ones to have suffered the biggest cuts”. Daye is working hard to make life easier for women, who are tired of having their bodies policed by the state, by fast-tracking its personalised contraception service during the COVID-19 crisis.
Known as the Contraception Recommendation Engine (CRE), the service asks women to fill in a free questionnaire online – declaring BMI, blood pressure, and medical history, as well as lifestyle questions and past experiences with contraception – before being provided with a birth control recommendation based on their answers. Women can then purchase the prescription directly from Daye and have it delivered directly to their door, or take the recommendation to their doctor in order to get it for free.
“Finding the right form of contraception for your body, lifestyle, and personal preferences is actually really hard,” Milanova explains. “There’s 15 different methods and on average, women have to try over four before finding the right one. We’re very lucky to live in a country that offers free healthcare, but the NHS is too underfunded and understaffed to have the time or resources to offer personalised contraceptive options to everyone who needs it.”
“We’re very lucky to live in a country that offers free healthcare, but the NHS is too underfunded and understaffed to have the time or resources to offer personalised contraceptive options to everyone who needs it” – Valentina Milanova, Daye
Daye’s CRE is just one of many innovative services available to women struggling to access birth control during the pandemic. Natural Cycles, a hormone-free birth control app that analyses women’s fertility status, has seen an uptake in users amid the crisis, as women look for methods that don’t require face-to-face interactions. Could digital contraception be the future? “Natural Cycles is a very good option because you can start and stop it whenever you want,” the app’s co-founder Elina Berglund tells Dazed. “If you don’t have access to your normal birth control right now, but can get access later, you can go back.” The app has also introduced a COVID-19 symptom tracker, enabling users to share any concerning symptoms with their healthcare provider.
Speaking to Dazed previously, Natural Cycles’ co-founder Dr Raoul Scherwitzl explained how the app works. “A woman measures her temperature in the morning, enters that data into the app and then the app returns a red or green day. On red days, you should use protection or abstain from vaginal intercourse, as you are fertile during these days. On green days, you do not need to use protection as you are not fertile.”
Berglund asserts that the app puts the knowledge into the user’s hands, something which she believes is especially vital during the pandemic. “Knowing how your body works is really important right now,” she says. “Look into which methods are approved birth control, what their effectiveness rates are, their pros and cons, and how accessible they are. Having all the information at hand is essential.” It’s important though that you’re using the app as directed to best protect yourself.
For women who are determined to stick to their regular form of contraception in the face of coronavirus, Dr Anne Lashford, vice president of the Faculty of Sexual and Reproductive Healthcare (FSRH), tells Dazed that they should contact their GP or local reproductive healthcare clinic. For those looking to access the combined or mini pill, “they will be offered a phone or video consultation”, and will then either be posted a prescription, or be able to collect one from their local pharmacy.
When it comes to the coil and implant, Lashford explains that many are “effective for contraception for a year or longer than is usually recommended”, and asserts that “they don’t cause health problems if used for longer, so women can postpone replacement for the time being”. Exceptions to this rule include the five-year copper intrauterine contraceptive (IUD) and the low-progesterone intrauterine systems (IUS), Kyleena and Jaydess.
“(Our) overstretched and underfunded sexual and reproductive healthcare services were not sustainably supported to provide care to women and girls either before or during a pandemic” – Dr Anne Lashford, FSRH
“Now that some of the lockdown requirements have changed, long-acting, reversible contraceptives such as IUDs, IUS, and implants – the most effective methods – should be prioritised where possible,” says Lashford. “However, because of the risk of COVID-19 infection, it might still be the case that doctors and nurses will not be able to fit or change an IUD or IUS. In this scenario, women will be offered temporary oral contraception, and arrangements will be made for the woman’s chosen method to be fitted when the situation allows.”
The inaccessibility of vital sexual health services during this time has shone a light on the hoops women have to jump through to access contraception and abortions in regular life. “Lockdown has highlighted huge issues in contraceptive services,” Milanova declares. “Women shouldn’t need to take time out of their day to get repeat prescriptions, or queue endlessly in pharmacies, or panic because their pill pack is running out and they don’t know how to refill their prescription.”
“Even before lockdown,” Milanova continues, “on average, women had to wait two weeks for a contraceptive appointment, and some even reported a two month wait time when it came to long-acting reversible contraceptive (LARC) methods.”
Our new leaflet for women is designed to be used and distributed by healthcare professionals to support women to understand their contraceptive options during the #covid19 pandemic. Download it here: https://t.co/7PDSEwEnM9#womenshealth_covid19@RCObsGyn@rcgppic.twitter.com/mn6QNR5vvp— The FSRH (@FSRH_UK) April 27, 2020
“The pandemic has highlighted that contraceptive services need sustainable investment,” Lashford tells Dazed. “Funding and commissioning challenges have led to an overstretched and underfunded sexual and reproductive healthcare service that was not sustainably supported to provide care to women and girls either before or during a pandemic. The coronavirus will put unprecedented financial pressure on public service budgets for years to come. In light of this future strain, contraceptive services in primary and community care are more important than ever.”
A recent study revealed significant gaps in women’s sex education knowledge and lack of accessibility to learning tools – in Northern Ireland, just 54 per cent of women surveyed said they were taught sex ed in school. Other elements of the study found worrying myths and misinformation around sex, the menstrual cycle, and pregnancy. In September 2020, a new law will be implemented in England which makes it compulsory to teach relationships and sex education in schools, with the hope this will become a UK-wide obligation.
With the world set to emerge from the pandemic wildly different than it was before, experts are hopeful that accessibility to contraception will improve, with lessons learned during this time taken into the future. “I hope that positive changes improving access to contraception will stay,” concludes Lashford. “For instance, the availability of different modalities of consultation – face-to-face, remote, and online – is vital to provide comprehensive care for all women and girls, and to deal with the increased demand for sexual and reproductive healthcare after services normalise.”