COVID-19 disrupted sexual health and contraceptive services in England, with services adapting through remote delivery innovations that were retained post-pandemic, and 'readiness to adapt was aided by the pre-pandemic direction-of-travel towards greater use of digital and telemedicine services.'
Key Findings
Results
Sexual health and contraceptive services continued to operate throughout the COVID-19 pandemic in England, with in-person provision remaining available almost continuously for urgent and vulnerable cases.
Staff described maintaining in-person access for urgent or vulnerable cases despite broader disruptions.
SARA (Service Availability and Readiness Assessment) data confirmed continued service availability across both time points.
The study was conducted at a sexual health and contraceptive clinical service in the Southeast of England.
Data were collected in two phases approximately 9 months apart (November 2021 and July 2022).
Results
COVID-19 prevention measures and staff capacity issues impacted patient choice regarding how services could be accessed and which contraceptive methods were available.
Staff capacity was reduced due to staff redeployment and staff sickness.
Patient choice regarding service access modality and available contraception methods was restricted.
Patients experienced delays in accessing healthcare.
These impacts were identified through in-depth interviews with staff (n=4) and clients (n=20).
Results
Postal home self-sampling for STIs and HIV was expanded during the pandemic as a service adaptation to reduce clinic visits.
Home self-sampling expansion was one of the key innovations introduced to reduce in-person clinic attendance.
This adaptation was identified through qualitative interview data.
The expansion was part of broader efforts to maintain service delivery while minimizing COVID-19 transmission risk.
SARA data corroborated the continued availability of STI/HIV testing services.
Results
Telephone contraceptive counselling was introduced during the pandemic and was retained due to its popularity with clients.
Telephone counselling was a new service modality introduced to reduce the need for clinic visits.
Its retention post-disruption was attributed to client popularity.
This finding emerged from qualitative interviews with both staff and clients.
The retention of this innovation reflects a broader shift toward more remote delivery of services compared to pre-pandemic.
Results
By Time 2 (July 2022), sexual health and contraceptive services were running close to normal.
Time 2 data were collected approximately 9 months after Time 1 (November 2021).
Recovery to near-normal operations was confirmed by both SARA quantitative data and qualitative interview accounts.
The longitudinal design allowed tracking of service recovery over the approximately 9-month interval.
Despite near-normal operations, more service elements were being delivered remotely compared to pre-pandemic.
Discussion
Pre-pandemic trends toward digital and telemedicine services aided readiness to adapt sexual health services during the COVID-19 pandemic.
Staff and service-level data indicated that prior familiarity with digital service delivery facilitated rapid adaptation.
The authors described this as a 'pre-pandemic direction-of-travel towards greater use of digital and telemedicine services.'
This contextual factor was identified as a facilitator in both qualitative interviews and the broader service assessment.
The finding has implications for future pandemic preparedness in sexual and reproductive health services.
Methods
The study used a longitudinal mixed-methods design combining in-depth qualitative interviews and a WHO-validated quantitative Service Availability and Readiness Assessment (SARA).
In-depth interviews were conducted with n=4 staff and n=20 clients at a sexual health and contraceptive clinical service in Southeast England.
Data were collected at two time points approximately 9 months apart: November 2021 (Time 1) and July 2022 (Time 2).
The SARA tool was based on World Health Organization validated instruments.
The study was part of a multi-country project examining COVID-19 impacts on contraceptive and sexual health services.
Conclusions
The authors concluded that innovations introduced during the pandemic require robust evaluation to ensure optimisation for public health benefit in both pandemic and post-pandemic contexts.
Remote service innovations such as telephone counselling and postal self-sampling were specifically identified as requiring evaluation.
The call for evaluation applies to both ongoing pandemic conditions and the recovery phase.
This conclusion was drawn from the overall mixed-methods findings across both time points.
The authors framed this as necessary to determine whether innovations represent genuine improvements in public health service delivery.
What This Means
This research suggests that sexual health and contraceptive services in England were significantly disrupted by the COVID-19 pandemic, but managed to keep operating throughout — particularly for people with urgent needs or who were in vulnerable situations. The disruptions were mainly caused by staff being redeployed to other parts of the health system, staff illness, and infection control requirements, which limited patients' choices about how to access care and which contraceptive methods were available, and led to delays. The study tracked one clinical service in Southeast England over two time points roughly nine months apart (late 2021 to mid-2022), using both interviews with staff and clients and a standardized assessment tool developed by the World Health Organization.
To cope with these pressures, the service introduced new ways of delivering care, including postal home test kits for sexually transmitted infections and HIV, and telephone-based contraceptive counselling. These were designed to reduce unnecessary in-person visits while keeping care accessible. By the second data collection point in July 2022, services had largely returned to normal, though with more remote elements than before the pandemic. Notably, telephone counselling was kept in place after restrictions eased because clients liked it — suggesting that some pandemic-era changes may represent genuine improvements rather than just temporary workarounds.
This research suggests that having already been moving toward more digital and remote healthcare before the pandemic gave this service a head start in adapting quickly. The findings highlight how sexual and reproductive health services can be resilient during a public health crisis, but also point out that not all changes introduced under pressure will necessarily be beneficial for everyone. The authors emphasize that new service models introduced during COVID-19 need careful evaluation to make sure they truly benefit public health, both for future emergencies and in everyday healthcare settings.
Sawyer A, Aicken C, Huber J, Vera J, Williams D, Ali M, et al.. (2026). Contraceptive and sexual health services during the COVID-19 pandemic and recovery: a mixed-methods study in England.. Reproductive health. https://doi.org/10.1186/s12978-025-02184-x