The COVID-19 pandemic negatively impacted SRH service provision and utilization in China, with family planning, contraception, and safe abortion services completely or partially disrupted, attributed to both supply-side and demand-side factors, with telehealth, task shifting, and triaging identified as key resilience strategies.
Key Findings
Results
Family planning, contraception, and safe abortion services were completely or partially disrupted by the COVID-19 pandemic in China, with greater effects at baseline.
A cross-sectional panel survey design with two data collection points was used to capture changes in SRH service availability.
Disruption was attributed to both supply-side and demand-side factors.
Effects were greater at the baseline data collection point compared to the follow-up point.
The study covered health facilities in Wuhan, Beijing, and Changsha.
Results
Health facilities responded to pandemic-related disruptions of essential health services most commonly through telemedicine, task shifting/role delegation, and triaging to prioritize resource allocation.
These three strategies were the most commonly identified facility-level responses to the pandemic's adverse impact.
Facilities used triaging to prioritize resource allocation during the pandemic.
Task shifting and role delegation were used as adaptive strategies.
Most participants expressed support for the further expansion of telehealth strategies to improve access to SRH resources.
Results
Three major themes emerged from qualitative data: barriers to SRH service delivery, barriers to access and utilization of SRH services, and resilient innovations in response to COVID-19.
109 in-depth interviews were conducted with healthcare providers, clients, and their partners.
Interviews were conducted across seven purposively selected health facilities in Wuhan, Beijing, and Changsha.
Data were collected between November 2020 and December 2022.
An adapted grounded theory and thematic analysis approach was applied to analyze the interview data.
Results
Women faced numerous barriers to accessing SRH services during the pandemic, including lockdowns and mobility restrictions, lack of access to information, and limited access to SRH products.
Lockdowns and mobility restrictions were identified as demand-side barriers to SRH service access.
Lack of access to information was a distinct barrier experienced by women seeking SRH services.
Limited access to SRH products was reported as an additional challenge during the pandemic.
These barriers were identified through qualitative interviews with women seeking SRH services and their partners.
Results
Service providers experienced barriers in providing SRH services to women during the pandemic, including gender-specific challenges for female providers.
Healthcare providers were among the 109 in-depth interview participants.
Gender-specific needs of female providers were identified as a dimension of supply-side barriers.
Findings underscore the importance of addressing gender-specific needs of female providers to sustain essential SRH services during future crises.
Provider-client communication was identified as an area needing tailoring during emergencies.
Discussion
Improved communication from healthcare providers, support for female health workers, expanded use of telehealth, and strengthened community engagement were identified as key strategies to maintain SRH service access during emergencies.
Most participants expressed support for further expansion of telehealth strategies.
Community involvement was highlighted as helping people stay informed and connected to care.
These strategies were identified from qualitative interviews conducted across three Chinese cities.
Findings are intended to guide policy development and enhance service provision in alignment with societal needs.
Methods
The study used a mixed-methods design combining a cross-sectional panel survey and 109 in-depth interviews across seven purposively selected health facilities in three Chinese cities.
Seven health facilities were purposively selected in Wuhan, Beijing, and Changsha.
Qualitative data collection occurred between November 2020 and December 2022.
Participants included healthcare providers, clients, and their partners.
The study was part of a larger cross-country study on the impact of the COVID-19 pandemic on health systems.
A questionnaire was developed to assess the readiness and resilience of China's health system.
What This Means
This research suggests that the COVID-19 pandemic significantly disrupted access to sexual and reproductive health (SRH) services in China, particularly family planning, contraception, and safe abortion care. Researchers surveyed health facilities and conducted over 100 in-depth interviews with patients, their partners, and healthcare workers across three Chinese cities — Wuhan, Beijing, and Changsha — between 2020 and 2022. The disruptions were caused by problems on both the provider side (such as redeployed staff and closed clinics) and the patient side (such as lockdowns, lack of information, and inability to obtain contraceptive products).
This research suggests that health facilities adapted to these disruptions primarily through telemedicine, reassigning staff roles, and prioritizing the most urgent cases. Women and healthcare providers both experienced significant challenges, with female healthcare workers facing additional gender-specific burdens. Participants broadly supported expanding digital and telehealth services as a way to keep SRH care accessible during emergencies, and community engagement was seen as important for keeping people informed and connected to services.
This research suggests that future public health emergency planning should prioritize maintaining SRH services by investing in telehealth infrastructure, improving how providers communicate with patients, addressing the specific needs of female health workers, and building stronger community networks. The findings are intended to help policymakers and health system managers create more resilient and responsive health services that can better withstand crises without leaving women's reproductive health needs unmet.
Zhang H, Wang H, Xie X, Xiao A, Ali M, Kim C, et al.. (2025). Evaluating health system barriers to sexual and reproductive health service delivery during the COVID-19 pandemic in China: a mixed-methods study.. Reproductive health. https://doi.org/10.1186/s12978-025-02093-z