Title: Expansion of Remote Contraceptive Services in England: Implications for Inequalities in Women’s Reproductive Health.
Funder: The Academy of Medical Sciences

Abstract: This research aims to investigate preferences for contraceptive service delivery among women in England, and experiences of/barriers to remote contraceptive services. This research responds to the rapid expansion of remote (video/online/telephone) contraceptive provision during the COVID-19 pandemic. Following this shift, women’s preferences for contraceptive service delivery and implications for reproductive health inequalities remain unclear. An explanatory sequential mixed methods design, applying an intersectionality framework, will facilitate examination of factors shaping preferences for contraceptive service delivery sensitive to multiple axes of inequality. Quantitative data will be drawn from the digital Women’s Reproductive Health Survey, led by Public Health England and London School of Hygiene and Tropical Medicine, recruiting ~7000 women aged 16-55 in England in June 2021. The primary outcome, preferences for contraceptive service delivery, will be derived from response to the question: “How would you prefer to access contraceptive services to arrange the supply or fitting of a contraceptive method?”. Secondary outcomes will measure uptake of, and satisfaction with, remote contraceptive services. Latent class analysis will identify combinations of characteristics reported by women preferring non-remote contraceptive services. As online survey delivery may result in differential exclusion of those with reduced acceptability/uptake of remote services, latent class reliability will be tested among a smaller sample recruited offline. Subsequently, thematic analysis of qualitative data from narrative interviews with a purposive sample of 15-20 women (selected to reflect quantitative findings) will explore experiences of/barriers to remote contraceptive services. Findings will inform recommendations to promote equitable, person-centred contraceptive services in a digitally enabled environment.

Lay abstract: Contraception is important as it enables women to control when (and if) to have children. During the COVID-19 pandemic, more contraceptive services have been offered remotely rather than face-to-face. For example, appointments to access contraception may be conducted over video or telephone, or women may access online contraceptive services (where an online questionnaire is completed before being reviewed by a doctor). These remote contraceptive services are likely to continue to be offered beyond the Covid-19 pandemic. Access to contraception services via video, internet or telephone may be preferred by some women, reducing the time and travel to attend face-to-face appointments. However, they may not be welcomed by all women, particularly those who do not have access to the necessary technology, for whom English is not the first language, or who do not feel safe/comfortable having private conversations about contraception outside healthcare settings. Since remote contraceptive services have become more widespread, women’s preferences for how they want to access contraceptive services (remote/face-to-face/combination) have not been established. This study will aim to investigate women’s preferred way of accessing contraceptive services and explore women’s experiences of using remote contraceptive services. It will also aim to identify groups of women who may face barriers to accessing remote contraceptive services. It will seek to obtain the view of a broad range of women through a survey and interviews to draw out differences in experience and opinion. Findings will be used to develop recommendations to ensure contraceptive services are accessible for all women in England.

Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH