COVID-19 and Sexual and Reproductive Health Services in King County, Washington

Background: Lack of continuous access to high-quality sexual and reproductive health (SRH) services endangers individual- and population-level health. Understanding how the COVID-19 pandemic impacted SRH services will inform public health practices that guarantee access to SRH resources during times of future pandemics. The objective of this study was to investigate SRH prior to and during COVID-19 in Seattle and King County.
Methods: This study was conducted using clinical records from the University of Washington Healthcare System and data from U.S. Census Bureau American Community Survey and Public Health Seattle and King County (Participants=52,974). Prevalence of the number of SRH appointments accessed, as well as prevalence of the number of distinct SRH services provided, among King County residents aged 15-49 were determined using information from clinical records and Census data. Prevalence ratios and corresponding 95% confidence intervals (CI) were used to compare prevalence pre- and post-pandemic onset (March 24, 2019-November 30, 2019 and March 24, 2020-November 30, 2020, respectively). In addition, prevalence ratios for groups stratified by sex, age groups, and periods of the pandemic (Early Pandemic, Post Stay-at-Home, and Third Wave) were estimated.
Results: Among the total study participants, 84% were female, 57% were White, and 76% used private insurance. There was a 13% reduction (95% CI: 12%, 15%) in the number of SRH service appointments accessed in 2020 compared to 2019, and a similar 14% reduction (95% CI: 12%, 15%) in the number of distinct services. Impact varied by age and sex, with a decrease of 40% (95% CI: 35%, 45%) among 15–19-year-olds compared to a 7% decrease (95% CI: 3%, 10%) among 30–34-year-olds. An 11% (95% CI: 10%, 13%) reduction in appointments was observed among females, and a 23% (95% CI: 20%, 26%) reduction among males was observed. Difference by period of the pandemic was also observed, with a decrease in appointments of 53% (95% CI: 54%, 51%) in the Early Pandemic period compared to an increase of 5% (95% CI: 1%, 8%) in the Third Wave period. The pandemic affected types of SRH services variably, with a decrease of 26% (95% CI: 17%, 34%) in HPV vaccination services, compared to an increase of 15% (95% CI: 7%, 24%) in HIV screening services.
Conclusion: SRH service provision was significantly affected by the onset of the pandemic, particularly among 15–19-year-olds, males, and during the Early Pandemic.