The hidden toll of the covid contraception crisis

Unplanned pregnancies. Months of crippling pain. And women left with little choice but to have a home abortion: As sexual health services collapse, the hidden toll of the covid contraception crisis

  • Women have struggled to access long-acting contraceptives during pandemic
  • One in three UK pharmacies are unable to provide emergency contraception 
  • Ruth Shoult, 39, from Milton Keynes, struggled to get a contraceptive implant
  • Katie Barber, 32, had a DIY abortion because of an unplanned pregnancy

Overwhelmed and exhausted from putting on a brave face, it took several hours for the reality of what was happening to Katie Barber to sink in. When it did, she sat in her bathroom and cried.

The 32-year-old never imagined she’d be terminating a pregnancy at this settled stage in her life, let alone undertaking the procedure herself, unsupervised, at home. Then again, she could scarcely have predicted that a pandemic would throw her contraception plans into disarray, either. In April this year, the mother-of-two had gone to her GP to request the contraceptive implant — a matchstick-sized rod (placed under the skin in the upper arm) that releases the hormone progestogen to prevent pregnancy.

But because of lockdown, the service couldn’t be provided. So she and her fiance, Mark, used condoms. Less effective than the implant, they led to an unplanned pregnancy.

British women revealed the struggles they’ve experienced when trying to get contraception throughout the pandemic (file image) 

With two children under three already, another baby wasn’t an option. So a fortnight ago, Katie had a DIY abortion, the necessary pills having been delivered to her by post — a newly introduced way to terminate a pregnancy, made legal this March to prevent women having to go to hospital and increasing the spread of the virus.

‘The termination is something that will never leave me,’ says Katie, from Liverpool. ‘Although I’m relieved it is over, a part of me will always feel sad.’

Although she has berated herself for being irresponsible, she also says that had she been able to access the contraception she wanted, ‘the situation would never have happened. It is disappointing.’

Katie is far from alone in struggling to access contraception this year.

In September, an inquiry by the All Party Parliamentary Group on Sexual and Reproductive Health found the impact of coronavirus had compounded years of cuts to contraceptive services, making a ‘difficult situation even worse’.

Closures and reduced opening hours at GP clinics and sexual health centres mean women are being ‘bounced from service to service’. Accessing long-acting reversible contraceptives (LARCs), such as implants and coils, has become particularly problematic.

Already underfunded (meaning GPs are often not incentivised to offer the services), LARCs have to be fitted by a professional. But doctors have tried to limit contact during lockdown, leaving women reliant on less effective methods, such as the Pill and condoms.

Katie Barber, 32, from Liverpool, who has two sons aged three and one, had a DIY abortion at home a fortnight ago (file image)

Many clinics are currently closed. Even with those that are open, the NHS is encouraging women to call rather than visit, and only attend in person if they’ve been told to.

A recent survey by sexual health charity MSI Reproductive Choices found 36 per cent of women were unsure how to access contraception during the pandemic, while 35 per cent who had tried to access a contraceptive service thought the provision had got worse.

‘Women’s need for contraception does not stop during an emergency, but, once again, women and girls have been disgracefully neglected,’ Julia Hogan, lead contraceptive nurse consultant for MSI Reproductive Choices, has said. She added that ‘all too often’, women are becoming pregnant as a result.

Katie, a technology developer for a bank, and her retail manager fiance Mark had two sons, now aged three and one, in quick succession. Her youngest was four months old when the first lockdown started and, having relied on condoms after he was born, she wanted to explore a permanent option.

So she called her GP and requested the implant (she’d had one fitted a decade earlier), which is 99 per cent effective for three years.

‘The receptionist told me they couldn’t offer the service because they wanted to reduce the number of people in the surgery,’ says Katie. ‘She offered me a phone consultation to go on the Pill instead.’

For Katie, this wasn’t an option. ‘I’d been on it as a teenager and it made me tearful and snappy,’ she says — an emotional upheaval that would be difficult enough at the best of times, let alone in a pandemic. ‘I was frustrated.’ Although, as Katie puts it, ‘condoms killed the mood’ and, at 98 per cent effective, are less reliable than the implant, she and Mark continued using them. She admits, however, that ‘there were a couple of times when we didn’t use one, because I thought I knew where I was in my cycle, and that I couldn’t get pregnant’.

Whether a condom split or she got her timing wrong, she doesn’t know. But in September, her period was two weeks late.

Ruth Shoult, 39, (pictured) from Milton Keynes, was told contraceptive implants weren’t being offered during lockdown 

‘I felt nauseous and exhausted,’ says Katie. ‘I put off doing the test for days, as I knew we didn’t have the mental capacity for another baby and was putting off the inevitable.’

Even if she had realised sooner, taking the morning-after pill may not have been straightforward. ‘Our research has found that one in three pharmacies is unable to provide emergency contraception in a confidential and Covid‑secure way,’ says Katherine O’Brien, of the charity British Pregnancy Advisory Service (BPAS).

Licensing restrictions mean women must have a consultation before they can be prescribed emergency contraception. But, as O’Brien explains, social-distancing rules mean this consultation, ‘which may be highly personal and include questions about their sex life’, often has to happen on a public shop floor. ‘This may put women off emergency contraception, leading to unplanned pregnancies.’

When her pregnancy test proved positive, Katie called BPAS. A phone consultation with a nurse determined she was seven weeks pregnant. ‘She said I could go into hospital for a scan, or they could send everything I needed,’ says Katie. ‘I agreed to do it at home.’

Before the pandemic, abortion treatment was legal only in NHS hospitals and on premises licensed for the purposes. But in March, Health Secretary Matt Hancock granted temporary permission for abortion providers to use telemedicine — healthcare via phone and video technologies — to allow women up to nine weeks and six days’ gestation to receive abortion medication by post, to reduce the risk of getting Covid.

The resultant BPAS service, Pills by Post, launched in April. In the first three months the charity provided 16,910 such treatments: 80 per cent of all its medical abortions.

The medication comprises two pills containing mifepristone, which ends pregnancy by blocking the hormone progesterone; and a second medicine, misoprostol, that is taken a day or two later and causes the womb to contract. ‘It was discreetly posted,’ says Katie. ‘But I was nervous, worried I wasn’t in a medical environment and felt guilty. As I was personally terminating the pregnancy, I couldn’t close my eyes and take my head somewhere else.’

Ruth (pictured) was told by her GP to try for an appointment to have an implant fitted at a sexual health clinic

Two hours after taking the second round of medication, Katie started bleeding, which continued heavily for 24 hours. ‘I lay on the sofa as Mark looked after the children,’ she says. ‘It was horrible wondering if every blood clot was my baby.’

She and Mark, whose names have been changed for this article, have told no one about the termination. ‘We worry we’d be judged,’ says Katie, who has started taking a progestogen-only Pill that she hopes will have less impact on her mood.

Even medics seem unsure of what contraceptive services they will be able to provide during the pandemic. And the potential arrival of a vaccine next month may actually make the situation worse, with GP surgeries prioritising its distribution.

In anticipation of delays, Ruth Shoult called her GP to book an appointment for a new implant to be fitted in April, three months before her current one was due to expire. ‘The receptionist told me they were still doing implants so I should call back the month before it was due, to book in.’

Yet when Ruth, 39, a supply teacher from Milton Keynes and married for six years to Daniel, 30, a road markings supervisor, called back in June, she was told the service was no longer available. ‘The receptionist said it was due to lockdown,’ says Ruth, who has three sons aged 18, 12 and five.

‘I was told a nurse would call me back to discuss my options. But no call came. I didn’t want any more children, and my husband likes to have sex. I was stressed and annoyed. The service should have been available throughout.’

Ruth (pictured) drove 45-minutes to have her implant fitted by a nurse who had seen 23 patients in one day

When she called back a week before the deadline, she was told she was still on a ‘waiting list’ of patients to call. ‘When I stressed it was urgent, they suggested I try to get an appointment at a sexual health clinic.’

The receptionist recommended iCaSH — integrated Contraception and Sexual Health services — run by Cambridgeshire Community Services NHS Trust.

Ruth was initially told by a receptionist the implant wasn’t being offered, but later a nurse agreed to book her in at a clinic in Bedford. ‘It is a 45-minute drive from my home, but was the only clinic that had space,’ she says.

In July, the day after her implant had been due to be replaced, she finally had it fitted. ‘My nurse told me she was the only one in the area doing implants, that I was her 23rd patient of the day and that they’d had to stop bookings for the foreseeable future, as they couldn’t fit any more in,’ says Ruth.

Similarly difficult to get hold of is the contraceptive coil, considered more than 99 per cent effective. Available either as an IUD (intrauterine device) containing copper, or an IUS (intrauterine system) that releases the hormone progestogen, they are fitted into the uterus and prevent pregnancy for five years.

Due to have her hormonal coil refitted last March, Sarah Maddock, 43, a lawyer from Bristol, called her GP surgery in February only to be told the service was no longer offered.

‘They gave me the name of a sexual health clinic. But it wouldn’t book me in more than two weeks in advance — then the pandemic happened and they closed.’

Sarah Maddock, 43, (pictured) from Bristol, who has two sons aged 11 and nine, was told the service to have her hormonal coil refitted isn’t available

Sarah, who has two sons aged 11 and nine, and is in a two-year relationship with Gabriel, 46, who owns a clothing company, called her GP back and was put on the contraceptive Pill ‘until the clinic reopened’. She says: ‘It wasn’t what I wanted at all. I’m entering the perimenopausal phase and I’m sure it can’t be good for me to be taking additional synthetic hormones.’ Nine months on, and despite months out of lockdown, the sexual health clinic yesterday told Sarah it would need a referral from her GP before staff could refit her coil, and even then it couldn’t guarantee that it could do the procedure.

As things stand, Sarah is still on the Pill and her existing coil has yet to be removed.

‘My GP says it’s fine, but I have a foreign body inside me that, according to guidance, should have been removed getting on for a year ago,’ says Sarah.

‘I don’t understand why these services are adversely affected by the pandemic. If I could get my nails done and hair cut with people breathing in my face, why couldn’t I go to a clinic with a mask on to get my coil removed?’

For Laura Lightbody, being prescribed the contraceptive Pill without an appointment wasn’t an option. A mother of five children aged eight, six, five, three and one, Laura was looking for a contraceptive solution now her family was complete.

But she had been diagnosed with postpartum thyroiditis — a condition in new mums in which the immune system attacks the thyroid — after her third child was born in 2015. She was told the hormones in the pill could harm her thyroid.

Sarah (pictured) said if hair and nail salons were able to operate, clinics should be offering contraception services 

‘I needed a face-to-face consultation to discuss my options,’ says Laura, 38, from Telford, Shropshire, married to Tyrone, 36, a hospital consultant. But her GP’s receptionist said they weren’t offering consultations because of the pandemic, and that she should either go to a sexual health clinic or buy condoms. ‘I didn’t want to go to a clinic where they might not understand my thyroid condition,’ she says.

So she and Tyrone — who, as a doctor, is not allowed to prescribe medication to relatives — endured periods of ‘enforced chastity’ interspersed with occasional sex with condoms. ‘After eight years of not using anything, we didn’t enjoy condoms,’ says Laura.

In June, she called her GP back. After a 45-minute wait on the phone, she was finally offered an appointment with a nurse — only for it to be cancelled by text, without explanation, the day before. The following month, a second appointment was cancelled, also by text.

Aside from not enjoying condoms, Laura says: ‘Condoms put men in control. I feel the right to not get pregnant has been taken away from me. Fortunately, I’m in a loving marriage, but what if I were in a controlling relationship where an extra pregnancy put me at risk?’

It took eight months until she was finally offered an appointment with a nurse last week, where she was prescribed the mini Pill, which contains only progestogen as opposed to the oestrogen and progesterone in the regular Pill, which the nurse said would be safe for Laura’s thyroid.

Jade Fox, 24, (pictured) who had a copper coil fitted as a form of emergency contraception, revealed she was unable to get a follow-up appointment to have it removed

Youth worker Jade Fox, 24, is also aware that delays to contraception services can compound health issues. Jade had the copper coil fitted at a sexual health clinic last July as a form of emergency contraception. She was in a long-term relationship but a condom split, and the copper coil can be used up to five days after unprotected sex.

She was told she could have it removed after five weeks, when the danger of pregnancy had passed. But she says she was unable to get a follow-up appointment at the clinic. ‘When I visited, they said I had to call; when I called, they said I could only have an on-the-day appointment. I wasted hours on the phone before giving up,’ she says.

Severe menstrual pain and bleeding can be a side-effect of the copper coil for some women, and Jade found her already painful periods growing longer — lasting eight days instead of four — and heavier. ‘I had to take ibuprofen constantly,’ says Jade. ‘My job, working with children, was hard when I was grimacing with pain.’

In April, her GP surgery offered an appointment with a male doctor to remove her copper coil and refit a hormonal coil, which can reduce period pains. But Jade says: ‘I’d had a bad experience with a male gynaecologist before, so asked to be put on the waiting list for a female doctor.’

In May, having not heard anything, she called back to say she was still in pain. This time, she had a phone consultation with a female GP, who said she was referring Jade to her local hospital’s gynaecology ward for further investigation. Since then, however, she hasn’t had so much as a letter confirming her appointment.

Seven months on, she is still waiting. ‘It’s upsetting to have a copper coil causing pain when a hormonal coil could alleviate the symptoms,’ she says. ‘I feel I’m not being listened to. It’s hard enough to get contraception at the best of times. The pandemic has made it even worse.’

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