Sexual and Reproductive Health in Britain During the First Year of the COVID-19 Pandemic: National Population Survey (Natsal-COVID Study)

Background: Restrictions to prevent SARS-CoV-2 transmission profoundly affected sexual and reproductive health (SRH) and services, but the consequences remain unclear. We examined SRH outcomes in Britain during the first year of the pandemic. Methods: 6,658 participants (18-59 years) completed a web-panel survey in March-April 2021. We used quota-based sampling and weighting to achieve a quasi-representative population sample. We estimated SRH outcomes in the year from the first UK lockdown in March 2020, by age and gender, and by same-sex behaviour. We triangulated our data descriptively with the most recent probability sample population data (from Natsal-3; collected 2010-12) and surveillance data (2010-2020) to provide context. Findings: Among 5,733 participants reporting sexual experience ever, over two-thirds reported one or more sexual partner(s) in the year following lockdown (women 71·8%; men 69·9%); median of 2 occasions of sex per four weeks. Compared with Natsal-3, we found less sexual risk behaviour (lower reporting of multiple partners, new partners, and new condomless partners). Reduced risk included among participants reporting same-sex behaviour. We found similar reporting of HIV testing and STI-related service use, but less reporting of chlamydia testing; fewer reported pregnancies, of which a smaller proportion were scored as unplanned; less reported abortion; and increased sexual dissatisfaction and distress. Compared with trends in surveillance data over the previous decade, we found lower than expected use of STI related services, lower levels of chlamydia testing and fewer conceptions and abortions. Interpretation: We observed major shifts in sexual behaviour, SRH, and service uptake in the year following the first COVID-19 lockdown in Britain. These data from multiple sources suggest that shifts were at least partly due to the pandemic and indicate the scale of impact. Restrictions on social mixing and disruption to SRH services are plausible explanations. Funding Information: Natsal (Wellcome/ESRC/NIHR), MRC/CSO, and UCL Coronavirus Response Fund. Declaration of Interests: The other authors declare that they have no conflicts of interest.Ethics Approval Statement: We obtained ethics approval from University of Glasgow MVLS College Ethics Committee (reference 20019174) and London School of Hygiene and Tropical Medicine Research Ethics committee (reference 22565).