The Impact of the COVID-19 Pandemic on Sexual and Reproductive Health Outcomes Among Adolescent Females in Ontario, Canada

Background: COVID-19 has been recognized as a significant threat to adolescents’ sexual and reproductive health and rights (ASRHR). This study aimed to assess the effect of the COVID-19 pandemic on population-based pregnancy rates and sexual health-related care utilization patterns among adolescent females in Ontario, Canada, and to evaluate potential inequities in the impact of the pandemic on ASRHR outcomes by key sociodemographic characteristics.Methods: This was a population-based, repeated cross-sectional study of all female adolescents (12 to 19 years) residing in Ontario, Canada during the pre- and post-COVID-19 pandemic onset periods. The primary outcome was pregnancy; secondary outcomes were contraceptive management visits, prescription contraception uptake, and sexually-transmitted infection management visits. Poisson models with generalized estimating equations for clustered count data were used to model the trend of pre-COVID monthly outcome rates. Absolute rate differences between observed and expected outcome rates for each pandemic month were then calculated. Differential effects of the pandemic on outcomes were assessed according to urbanicity, neighbourhood income quintile, immigration status, and geographic region of residence.Findings: During the COVID-19 pandemic, lower-than-expected population-level rates of adolescent pregnancy (rate ratio 0.88; 95% CI: 0.87-0.90) and health care encounters for contraceptive (rate ratio 0.88; 95% CI: 0.84-0.93) and STI management (rate ratio 0.57; 95% CI: 0.55-0.58) were observed. At the end of the study period, rates of sexual health-related health care visits had not returned to prepandemic rates. Rates of pregnancy for adolescents with sociodemographic characteristics with higher pre-pandemic pregnancy rates showed less of a decline.Interpretation: The COVID-19 pandemic resulted in decreased population-level rates of adolescent pregnancy and sexual health related healthcare utilization. However, pregnancy rates were less significantly reduced among more structurally vulnerable adolescents, suggesting a further exacerbation of pre-existing inequities.Funding Information: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This study also received funding from the Edwin S. H. Leong Centre for Health Children at the University of Toronto.Declaration of Interests: The authors have no conflicts of interest to disclose. Ethics Approval Statement: This study received ethical approval from the Research Ethics Board of the Hospital for Sick Children (REB file #1000076956).