OPINION ARTICLE

ISSN 2358-291X (Online)

Access to contraception during the Covid-19

pandemic: barriers and perspectives
Acesso à contracepção durante a pandemia de Covid-19: barreiras
e perspectivas
Ana Gabriela Álvares Travassos1 , Talita Rocha de Aquino1 , Carla Santos Almeida1 ,
Milena Bastos Brito2 
Curso de Medicina, Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB) - Salvador (BA), Brasil.
1

Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP) - Salvador (BA), Brasil.
2

How to cite: Travassos AGA, Aquino TR, Almeida CS, Brito MB. Access to contraception during the Covid-19 pandemic: bar-
riers and perspectives. Cad Saúde Colet, 2022;30(2)158-162. https://doi.org/10.1590/1414-462X202230020403

Abstract
Background: The SARS-CoV-2 pandemic, which started in December 2019, was declared by the World
Health Organization (WHO) as an international public health emergency in January 2020, with an impact
on access to sexual and reproductive health services for women. Objective: To discuss contraception in
the pandemic context, based on current public policies and the world and Brazilian scenario. Method: This
is an opinion article, which describes the barriers and possible solutions for access to qualified sexual
and reproductive health care for women. Results: Relevant topics were explored, such as: the change
in the logistics of services, the reduction in the number of consultations, the difficulty in importing
contraceptives, the lack of trained professionals, and the bureaucratization of access to contraceptives
methods. The use of telemedicine and the strengthening of Primary Health Care are considered strategies
to guarantee access and change the reality of women. Conclusion: In this context, it is necessary to
maintain the actions of sexual and reproductive planning services to prevent injuries from unplanned
pregnancies and increase maternal morbidity and mortality.
Keywords: contraception; primary health care; Covid-19; telemedicine.

Resumo
Introdução: A pandemia por SARS-CoV-2, iniciada em dezembro de 2019, foi declarada pela Organização
Mundial da Saúde (OMS) como emergência de saúde pública internacional em janeiro de 2020, com
impacto sobre o acesso a serviços de saúde sexual e reprodutiva para as mulheres. Objetivo: Discutir
a contracepção no contexto pandêmico, a partir das políticas públicas vigentes e do cenário mundial e
brasileiro. Método: Trata-se de um artigo de opinião, onde se descreve as barreiras e possíveis soluções para
o acesso à assistência de saúde sexual e reprodutiva qualificada para as mulheres. Resultados: Explorou-se
temas relevantes como: mudança na logística dos serviços, redução do número de consultas, dificuldade
na importação de contraceptivos, falta de profissionais capacitados, burocratização do acesso a métodos
contraceptivos. O uso da telemedicina e o fortalecimento da Atenção Primária à Saúde são consideradas
estratégias para garantia do acesso e modificação da realidade das mulheres. Conclusão: Faz-se necessário
nesse contexto, a manutenção das ações dos serviços de planejamento sexual e reprodutivo para prevenir
agravos provenientes de gestações não planejadas e aumento na morbimortalidade materna.
Palavras-chave: contracepção; atenção primária à saúde; Covid-19; telemedicina.

Study carried out at Mestrado Profissional de Saude Coletiva, Departamento de Ciências da Vida, Universidade do Estado
da Bahia (UNEB) – Salvador (BA), Brasil. This is an Open Access article
Correspondence: Ana Gabriela Álvares Travassos. E-mail: [email protected] distributed under the terms
Financial support: none. of the Creative Commons
Conflict of interests: nothing to declare. Attribution License, which
Ethical issues: This article did not involve research with human beings, and submission to the Ethics Committee was not permits unrestricted use,
distribution, and reproduction
required.
in any medium, provided the
Received on: Aug. 11, 2020. Accepted on: Nov. 09, 2020
original work is properly cited.

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 Access to contraception during Covid-19 pandemic

INTRODUCTION
The Sars-Cov-2 pandemic, which started in China in December 2019 with cases described
in the city of Wuhan, was declared an international public health emergency in January 2020 by
the World Health Organization (WHO)1. Currently, by November 2020, there are more than
46 million cases of Covid-19 in 216 countries, with more than five million five hundred thousand
cases in Brazil, according to the most recent data2. The global scenario is unpredictable, with
a second wave of infection in some countries and a consequent reorganization of health
assistance services.
The data demonstrate differences in COVID-19 manifestations between genders3, with
men presenting more severe clinical conditions and worse outcomes4. However, when we
assess the repercussions of the pandemic in different spheres of life, the global impact on the
daily lives of women is notable. In addition to coping with increased domestic work and caring
for children, together with home office in some contexts, a significant increase in domestic
violence (in all its manifestations) has been observed, with damage to women’s biopsychosocial
well-being5.
The social distancing guidelines adopted by many countries, including Brazil, were an
efficient strategy to contain the spread of the virus6. However, they have also contributed to
aggravating health inequalities due to worsening a lack of assistance, and vulnerabilities of
women. Changes to mental health and sexual behavior during the pandemic were common,
while family conflicts and the insecurity and fear that accompanied this period worsened
domestic relationships7.
The effects of Covid-19 on pregnancies are still not entirely clear. The current literature
presents reports of vertical transmission, abortion, premature birth and fetal distress, however,
to date, no association with malformation has been identified. Pregnant and postpartum women
evolve more severe cases when compared to women outside the gestational period8. Therefore,
many women consider postponing their pregnancies. However, the greater proximity between
couples due to isolation has increased levels of unprotected sex with a growth in unplanned
pregnancies being expected9.
The health care system in Brazil is structured in levels of care according to the complexity of
the services in question, aiming to achieve universality, integrality, and equity of care. The right
to sexual and reproductive health has been discussed in Brazil since the creation of the Family
Planning Law nº 9.263/1996. Among recent material from the Ministry of Health (MS) on the
subject are materials that address international and national benchmarks. These include the
National Policy on Sexual and Reproductive Rights, which reinforces the need for actions that
strengthen these rights and highlights the essential role of Primary Health Care (PHC) as the
gateway to this line of care10,11.
Thus, the pandemic context demands the safeguarding of these principles, with the
maintenance of sexual and reproductive planning service initiatives across all assistance levels.
This involves open engagement, technical assistance and ethical respect to prevent harm from
unplanned pregnancies, unsafe abortions, or an increase in maternal morbidity and mortality9.
The Ministry of Health, in a recent technical note, stated that the right of adolescents and
women to sexual and reproductive health - including access to contraception/contraceptives
- is an essential service and should be maintained during the pandemic. However, the note
also highlighted those measures to reduce the spread of the virus (respiratory care hand
hygiene, use of personal protective equipment (PPE), physical distancing) should be observed12.
However, the note was subsequently withdrawn by presidential orientation, which weakened
and threatened the guarantee of such assistance during this critical period.

BARRIERS TO ACCESSING CONTRACEPTION SERVICES

Public and private women’s healthcare services were interrupted due to social distancing
strategies, with elective consultations canceled and a prioritizing of the workforce to care for
Covid-19 patients, which has affected the initiation and follow-up for use of contraceptive
methods13. Financial resources were directed towards purchasing materials used to combat

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the pandemic, such as respirators and personal protective equipment. Sexual and reproductive
planning services were not prioritized in health service organization, and misinformation
regarding access has left many women in different age groups without assistance9,14.
Many countries that produce supplies for hormone contraceptive methods and condoms
are Asian, with China and India having the highest concentration of related industries14,15.
The interruption of production and the reduced working hours in factories due to the pandemic,
have led to concerns about shortages of the most used contraceptive methods15. Difficulties
with importing medications or supplies, a lack of knowledge of contraceptive use in health
care services, and a lack of planning for adequate distribution of existing resources are factors
of concern in the current global context14.
Women in Brazil routinely experience obstacles when trying to access contraceptive
methods through the public health system. These include an insufficient number of trained
professionals, a lack of medication and condoms in the pharmacies of basic health units, the
need for a referral to another health unit, and changes to regulations for drug provision16,
despite government guidelines that extend the validity of prescriptions for 90 days12. In some
services, there are usually limits on women’s autonomy in choosing contraceptive methods,
restrictions on the types of methods offered, and disorganized teamwork processes, despite
established Ministry of Health protocols.
The barriers to using long-acting reversible contraceptives (LARCs) such as the copper
intrauterine device, levonorgestrel intrauterine system, and subdermal implants are even
greater. In the Brazilian public health system, only the copper intrauterine device is offered, but
availability varies between different regions. The myths and taboos associated with the LARCs
and the lack of training for LARC counseling and insertion has reduced the recommendation of
the method to women by health professionals, besides reinforcing young and adult women’s
resistance to the method. The lack of consistent protocols between municipal health secretaries
for the guarantee of the method’s availability can also lead to a disorganized work process,
impairing access to insertion17.
The significant safety and effectiveness of LARCs led the WHO to recommend extending
the life of the device to longer than initially recommended by manufacturers, during the period
of risk caused by the pandemic, demonstrating that this could be a viable option at this time18.
Accordingly, the Ministry of Health recommends maintaining the offer of IUDs in primary care
and maternity wards, especially during the immediate postpartum and post-abortion period.
The path of women through these services, until starting to use a contraceptive method
requires, in many instances, a doctor’s consultation, participation in talks or educational sessions,
laboratory and imaging tests, and a subsequent schedule to start the chosen method17,19. During
the pandemic, due to the need to reorganize the functioning of services, several stages of this
protocol could not be carried out, thereby questioning their relevance.
Moreover, some services ended up inviting women for a one-off family planning session,
without continuity. This disrupted the possibility of ongoing care for the evolution and
maintenance of the method16.

CURRENT POSSIBILITIES
The restructuring of services and health care regulations through technological
tools to prevent Coronavirus transmission presents new possibilities for contraceptive
care. Teleconsultation, via videoconference, allows anamnesis to be carried out to identify
contraindications for the use of contraceptive methods11, enables educational actions with
the presentation of possible and available contraceptive options, and opens a channel of
dialogue with the woman to clear up any doubts and assist in choosing the best contraceptive
method for her15,20.
Primary Health Care has a structuring role in this new scenario. The actions that make up
the Family Health Strategy, with the work of Community Health Agents and multi-professional
teams, bring the necessary capillarity to maintain the links of care with women in each
territory and to approach them according to their real health needs10,16. The information that

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already exists from monitoring registered families, allows an active search for women using
contraceptive methods, to schedule counseling regarding their maintenance during the
pandemic. Besides enabling an orderly search of the health care services, this logistical work
avoids increasing exposure of patients and healthcare teams to the virus.
Access to contraceptive care for women seeking to start contraception or change their
method can also be facilitated via teleconsultation. This allows for exchanging information
and encourages women’s autonomy in self healthcare. The use of accessibly worded digital
information can be encouraged for and by health teams9,20. The fear of using contraceptives
during the pandemic, due to misinformation disseminated on social media, can be clarified
during this virtual meeting, presenting reliable and reassuring data provided by WHO, health
associations (FEBRASGO, SBMFC) and the Ministry of Health19,21-23.
When analyzing the situation regarding sexual and reproductive health care during the
Covid-19 pandemic some evident challenges arise. These include reducing organizational
barriers, improving communication, strengthening primary health care initiatives as a
gateway to healthcare, updating and offering training to teams for technological tools,
and streamlining pharmaceutical logistical protocols. The establishment of intersectoral
actions involving education, social assistance and civil society actors are key aspects of this
process. All these elements can help facilitate the accessibility and effectiveness of sexual and
reproductive planning initiatives on an ongoing basis, changing the health situation and even
the socioeconomic reality of young and adult women.

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