Disabled people faced greater challenges accessing sexual and reproductive health services in the first year of the COVID-19 pandemic in Britain: evidence from the Natsal-COVID survey.

backgroundDisabled people face barriers to accessing sexual and reproductive health (SRH) services. There is evidence that the general population had difficulty accessing SRH services during COVID-19 but it remains unclear whether disabled people were differentially affected. This study sought to investigate whether people in Britain who reported a disability were more likely to report inability to access SRH services and whether this was associated with functional limitation.

methodsWe analysed data from the National Survey of Sexual Attitudes and Lifestyles (Natsal)-COVID 2 study. This was a cross-sectional, web panel survey of 6,658 18-59-year-old British residents in March-April 2021. Quota-based sampling and weighting were used to achieve quasi-representative population estimates. We defined disability as a long-term physical or mental health condition which affected ones' ability to carry out day-to-day activities. We calculated adjusted odds ratios (AOR) by reported disability status for wanting but being unable to access ≥ 1 SRH service, wanting but not trying to access SRH services, inability to access different SRH services, and unmet need for condoms. Reasons for, and outcomes after, inability to access services were also investigated.

resultsParticipants reporting a disability (unweighted n = 1,676), compared to not, were more likely to report wanting but being unable to access ≥ 1 SRH service (AOR 2.23 [1.77-2.82]), inability to access each SRH service type, and an unmet need for condoms. Increasing functional limitation levels were more strongly associated with reporting inability to access ≥ 1 SRH service. Reported disability was associated with higher odds of wanting but not trying to access SRH services (AOR 2.60 [1.50-4.52]) among men but not among women. Participants reporting a disability were more likely to report transport issues and accessing their desired service eventually but not in the way they wanted.

conclusionsOur study provides evidence that disabled people in Britain were more likely to have difficulty accessing SRH services during COVID-19. However, the extent to which these disparities were created or exacerbated by the pandemic, and whether inequalities persist, is not clear. Our results are relevant for contemporary service design, given that many changes introduced during the pandemic have endured.