Pregnancy and sexual health-related care use during the COVID-19 pandemic was lower than anticipated among adolescents, according to a recent study published in Pediatrics.
Takeaways
- Adolescent females showed lower utilization of pregnancy and sexual health-related care during the COVID-19 pandemic, indicating potential barriers or disruptions in accessing healthcare services.
- The pandemic worsened existing health inequities, particularly in sexual and reproductive health (SRH) among adolescents. Factors such as socioeconomic status, parental supervision, and risk-taking behaviors were further impacted.
- Adolescent pregnancy, a significant SRH outcome, saw a reduction during the pandemic period compared to pre-pandemic levels. However, this reduction also highlighted potential disruptions in access to contraception and reproductive health services.
- The study employed a population-based, repeated cross-sectional design, utilizing various databases including demographic data, health insurance records, and medical encounter databases to assess changes in pregnancy and SRH-related care.
- The findings underscore the importance of identifying and addressing the sexual and reproductive health implications of the pandemic among adolescents. This includes ensuring access to contraception, reproductive healthcare, and STI management despite disruptions caused by the pandemic.
Preexisting health inequities were worsened by the COVID-19 pandemic, with data indicating significant impacts on sexual and reproductive health (SRH). Adolescent SRH (ASRH) was especially impacted. This included disruptions in normative adolescent developmental trajectories, changes in parental supervision, different risk-taking behavior, and increased risk of relationship abuse.
Adolescent pregnancy is a significant ASRH outcome. Risk factors toward adolescent pregnancy include lower education, poverty, and adverse early life experiences. Outcomes include substance use risk, exposure to violence, poor educational attainment, and poverty for the adolescent parent and offspring.
To determine how population-based rates of pregnancy and sexual health-related care use changed among female adolescents during the COVID-19 pandemic, investigators conducted a population-based, repeated cross-sectional study. Participants included female patients aged 12 to 19 years living in Ontario, Canada before and during the COVID-19 pandemic with eligibility for provincial health insurance.
Sources consulted for data included the Registered Persons Database for demographic data, 2016 Canadian Census data for neighborhood income quartile, and the Immigration, Refugees and Citizenship Canada’s Permanent Resident Database for immigration status.
For medical encounter data, the Ontario Health Insurance Plan billings database was assessed for outpatient visits, the National Ambulatory Care Reporting System for emergency department visits, the Canadian Institute for Health Information Discharge Abstract Database for hospitalizations, and the MOMBABY dataset for obstetrical delivery hospitalizations.
The pre-pandemic period was defined as January 1, 2018, to February 29, 2020, and the COVID-19 pandemic as March 1, 2020, to December 31, 2022. Pandemic exposure was determined based on whether conception took place before or after pandemic onset.
Adolescent pregnancy was the primary outcome of the analysis, identified based on pregnancy ending in miscarriage, stillbirth, abortion, or livebirth. Covariates included urbanicity of residence, immigration status, neighborhood income quintile, and geographic region of residence.
Participants were aged a mean 15.5. years, and 90% lived in an urban setting. Participants were equally spread across income quartiles. Of participants, approximately 10% were immigrants or refuges and nearly 25% resided in the Central West region.
Pregnancy was reported in a mean 0.82 per 1000 adolescent females per month during the pre-pandemic period, with mean rates of live births and abortions of 0.32 per 1000 adolescent females and 0.39 per 1000 adolescent females per month, respectively.
A reduction in adolescent pregnancies was observed during the pandemic period, at 0.66 per 1000 adolescent females. This was below the expected rate of 0.80 per 1000 adolescent females.
The overall rate was 0.65 per 1000 adolescent females, which indicated 10 fewer pregnancies than expected per 100,000. A reduction of 13% was reported.
A significant drop in contraceptive management visits was also reported during the pandemic period, from 11.7 per 1000 adolescent females pre-pandemic to 7.3 per 1000 and 7.7 per 1000 in April and May 2020, respectively. Overall, the rate during the pandemic was 9.2 per 1000 adolescent females, vs an expected 11.3 per 1000.
Finally, a significant reduction in sexually transmitted infection (STI) management visits was reported. In April 2020, the rate was 0.65 per 1000 adolescent females, vs an expected 2.1 per 1000. These rates during the overall pandemic were 1.2 vs 2.2 per 1000, respectively.
These results indicated reduced rates of pregnancy, contraceptive, and STI visits among adolescent females during the COVID-19 pandemic. Investigators concluded SRH implications of the pandemic must be identified and addressed.
Reference
Vandermorris A, Toulany A, McKinnon B, et al. Sexual and reproductive health outcomes among adolescent females during the COVID-19 pandemic. Pediatrics. 2024. doi:10.1542/peds.2023-063889
