COVID-19: Why we must talk about sexual health

Brook’s Head of Policy and Public Affairs, Lisa Hallgarten, highlights some key steps you can take to protect your sexual and reproductive health during COVID-19, as well as Brook’s key asks for the Government to avert a sexual health crisis.

Staying at home during a lockdown sounds like the safest kind of sex – in theory.

In reality, many people will be cooped up with partners for extended periods of time. They’ll likely be bored, anxious, missing the gym and maybe having as much or more sex than usual. With GP surgeries being inundated and sexual health clinics operating as appointment-only to reduce overcrowded waiting rooms, accessing contraception could be as easy as tracking down pasta in your local supermarket.

Brook expects this to have a serious impact on STI and unintended pregnancy rates, at a time when STI testing/treatment and abortion services are not easily accessible.

It’s equally important to remember that safe sex isn’t just about being STI and pregnancy-free. In the conditions created by lockdown, it is hugely concerning that people of all ages may be trapped in dangerous domestic situations with violent, abusive or coercive family members or partners. What’s more, many charities and support services are all struggling to cope with reduced staffing and remote working.

How can you protect yourself and others during COVID-19?

There are some simple measures that everyone can take right now, and encourage others to do, to address a shortfall in sexual and reproductive health services.

• Stock up on condoms: these are the only method of contraception that also protects you from STIs. Get your repeat prescription: if you use the contraceptive pill, patch or ring, check how many you have and arrange to get more if you think you have less than a month’s supply.
• Don’t delay emergency contraception: if you think you need emergency contraception, don’t delay seeking help. If you are self-isolating or you have COVID-19 symptoms, you can buy emergency contraception online through Fettle, Superdrug and other pharmacies.
• Have a backup: if your current method of contraception is going to expire, you can start taking the progesterone only pill (PoP) which is effective within two days. The pill is safe to take (although the use is unlicensed) alongside the Injection, Implant, IUS or IUD, all of which can remain in place until face-to-face appointments are available again.
• Make use of online services: If you can afford to, you can stock up now on many methods of contraception online. Make sure you always access online medication through reputable websites like Fettle.
• Keep checking in with family and friends: if you are worried that someone you know is at risk of abuse at home, we’ve listed some useful services and helplines below.

Buying condoms and emergency contraception is an expensive business so it’s not a solution for everyone, and what if it’s too late for emergency contraception?

Nearly 4,000 abortions take place in England and Wales each week. So, just a fortnight’s self-isolation and inaccessibility of abortion provision could mean up to 8,000 people continuing pregnancies that they would otherwise end.

The government needs to do more to protect sexual and reproductive health and rights during these unprecedented times.

How can the Government help us avert a sexual and reproductive health crisis?

Brook believes that:

• Free condoms must be made available at the pharmacies and supermarkets that will remain open.
• The right regulatory and financial support must be given to allow pharmacists and those working in sexual health services to provide PoP free over the counter and by post. For many women PoP is their chosen method of contraception. For others it is a useful quick start method they can use while they consider other longer acting methods or other pill types. A few people have conditions that exclude them from using it, but it’s easy to establish who and most people are safe to take it.
• Emergency Hormonal Contraception must be made freely available over the counter and these should be combined with the POP for three months and the advice to take a pregnancy test at one month. (Of course it’s free at sexual health clinics and from GPs, but that may not be a realistic option in the next few weeks. At the pharmacy it’s too costly for many people and tends to be free only for under 25s by special arrangement in specific areas)
• The Secretary of State for Health must designate people’s homes as safe spaces for abortion (most women experience their abortion at home already, but legally have to take the first pill at a clinic).

This final point would provide a clinically safe and reliable solution, involving a phone or live chat conversation with a healthcare professional to establish gestation, health, treatment options and – if required – prescribing and sending the medication. It would prevent unnecessary travel and minimise health professionals’ need for in-person contact with dozens of people a week. Those needing hospital care may struggle to get help as hospitals close their doors to ‘non-urgent’ cases and suspend elective procedures, but telemedicine for those who can benefit would be a great start.

We are now living through a public health emergency, and clearly there are competing priorities. But access to sexual health care and services is essential and cannot be sidelined. As individuals, we have a responsibility to take extra care and minimise risks that would require us to leave the house for treatment and put additional strain on already overwhelmed healthcare services. Equally, the Government must acknowledge that ignoring sexual and reproductive health and rights could lead to a longer-lasting crisis with wide-reaching impact.

For more info on Brook services at this time:
https://www.brook.org.uk/covid-19-response/

Useful Brook pages:
https://www.brook.org.uk/topics/contraception/
https://www.brook.org.uk/topics/stis/

Abortion support:
https://www.brook.org.uk/your-life/abortion/
https://www.msichoices.org.uk/
https://www.bpas.org/contact-us/

Domestic violence / abuse support:
https://www.refuge.org.uk/
https://mensadviceline.org.uk/
https://www.womensaid.org.uk/

If you are worried about a young person, or if you are a young person:
https://www.childline.org.uk/
https://www.nspcc.org.uk/

Further information / evidence on taking abortion pills at home:
https://www.bmj.com/company/newsroom/allow-women-in-england-to-take-second-abortion-pill-at-home-healthcare-leaders-urge/
https://www.womenonweb.org/