Challenges in accessing family planning, contraceptive and abortion services, and sexually transmitted infections care during the COVID-19 pandemic in Italy: a mixed method study

Background: The Coronavirus Disease 2019 (COVID-19) pandemic disrupted the capacity of healthcare systems. This study aimed to provide a better understanding of the impact of the COVID-19 pandemic on sexual and reproductive healthcare (SRH) services. Methods: We conducted a mixed-method cross-sectional study at the SRH services of the tertiary care university hospital of Verona, Veneto region, Italy. Questionnaires based on WHO validated tools were administered to all consecutive clients once per month for 11 months (December 2021 to November 2022) to assess SRH services availability and readiness. In-depth interviews (IDIs) have been used to understand participants' perspectives. Results: The questionnaire was completed by 100 clients (average age 35.34 years; sexually transmitted infection care service: n=49; abortion service: n=24, family planning and contraception service: n=16, and anti-violence service: n=11). All SRH services continued to operate without a shortage of supplies, although some facilities had relocation of staff and a location change. IDIs involved 25 clients at the abortion and family planning services, and 5 clients at the sexually transmitted infection care service. Most clients self-referred to SRH services and sought information online, which was described as helpful, clear, and informative. Remote consultation was the primary access method, allowing planning for in-person attendance after initial triage. This approach was appreciated and considered time-saving and facilitating. Slight delays or longer than anticipated waits were reported by some clients, although mainly in the initial pandemic phase. The relocation of facilities and the restriction of supportive persons were significant barriers to some SRH services. The risk of COVID-19 was perceived as low or less relevant than the reason for accessing SRH care, and it did not limit the decision to access. Conclusions: Results of the present study reflect the importance of maintaining SRH services for clients during health emergencies. Expanding pre-existing remote services and innovations in SRH care delivery had a key role and were appreciated by clients. Telemedicine for initial triage or online consultations and prescriptions should be implemented in regular practice or predisposed for rapid implementation in emergencies, along with ensuring up-to-date information, particularly online.