In 2020, the unthinkable—the global COVID-19 pandemic. Subsequently, the impact on adolescents and young adults (AYA) proved to be an ongoing challenge with worsening health, including escalation of mental health disorders such as depression, anxiety, self-harm, and eating disorders.1,–6 As we recover from the pandemic and social isolation, adolescent sexual reproductive health (ASRH) reflects the ongoing impact of the pandemic the effect.
In this issue of Pediatrics, Vandermorris et al provide a large-scale assessment of ASRH before (January 1, 2018–February 28, 2023) and during (March 1, 2020–December 31, 2022) the pandemic with a comparison of expected results versus actual results.7
They evaluated Canadian administrative claims for more than 630 000 females aged 12 to 19 years, including pregnancy, contraceptive management visits, contraceptive prescription uptake, and sexually transmitted infections (STIs) management visits and cross-evaluated these variables with urbanicity, income, immigration/refugee status, and geographic region. This is a novel cross-sectional analysis in that authors compared prepandemic data with pandemic data and even used model projections for the pandemic period to predict and edify the pandemic’s impact.
Contrary to the increases in mental health concerns that occurred during the pandemic, pregnancy rates decreased by 13%. In line with this, there was a decrease in live births and abortions. These changes were likely from less unprotected intercourse; however, this decline was not consistent across different populations. Compared with nonimmigrants, immigrants, including refugees, had lower pregnancy rates and lower than expected pregnancy rates. In contrast, other specific vulnerable populations, including those with lower income and rural populations had higher pregnancy rates and less decline in pregnancy rates. Inequities persist even in circumstances that decrease pregnancy rates for others. Pregnancy loss (miscarriage, stillbirth) rates did not significantly change during the pandemic period, perhaps because of barriers to care, systemic stressors, and declines in abortion.
Contraceptive visits and contraceptive uptake decreased during the pandemic period for all AYA. Barriers to in-person or virtual care, pandemic restrictions, and a change in the provincial insurance prescription drug coverage that removed coverage for those younger than age 24 years with private insurance all likely contributed to decreased contraceptive care. Why did pregnancy rates decrease if contraception services declined? The authors speculate that decreased sexual couplings, pandemic-inspired changes in pregnancy intentions,8 and/or increased use of barrier or over-the-counter contraception may be the answer.
STI management visits had the steepest decline during the pandemic. By the end of the study periods, STI and contraception visits and contraceptive uptake had not recovered to prepandemic levels, suggesting a persistent loss of ASRH services.
This study provides a snapshot of the effects of the COVID-19 pandemic on ARSH in 1 high-income country, highlighting that even structurally vulnerable adolescent populations endured inequities that mitigated the few positive effects (lower pregnancy, lower live births, and lower abortion rates) of the pandemic. Essential ASRH services declined and did not appear to recover, potentially contributing to worsening health disparities for vulnerable populations. Ongoing monitoring and efforts to decrease ASRH inequities among vulnerable populations is essential because we do not yet know the long-term consequences of the pandemic. It is possible that the decrease in ASRH services will lead to persistence or even widening of inequities in rates of unplanned pregnancies, teen births, increased STIs, and fewer interactions with health care providers. For pediatricians, every encounter is an opportunity to provide our patients with ASRH services. By consistently screening for ASRH needs at all visits for all adolescents9 and by reducing barriers to care through novel approaches (eg, telehealth, providing contraceptive care at all appointments, supporting over-the-counter contraceptive access, universal STI screening), we can reduce ASRH inequities and improve outcomes for all AYA.
Dr Grubb drafted the commentary and reviewed it critically for important intellectual content; and she approved the final manuscript as submitted and agrees to be accountable for all aspects of the work.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2023-063889.
FUNDING: No external funding.
CONFLICT OF INTEREST DISCLOSURES: The author has no conflicts of interest to disclose.
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