Sexual and reproductive health outcomes among adolescent females during the COVID-19 pandemic

Background and Objectives — Coronavirus disease 2019 (COVID-19) posed a significant threat to adolescents’ sexual and reproductive health. In this study, we examined population-level pregnancy and sexual health-related care utilization among adolescent females in Ontario, Canada during the pandemic and evaluated relationships between these outcomes and key sociodemographic characteristics.

Methods — This was a population-based, repeated cross-sectional study of >630 000 female adolescents (12–19 years) during the prepandemic (January 1, 2018–February 29, 2020) and COVID-19 pandemic (March 1, 2020–December 31, 2022) periods. Primary outcome was pregnancy; secondary outcomes were contraceptive management visits, contraception prescription uptake, and sexually transmitted infection (STI) management visits. Poisson models with generalized estimating equations for clustered count data were used to model pre-COVID-19 trends and forecast expected rates during the COVID-19 period. Absolute rate differences between observed and expected outcome rates for each pandemic month were calculated overall and by urbanicity, neighborhood income, immigration status, and region.

Results — During the pandemic, lower-than-expected population-level rates of adolescent pregnancy (rate ratio 0.87; 95% confidence interval [CI]:0.85–0.88), and encounters for contraceptive (rate ratio 0.82; 95% CI:0.77–0.88) and STI management (rate ratio 0.52; 95% CI:0.51–0.53) were observed. Encounter rates did not return to pre-pandemic rates by study period end, despite health system reopening. Pregnancy rates among adolescent subpopulations with the highest pre-pandemic pregnancy rates changed least during the pandemic.

Conclusions — Population-level rates of adolescent pregnancy and sexual health-related care utilization were lower than expected during the COVID-19 pandemic, and below-expected care utilization rates persist. Pregnancy rates among more structurally vulnerable adolescents demonstrated less decline, suggesting exacerbation of preexisting inequities.