Evaluating health system barriers to sexual and reproductive health service delivery during the COVID-19 pandemic in China: a mixed-methods study.

Background: The disruption of sexual and reproductive health (SRH) services emerged as a key issue during the early COVID-19 outbreak. We aimed to assess the availability of SRH services in China during the COVID-19 pandemic.

Methods: The study is part of a larger cross-country study on the impact of COVID-19 pandemic on health system. A cross-sectional panel survey design with two data collection points was used to capture changes in SRH service availability as a result of the COVID-19 pandemic. We developed a questionnaire to assess the readiness and resilience of China's health system. We conducted 109 in-depth interviews with healthcare providers, clients, and their partners in seven purposively selected health facilities in Wuhan, Beijing, and Changsha between November 2020 and December 2022. An adapted grounded theory and thematic analysis approach were applied to analyze the interview data. Direct quotes and findings from the coding and categorization process were used to develop the results.

Results: The quantitative data showed that family planning, including contraception, and safe abortion services were completely or partially disrupted by the COVID-19 pandemic. The effects were greater at baseline. The disruption of services can be attributed to both supply-side and demand-side factors. Facilities responded to the pandemic's adverse impact on essential health services in multiple ways, most commonly through telemedicine, task shifting/role delegation, and triaging, to prioritize resource allocation. Three major themes emerged from the qualitative data: (1) barriers to SRH service delivery, (2) barriers to access and utilization of SRH services, and (3) resilient innovations in response to COVID-19. Service providers experienced barriers in providing SRH services to women during the pandemic. Women also faced numerous barriers and challenges to accessing SRH services, including lockdowns and mobility restrictions, lack of access to information, and limited access to SRH products. Most participants expressed support for the further expansion of telehealth strategies to improve access to SRH resources.

Conclusions: The COVID-19 pandemic negatively impacted SRH service provision and utilization in China. Our findings highlight the challenges of SRH service delivery during the COVID-19 pandemic and can be used to guide policy development and enhance service provision in alignment with societal needs. These findings underscore the importance of strengthening health systems by supporting telehealth expansion, tailoring provider-client communication, addressing the gender-specific needs of female providers, and leveraging community engagement to sustain essential SRH services during future crises.