Table 3.

Extracts from young people’s open-text responses (n=361) illustrating emerging barriers to pregnancy and sexually transmitted infection prevention in the context of COVID-19

Themes	Illustrative extracts
Self-censoring of SRH needs	“Don’t want to bother the GP practice at this time for the contraceptive pill.” [Woman, 19, heterosexual/straight] “Don’t want to go to GP or pharmacy as I feel like I’m wasting time that they could help someone else.” [Man, 16 heterosexual/straight] “I have found it difficult as most places only have time to see you if it’s an emergency and I feel embarrassed prioritising getting contraception over someone who could have a serious problem.” [Woman, 19, heterosexual/straight] “Although it isn't, it seems 'unnecessary' compared to other things.” [Woman, 20, bisexual] “At a pharmacy you have to queue to get in and feel like condoms really aren’t that necessary so feel like you are wasting people’s time who really need to be there.” [Woman, 21, heterosexual/straight] “Don’t feel that it is appropriate to go in and use the c-card scheme at the pharmacy right now so buy my own.” [Man, 17, gay]
Emerging confusion and anxiety about positive prevention in context of contradictory messages	Confusion and anxiety about changes to contraception care “I have the implant which I was told lasted 3 years and it ran out a couple of months ago, now I’ve been told it lasts for 4 years? I’ve checked online and nothing backs this up. Very worrying.” [Woman, 24, heterosexual/straight] “I haven't had my blood pressure checked when I collected my prescription for the pill. Not sure when that will be possible again or the possible impact this will have.” [Woman, 20, bisexual] “Nurse ordered me another 6 month prescription of the pill over the phone without being checked despite being asked to go for a check up last time I got more of the pill.” [Woman, 19, heterosexual/straight] “I would usually go in to my GP to make sure everything is okay and if I was having any issues before getting a top up. I needed a new type of birth control at the start of lockdown as the one I was on caused a lot of bleeding. Instead of an appointment I was just given a new one to try without a discussion with a doctor.” [Woman, 23, heterosexual/straight] “It means I can’t get my blood pressure checked to make sure my contraception isn’t negatively impacting my health.” [Woman, 20, heterosexual/straight] Confusion and anxiety about changes to STI testing “I regularly attended or pre-booked appointments with a sexual health clinic before or after sexual encounters mainly for a chat, information or peace of mind testing but recently from Covid-19 I found this a difficult task or I felt that it would not be (or considered to be) essential.” [Man, 22, bisexual] “I've waited months past since I have had symptoms of an STI/D due to not wanting to break social distancing/not sure how sexual health clinics have been dealing with it.” [Man, 21, pansexual] “Currently I have been trying to get a routine sexual health screening before I have sex with new people however due to lockdown the sex clinic in my area is only taking emergency appointments.” [Woman, 24, heterosexual/straight] “I have been sexually active during the lockdown with multiple partners. It has been extremely disappointing that the sexual health clinics have (and still are) closed. I am unable to order STI postal kits. Why? I phone up the clinic and they said that they are not testing.” [Woman, 24, heterosexual/straight] “I have had to seek out STI screening from a private company as the NHS service I use told me that I needed symptoms of something before I could be screened. I did NOT have this problem pre-lockdown.” [Woman, 24, bisexual]
Exacerbation of existing barriers to accessing condoms and contraceptive care	Gatekeeping of services “It’s almost impossible to get an appointment to receive my birth control injection. Not only that but I have been frequently judged and even asked, ‘Do you really think that is important right now?’ when making an appointment.” [Woman, 23, heterosexual/straight] “Harder to get an appointment. Seems like only the most urgent people get seen. Puts people off fighting for an appointment.” [Woman, 24, bisexual] Challenges advocating for own SRH needs “Had to get blood pressure check before they would renew my pill. Eventually after having run out for a month I told my Mum who sorted it out for me.” [Woman, 16, heterosexual/straight] “Difficult to get in contact with GP to get contraceptive pill - could not go to GP for blood pressure check, etc. I was encouraged to change pill which I strongly did not want to do as it had previous adverse effects. After standing my ground, I got my prescription. However, when I was a few years younger I would have just left it and stopped taking my pill to avoid the difficult conversations.” [Woman, 21, heterosexual/straight] Low confidence interacting remotely with healthcare professionals “Due to the virus, I've needed to phone my doctors and talk on the phone however I struggle to talk on the phone. So it’s hard for me to order my contraception.” [Prefer to self-describe gender, 18, pansexual] “I’m too embarrassed to call up about it and I’m scared they will not allow me to have free condoms as I am a girl looking for them for me and my boyfriend.” [Woman, 16, heterosexual/straight] “Had a lot of issues trying to get the contraceptive pill whilst in lockdown. Had issues with it and hard to explain to male doctors or on telephone.” [Woman, 18, bisexual] Pandemic-related constraints on privacy and independence “Shops haven’t been opened resulting in not getting contraceptives and not being able to order them without keeping it a secret from family members.” [Man, 16, heterosexual/straight] “I no longer do my own shopping because I’m shielding, so I feel embarrassed asking my mum to buy condoms.” [Woman, 19, queer] “I used to just buy condoms at the shops but with Covid I had to move in with my parents and my dad was doing the shopping… bit awkward asking him to get his daughter some condoms.” [Woman, 23, heterosexual/straight] Changes to usual points of access that allow young people to overcome access barriers “Because the online service was temporarily stopped I didn’t know where to get contraception for free and couldn't afford it.” [Man, 22, asexual] “Haven't been able to get free condoms as I've been unaware whether sexual health clinics were open and my usual place of obtaining them [my University] was shut.” [Man, 24, bisexual] “I get my condoms from a youth group which is shut due to social distancing and do not feel comfortable getting them somewhere else.” [Man, 16, pansexual] “The only place I knew and felt comfortable with getting condoms from was public bathrooms.” [Man, 18, bisexual] “… the one-way system and social distancing at the supermarkets has made it more embarrassing to buy from the shelves!” [Woman, 21, heterosexual/straight] “Would normally get them late at night at supermarket but nowhere’s open and I’d be too embarrassed to get them anywhere or anytime else.” [Man, 19, bisexual]

GP, general practitioner; NHS, National Health Service; SRH, sexual and reproductive health; STI/D, sexually transmitted infection/disease.