Table 1.

Thematic summary of the reasons and reported challenges related to reduced access and utilisation of SRH services (n=33)

Cause	Description	Study settings (n)	References
Transportation restrictions and disruptions (n=16)	Shutdown of public transportation made it difficult to access a clinic. Travel/mobility restrictions confined patients to certain regions and cut-off access to distant clinics. Abuse by police and soldiers at road blocks made travel difficult. Quarantine orders and curfew made it impossible to leave the home, schedule or attend appointments.	Australia (1), China (1), Kenya (1), Nepal (1), New Zealand (1), Uganda (3), UK (1), USA (2), Zimbabwe (1), mixed (4)	34 41 52 58 59 63 64 70 82 90 91 96 102 104 106–108
Financial burdens (n=9)	Income loss due to the pandemic made it more difficult to afford SRH services. Financial challenges made it difficult to afford resources to access services, such as cloth masks, public transportation and child care.	Kenya (2), Uganda (2), USA (3), mixed (2)	27 35 41 52 60 63 70 106 107
Limited medical or social resources (n=19)	Medical resources (staff, personal protective equipment (PPE), viral testing, etc) diverted from SRH services to COVID-19 effort. Stockouts: shortage of medications (particularly antiretrovirals (ARVs)) and transport disruptions on essential supplies. Complete closure of SRH clinics or service provision facilities. Decrease in the number of available shelters for women seeking refuge services due to increased demand and social distancing. Lack of interpreters to support women who need them. Community mutual aid efforts curtailed (eg, community babysitting for domestic violence survivors).	Australia (1), China (1), Kenya (1), Uganda (3), UK (2), USA (5), Zimbabwe (1), EU&CA* (2), mixed (3)	30 34 35 39 43 52 58 61 63 70 73 78 82 84 91 96 104 106 108
Lack of information (n=6)	Lack information on available services or avenues of support. Misunderstandings about follow-up after telehealth. Confusing information on threat of COVID-19.	Germany (1), New Zealand (1), Uganda (1), UK (1), Zimbabwe (1) mixed (1)	52 58 82 85 90 104
Legal restrictions and disruptions (n=4)	Abortion not deemed an essential service. Laws limit procedural changes necessary to restore access to SRH services, primarily abortion. Disruptions to legal proceedings complicated care-seeking for IPV victims.	US (2), EU&CA* (1), mixed (1)	34 35 80 107
Fear, safety or privacy concerns (n=12)	Lack of privacy to call provider or have telehealth appointment due to stay-at-home orders. Fear of exposure or contracting COVID-19 at a medical facility. Fear of being undocumented. Fear of receiving substandard medical care due to COVID-19.	Australia (1), Kenya (2), New Zealand (1), Uganda (2), UK (1), USA (2), mixed (3)	34 35 59 60 63 70 82 90 96 104 107 108
Technological challenges (n=6)	Shortage of technological facilities for virtual services. Patients or providers not as comfortable with telehealth services or perceive them as less effective or of lower quality. Increase in health disparities for patients who have less access to technology or language barriers.	Belgium (1), USA (4), SSA† (1)	29 31 32 36 89 105
Self-censorship of needs (n=2)	Patients did not think service was necessary in light of the pandemic and could wait to seek care.	New Zealand (1), UK (1)	82 90

*EU&CA refers to Europe and Central Asia.

†SSA refers to sub-Saharan Africa.

IPV, intimate partner violence; SRH, sexual and reproductive health.