Sexual and reproductive health service delivery innovations and adaptations during COVID-19: A systematic review and crowdsourcing open call

This paper sought to identify and describe the innovations and adaptations implemented to ensure delivery of Sexual and Reproductive Health services during the COVID-19 pandemic and the potential for enhancing SRH services in other settings or in future emergencies. We searched five databases including PubMed, EMBASE, Scopus, Cochrane Library, and CINAHL. The review was registered on Prospero (CRD42022329411). The open call was launched and promoted widely; each submission was screened by five independent reviewers. The GRADE-CERQual methodology was used to assess confidence in each study finding. A thematic synthesis approach was employed for textual data and for studies with similar outcomes, a fixed effects model was employed. We identified 10,891 citations and 78 studies were included. We received 80 submissions to the open call, and 18 submissions contributed to the study findings. Submissions came from 42 countries, most of which were LMICs (37/42). Telemedicine was one main mode of continuing SRH services during the pandemic (moderate certainty). Teleabortion, or the provision of medication abortion remotely via telemedicine, was found to be a safe and effective way to maintain abortion service (97·9% of cases with 95% CI = 95·6 to 99·4%). However, increased reliance on telemedicine exacerbates inequities for low-income and rural populations. Self-care and self-testing enabled individuals to receive care for STIs (moderate certainty). This work identified strategies used to deliver SRH services during COVID-19 and the data suggest that many strategies relied on telemedicine to sustain SRH services. Self-care interventions were also used to sustain delivery of SRH services. There is need for further research to understand the long-term impact of these interventions and how they can be sustained over time.