1. Introduction

The emergence of the coronavirus disease 2019 (COVID-19) pandemic has transformed the pre-existing worldwide sexual and reproductive health environment rapidly [1,2]. The provision and supply of contraceptives and a wide variety of sexual health, new-born, and maternal health services have been seriously affected or disrupted [3,4,5].

More than two decades ago, the United Nations at the International Conference on Population and Development (ICPD), held in Cairo, recognized the role of an adequate response to an individual’s reproductive health needs as a panacea to universal economic and social development [6]. The gathering further endorsed the equal distribution of family planning and other related sexual and reproductive health services via the primary healthcare system to encourage comprehensive reproductive health care utilization [6]. Therefore, reproductive health implies an individual’s ability to have a satisfying and safe sex life and have the capacity and freedom to reproduce at their desire [6], hence the need to provide adequate and friendly access to safe, effective, affordable, and acceptable methods of family planning and health care services of their choice that will increase maternal and child health safety. This concept also includes sexual health, which is considered the enhancement of life and personal relations relating to reproduction and sexually transmitted infections (STIs) [6,7].

Prior to the emergence of COVID-19, adverse sexual and reproductive health outcomes have been a major issue globally, with an estimated 210 million women being exposed to pregnancy complications, and approximately half a million of these women dying between pregnancy and the post-partum period [8]. In addition, about 68 000 women die every year from complications of unsafe abortions [9]. In the same vein, 3.3 million infants were stillborn, whilst 3 million babies die in the first week of their life yearly [8]. This is also coupled with more than 340 million new sexually transmitted bacterial and protozoal infections acquired every year [10].

Interestingly, uninterrupted access to sexual and reproductive services has been identified as a remedy to curb these adverse sexual and reproductive health globally and across all socio-demographic characteristics [11,12,13,14]. However, the sudden emergence of the COVID-19 outbreak and the virus’s declaration as a global health concern in the first quarter of the year 2020 led many governments worldwide to enforce country-national lockdowns in order to limit the propagation of the virus [15]. These measures have been documented to have altered sexual and reproductive health (SRH) services around the world [16].

Specifically, SRH services such as family planning supplies [17], sexual health [18], and maternal and child health services [17,19] have been disrupted. To ensure adherence to guidelines prescribed by the World Health Organization (WHO) [20], authors at the Guttmacher Institute and others have opined that the sudden halt in supply of SRH services would lead to an unexpected rise in adverse SRH [17,21,22].

2. Screening Results

After the database search, this scoping review found two hundred and eighty-nine (289) eligible studies from a total of 1575 articles after title screening and removing duplicates. A total of 47 articles were also excluded following the abstract and 225 after full article screening. Hence, 17 articles were included for analysis. Results of the article screening are presented in Figure 1.

Figure 1. PRISMA flow-chart of the study selection process. (Source: Adapted from Moher et al. [30]).

The preferred report items for systematic and meta-analysis (PRISMA) flow chart for the screening and selection of studies in this review is shown in Figure 1.

3. Characteristics of the Included Studies

Table 1 shows the characteristics of the included studies. These included studies were conducted in various high income countries (HICs) and low-middle income countries (LMICs) (Figure 2): 23% of the studies were done in the United Kingdom [31,32,33,34], 6% in Brazil [35], 17% in the United States [36,37,38], 6% in Wales [39], 12% in Italy [40,41], 6% in Israel [42], 6% in the United States, Canada, United Kingdom, Australia, and other countries [43], 6% in Turkey [44], 6% in Belgium [45], 6% in Poland [46], and 6% in HICs and LMICs [47].

Figure 2. Distribution of the countries represented in the included studies (n = 17).

Three studies showed evidence on the impact of COVID-19 and family planning services [36,40,44], six studies reported on COVID-19 impact on maternal and child services [31,33,34,44,45,47], and eleven studies reported on COVID-19 and sexual behavior [32,35,36,37,38,39,41,42,43,44,46].

4. Quality of Evidence from the Included Studies

All the included studies received a high quality score ranging from 80% to 100% during the methodological quality assessment. Overall, the included studies were deemed to have a low chance of bias.

Table 2 below shows that the most common sexual and reproductive health service impacted by the outbreak of COVID-19 was sexual behavior because changes in pattern of sexual behavior were reported in almost all the countries included in the study except in Belgium, with 11 studies reporting unusual sexual behavior during the COVID-19 pandemic [32,35,36,37,38,39,41,42,43,44,46]. Contraceptive use or family planning service disruption was reported in the United States [36], Italy [40], and Turkey [44], with 3 studies reporting limited access to contraceptive of choice. Maternal and child health services disruption was reported in the United Kingdom thrice [31,33,34], Turkey once [44], Belgium once [45], and once in a study conducted in more than one country [47].

Table 2. Showing common findings in all countries included in the study.

Countries Included in the Study
COVID-19 and SHR Services	United Kingdom	Brazil	United States	Wales	Italy	Israel	Turkey	Belgium	Poland	Multiple Countries
COVID-19 and family planning services			X *		X *		X *
COVID-19 and maternal and child services	XX ***						XX *	XX *		XX *
COVID-19 and sexual behavior	XXX *	XXX *	XXX ***	XXX *	XXX *	XXX*	XXX *		XXX *	XXX *

Source: Authors, X represents family planning services were disrupted by COVID-19 outbreak, XX represents maternal and health care services were disrupted by COVID-19 outbreak, XXX represents COVID-19 impacted sexual behavior, * represents number of times study reported any of the SRH by countries.

5. Themes from Included Studies

5.1. COVID-19 and Family Planning Services

Four of the seventeen included studies reported on the impact of COVID-19 and family planning services [36,37,40,44]. A study conducted in Turkey showed a significant decrease in contraception use during the pandemic compared with the time prior to the pandemic [44].

A cross-sectional study carried out in Italy reported that 50.5% of single or non-cohabiting women had discontinued their short-acting reversible contraception (SARC) method while social distancing due to the COVID-19 pandemic, for non-method-related reasons [40]. However, 46.5% of the non-cohabiting or single women did not adhere to the social distancing guidelines and continued with their sexual activity resulting in 14.9% of the women having an unplanned pregnancy and requesting termination [40]. A study conducted on the impact of COVID-19 on men who have sex with men (MSM) in the United States demonstrated that 9.4% of the participants had less access to condoms, while 5.4% reported less use of a condom [36].

On the contrary, Sanchez et al. [36] reported that 89.4% and 92.9% of the participants had no change in access to or condom use, consecutively, and condom access and usage remained unchanged due to COVID-19 [36] as shown in Table 3.

Table 3. Summary characteristics of the included studies.

Author and Year	Study Setting (Country)	Study Design	Population (n) (Sample Size and Target Pop)	COVID-19 and Family Planning Services	COVID-19 and Maternal and Child Services	COVID-19 and Sexual Behavior
Babu Karavadra et al. and 2020 [31]	United Kingdom	Cross-sectional (Web survey)	Women who were pregnant or delivered during COVID-19, n = 1451		- 62% felt lack of interpersonal care. - 14% cannot express themselves well over the phone. - 2% had mobile issues and could not access maternal healthcare services. - 12% could not attend routine scan appointments due to fears about contracting COVID-19. - 18% felt neglected by health workers.
Thiago S. Torres et al. and 2020 [35]	Brazil	Cross-sectional (Web-survey)	n = 3486 among cismen			- 24% off-PrEP were at substantial HIV-risk. - 46.6% had access challenge in picking up PrEP medication. - 28.8% had virtual sex. - 10.5% reported condomlessreceptive anal sex with a casual partner.
Travis H. Sanchez et al. and 2020 [36]	United States	Cross-sectional (Web survey)	Men who have sex with men n = 1051	- 9.4% had less access to condoms. - 5.4% reported less use of a condom.		- 68% reported fewer opportunities in having sex with a partner. - 25.4% had less access to HIV/STI testing or treatment centers. - 54.9% having trouble getting PrEP prescription. - 54.1% having trouble getting PrEP medication.
David Gillespie et al. and 2020 [39]	Wales	Longitudinal survey (Web survey)	Participants were individuals accessing PrEP n = 56			- 20% reported condomless sex.
Salvatore Caruso and 2020 [40]	Italy	Cross-sectional (Web survey)	Among women known to be using hormonal contraceptives, n = 169	- 50.5% of non-cohabiting women discontinued SARC use during social distancing, for non-method-related reasons - 14.9% had an unplanned pregnancy.
Rob Stephenson et al. and 2020 [37]	United States	Cross-sectional (Web survey)	Among gay, bisexual, and other men who have sex with men, n = 518			- 1.4% reported that they had participated in transactional sex. - 9% reported that COVID-19 had prevented them from accessing their PrEP prescriptions.
Guy Shilo and Zohar Mor and 2020 [42]	Israel	Cross-sectional (Web survey)	Among men who have sex with men, n = 2562			- 39.5% met new casual sex partners during this period. - Only 3.2% could imagine themselves having sex with a partner who is infected with COVID-19 compared with 30.1% in case of HIV. - 84% had had up to 3 sexual partners. - 2.1% met more than 10 sexual partners.
Michele Carlo Schiavi and 2020 [41]	Italy	Cross-sectional	Women of reproductive age, n = 89			- 9% of women did not have sexual intercourse during the month of social restriction. - The number of women who practiced sexual intercourses four times/ month, 4 weeks after the introduction of the social distancing measures due to the COVID-19 outbreak, decreased from 89 (100%) to 52 (58.4%). - Women who had sexual intercourse eight times/month decreased from 31 (34.8%) vs. 8 (9%).
Louis Jacob et al. and 2020 [32]	United Kingdom	Cross-sectional (Web survey)	n = 868			- 40% of the population reported engaging in sexual activity at least once per week. - The prevalence of sexual activity significantly increased from 33.5% in people who were self-isolated for 0–5 days to 47.0% in those who were self-isolated for 11 days.
Tyrel J. Starks et al. and 2020 [38]	United States	Cohort-control design	Among sexual minority men, n = 455			- The unweighted probability of reporting CAS with a casual partner declined significantly from 71.6% pre-COVID to 26.4% during COVID.
Justin J. Lehmiller et al. and 2020 [43]	United States 73.4% Canada 6.0% United Kingdom 5.7% Australia 2.4% Other countries, 12.5%	Cross-sectional (Web survey)	Among participants 18 years of age or older, n = 1559			- 43.5% reported a decline in the quality of their sex life. - 20.8% of participants reported masturbating once per day or more during the past year, 23.2% reported this frequency since the pandemic began.
Bahar Yuksel, Faruk Ozgor and 2020 [44]	Turkey	Cross-sectional (Telephone)	Among married patients who were older than 18 years and sexually active, n = 58	- Use of contraception during the pandemic significantly decreased compared with the period before (10 participants vs. 24 participants, p = 0.004).	- Before the pandemic, 19 (32.7%) participants intended to become pregnant, however during the pandemic, this number decreased to 3 (5.1%) (p = 0.001).	- Average weekly frequency of sexual intercourse was significantly increased during the pandemic compared with the 6–12 months prior (2.4 vs. 1.9; p = 0.001).
Helen I McDonald et al. and 2020 [33]	United Kingdom	Cross-sectional	Vaccination among children n = 67,116		- Measles-mumps-rubella vaccination counts fell from February 2020, and in the 3 weeks after the introduction of physical distancing measures were 19.8% lower (95% confidence interval: −20.7 to −18.9) than the same period in 2019. - There was a general decrease in hexavalent vaccinations delivered in 2020 compared with 2019, but no evidence of an increase in the rate of decline with the introduction of physical distancing measures. Counts of both vaccinations increased in weeks 16 and 17, despite physical distancing measures remaining in place.
Michael Ceulemans et al. and 2020 [45]	Belgium	Cross-sectional (Web survey)	2647 pregnant and 3823 breastfeeding women, n = 6470		- 90% refuted that the pandemic affected their breastfeeding practices, nor indicated that the coronavirus was responsible for breastfeeding cessation. - 86% of all pregnant respondents answered that their pregnancy was mainly followed-up by an obstetrician. - 40% cited that the pandemic negatively influenced the extent of medical counseling by medical specialists. - 43% of the breastfeeding women reported having experienced some impact of the pandemic on the extent of medical counseling during the breastfeeding period. - 39% of the breastfeeding women reported having experienced the impact of the pandemic on the extent of social support they received during the breastfeeding period.
Anna Fuchs et al. and 2020 [46]	Poland	Cross-sectional	764 sexually active female patients and above 18 years			- Desire, arousal, lubrication, orgasm, satisfaction, and pain decreased. - The number of women with sexual dysfunction (overall FSFI score 26 or below) before the pandemic was 15.3% and increased to 34.3% during the total lockdown.
James John Ashton et al. 2020 [34]	United Kingdom	Cross-sectional	20 tertiaries pediatric IBD centers		- Over 50% of children and young people presenting with a suspected diagnosis of IBD were diagnosed without a histological diagnosis due to restrictions placed on endoscopy at over 90% of centers across the UK. - A total of 122 patients were diagnosed with confirmed, or presumed IBD during April 2020. Of these patients, 53.3% (n = 65) were presumed diagnoses and had not undergone endoscopic or histological examination.
Anja Saso, Helen Skirrow and Beate Kampmann and 2020 [47]	LMICs and HICs	Cross-sectional (Web survey)	n = 48		- 50% or more reported issues with vaccine delivery within their country. - Lack of access to maternal and child health services. - Provider issues with vaccine supply due to COVID-19.

This entry is adapted from the peer-reviewed paper 10.3390/healthcare9040436