• contraceptives, oral
• COVID-19
• family planning services
• general practice
• hormonal contraception
• Sexual Health

A number of restrictions on daily life accompanied the COVID-19 pandemic. One such restriction was the change towards remote consultations, such as telephone triage and video-based telehealth appointments in general practices. The changes in oral contraceptive prescribing in Scottish general practices from January 2016 to January 2023 were examined. While the effects of COVID-19 on contraceptive prescribing within English general practices have been described,1 reports on the effects in Scotland are lacking.

Prescribing data are collected centrally in Scotland and published monthly in the Scottish Health and Social Care Open Data repository.2 This aggregated, anonymous dataset is 100% complete for all prescriptions written in general practice throughout Scotland. R v4.4.0 was used to access this dataset. Initially, the complete dataset was filtered using a SQL query to extract and categorise contraceptive medicines by returning results with truncated British National Formulary (BNF) item codes beginning with 07030* or 21040*. These results were then filtered to return combined oral contraceptive pills (COCPs) and progestogen-only pills (POPs). Data were extracted as the total quantity of items for which the dispenser was reimbursed; for example, a pack of 21 tablets would count as 21 items.3

To account for inherent differences in prescribing frequencies between contraceptive methods, a standardised metric – ‘months of contraceptive coverage’ – was calculated by dividing the quantity of items dispensed by the pack size then multiplying this by the duration of contraception provided.1 For example, a copper intrauterine device with a 5-year lifespan provides 60 months of contraceptive coverage (1/1 * 60). In contrast, a 6-month prescription of an oral contraceptive offers 6 months of contraceptive coverage (126/21 * 1) despite 126 items being dispensed.

By months of contraceptive coverage provided (53.0%; 26 945 530/50 802 518 months of contraceptive coverage), and the number of items dispensed (99.6%; 565 856 132/568 265 489 dispensed items), oral contraception was the major form of contraception dispensed by Scottish general practices in this dataset, and was therefore chosen as the focus of this study.

Figure 1 illustrates how the trends in prescribing COCPs and POPs have changed over the course of this study. Evidently, the onset of the COVID-19 pandemic and its associated restrictions decreased the number of items dispensed per month dramatically for both POPs (17.4%; 2 921 980/3 539 391) and COCPs (38.1%; 2 065 892/3 339 450) in May 2020 compared with March 2020.

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Figure 1

Trends in prescribing of combined oral contraceptive pills (COCPs) and progestogen-only pills (POPs) by Scottish general practices during the period 2016–2022.

COCPs dispensed per month remained lower than pre-COVID-19 levels (January 2016 to February 2020) even after all COVID-19 restrictions were lifted (May 2022 to January 2023) (median 67.0%; 2 362 855/3 527 299 items dispensed per month; IQR 61.2%–74.8%; Q₁ 2 236 121/2 988 982; Q₃ 2 489 589/4 065 616 items dispensed per month). Conversely, POP prescribing post-COVID-19 remained higher than pre-COVID-19 (112.8%; 3 372 954/2 990 333 items dispensed per month; IQR 108.2%–118.5%; Q₁ 3 144 725/2 653 457; Q₃ 3 601 183/3 327 209 items dispensed per month).

The trend of declining COCP prescriptions and increasing POP prescriptions has been observed in the UK since 2000.4 However, it is unclear without further analysis whether COVID-19 increased the rate of these changes. Further statistical analysis using time–series modelling might answer this question. Overall, there is a clear change in oral contraceptive prescribing in Scottish general practices after COVID-19, with POPs more commonly dispensed than COCPs.