The COVID-19 pandemic and the consequent confinement measures adopted in the various countries (e.g. lockdown, social distancing, essential exits, etc.) could have a profound impact on sexuality, reproductive health, and social life. To date, precise data on the possible effects that these procedures may have had in the emergency and reorganization phases are not yet available. Confinement procedures may have worsened mental and sexual health, increased cases of domestic violence and significantly reduced access to essential reproductive health services (e.g., access to contraceptives and assistance for pregnancy).
The current research project falls within this complex scenario and involves the administration of the ISHARE questionnaire (International Sexual and Reproductive Health survey) developed by an international task force of the World Health Organization (WHO). The purpose of this cross-sectional study is to better understand how COVID-19 confinement measures may have changed some aspects of sexual and reproductive health (sexual behaviour, gestation, childbirth, prenatal care, contraception, management of sexually transmitted infections, domestic sexual- and gender-based violence) in different countries.
Specifically, our research team will deal with the Italian translation and adaptation of the tool as well as the collection and analysis of data in the Italian context. The data collected on the Italian population will be used for national and international comparative studies. Participants will be recruited online through a snowball methodology. Eligible participants will be volunteers aged 18 or over who have given their consent to participate in the study.
The Italian study results will be useful both to deepen the effects of COVID-19 on sexual and reproductive care services in our country (among the first and most affected by the pandemic), and by identifying some of the most impacted areas on which recommend future actions.
We are facing a global emergency whose effects are still poorly understood and predictable: COVID-19 has put practices, beliefs, routines, and identities in crisis, having a profound impact not only directly on people¿s life, but also on economy and health care system [1]. In this sense, sexual and reproductive health and rights represents a significant public health issue during the pandemics. Only limited and preliminary scientific evidence is available to identify the impact of the COVID-19 and related safety measures on mental, sexual, and reproductive health, including clinical presentation and outcomes of the infection during pregnancy and for people living with HIV [18].
Beyond the clinical scope of sexual and reproductive health actions, we should not neglect the impacts at the health care system level and disruptions or interruptions in regular provision of these services, such as pre- and postnatal checks, safe abortion, contraception, HIV and STIs care [19].
Furthermore, other aspects deserving attention such as the expected increase of gender-based violence and domestic abuse, stigma and discrimination associated with COVID-19 and their effects on patients and health care providers. Therefore, there is an urgent need for the scientific community to generate sound clinical, epidemiological, and psycho-social behavioral links between COVID-19 and sexual and reproductive health and rights outcomes [18].
The global study, of which the current proposal represents the Italian contribute, aims to be the largest multicenter study in relation to sexual and reproductive health in times of COVID-19, being directed by the WHO and covering over 30 countries from all over the world (including Italy, Portugal, Latvia, Moldova, Sweden, Denmark, Spain, USA, Ecuador, Uruguay, Mexico, Kenya, Mozambique, South Africa, Uganda, Ethiopia, Burkina Faso, Nigeria, Tanzania, China, Malaysia, Singapore, Lebanon, and others). Moreover, the call for joining the global project is still open and it is very likely that the number of country/research groups joining this venture will raise significantly in the next weeks [17].
Another very important point that underlines the urgency and innovation of the current research proposal is that at the moment precise data that can direct effective government and health actions are not available, neither in our country, neither globally. Our study will generate important results and policy implications will be discussed both at national and international level. The study outcomes will help guiding policy and research related to sexual and reproductive health in the selected areas. For example, Italian results on COVID-19 confinement measures¿ effects on pregnancy and post-partum care will show possible problems faced by women and families with services, putting the basis for direct national and local actions. Furthermore, it could emerge that some types of distance support actions to motherhood taken by services in the lockdown period have been effective and satisfying, and therefore the may be implementable in the daily care routine to reduce some costs and avoid physical limitations (e.g., reaching the care service buildings). Sexual and reproductive health impact and consequent directions on where addressing national and international funds are primary in this historical moment. Beside the Covid-19, this is an exceptional occasion where national differences and similarities on sexuality and reproduction related issues may emerge, as well as how different COVIS-19 confinement measures have changed the lives of people in different countries.
Despite the numerous strength points, it should be recognized that the research project has several limitations due to the online assessment and the not representability of the sample (based on a convenience population reached with a snowball method). Inferences to other settings will need to be made with caution. In addition, the online nature of the survey will exclude individuals who do not have internet access or are less familiar with digital medias. However, the project represents a good compromise, being able to reach as many participants as possible in different countries and settings, being economically sustainable and respecting people who are still limited in their movements or are under social distancing/isolation measures.