Objective A weak and politicised COVID-19 pandemic response in the United States (US) that failed to prioritise sexual and reproductive health and rights (SRHR) overlaid longstanding SRHR inequities. In this study we investigated how COVID-19 affected SRHR service provision in the US during the first 6 months of the pandemic. Methods We used a multiphase, three-part, mixed method approach incorporating: (1) a comprehensive review of state-by-state emergency response policies that mapped state-level actions to protect or suspend SRHR services including abortion, (2) a survey of SRHR service providers (n=40) in a sample of 10 states that either protected or suspended services and (3) in-depth interviews (n=15) with SRHR service providers and advocacy organisations. Results Twenty-one states designated some or all SRHR services as essential and therefore exempt from emergency restrictions. Protections, however, varied by state and were not always comprehensive. Fourteen states acted to suspend abortion. Five cross-cutting themes surrounding COVID-19’s impact on SRHR services emerged across the survey and interviews: reductions in SRHR service provision; shifts in service utilisation; infrastructural impacts; the critical role of state and local governments; and exacerbation of SRHR inequities for certain groups. Conclusions This study demonstrates serious disruptions to the provision of SRHR care that exacerbated existing SRHR inequities. The presence or absence of policy protections for SRHR services had critical implications for providers and patients. Policymakers and service providers must prioritise and integrate SRHR into emergency preparedness planning and implementation, with earmarked funding and tailored service delivery for historically oppressed groups. The data that support the findings of this study are available on reasonable request from the corresponding author (MM). The data are not publicly available due to research ethics board restrictions.

中文翻译：

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“争先恐后地想办法”：COVID-19 对美国性健康和生殖健康及权利影响的混合方法分析

目标 美国 (US) 对 COVID-19 大流行的应对措施薄弱且政治化，未能优先考虑性和生殖健康与权利 (SRHR)，这掩盖了长期存在的 SRHR 不平等现象。在这项研究中，我们调查了 COVID-19 在大流行的前 6 个月如何影响美国的 SRHR 服务提供。方SRHR 服务提供商 (n=40) 在 10 个保护或暂停服务的样本中，以及 (3) 与 SRHR 服务提供商和倡导组织的深入访谈 (n=15)。结果 21 个州将部分或所有 SRHR 服务指定为必不可少的，因此免于紧急限制。然而，保护措施因州而异，并不总是全面的。十四个州采取行动暂停堕胎。调查和访谈中出现了围绕 COVID-19 对 SRHR 服务的影响的五个交叉主题：服务利用的转变；基础设施影响；州和地方政府的关键作用；某些群体的 SRHR 不平等加剧。结论 本研究表明，SRHR 护理的提供受到严重破坏，加剧了现有的 SRHR 不平等现象。是否存在针对 SRHR 服务的政策保护对提供者和患者具有重要影响。政策制定者和服务提供者必须优先考虑 SRHR 并将其纳入应急准备规划和实施，为历史上受压迫的群体提供专项资金和量身定制的服务。支持本研究结果的数据可应相应作者 (MM) 的合理要求提供。由于研究伦理委员会的限制，这些数据不公开。