Background In Scotland, the effects of the COVID-19 pandemic on women's access to contraception are unknown. Globally, COVID-19 restrictions have led to a shift to telehealth service delivery alongside a reduction in contraceptive provision. Research into whether the effects of COVID-19 on contraception have abated after restrictions have been lifted is lacking. Methods This is a retrospective longitudinal study of prescribing data from the Scottish Health and Social Care Open Data repository (https://www.opendata.nhs.scot) between January 2016 and January 2023. Contraceptives were extracted and categorised using truncated British National Formulary codes and analysed using R. Contraceptive provision was compared across four periods: pre-COVID-19 (01/01/2016-23/03/2020), lockdown (24/03/2020-9/05/2020 & 05/01/2021-26/04/2021), restrictions (30/05/2020-04/01/2021 & 27/04/2021-30/04/2022), and post-COVID-19 (01/05/2022-01/01/2023). Results During lockdowns, contraceptive prescribing in Scotland decreased by 82.90% of pre-COVID-19 levels. This trend was more severe for long-acting reversible contraception which fell to 11.80% of pre-COVID-19 prescriptions. After COVID-19, the level of contraceptive prescribing has risen to 108.23% of its pre- pandemic level. Large increases in subcutaneous medroxyprogesterone acetate (499.05%), progestogen- only pills (125.07%), the patch (165.09%), levonorgestrel-IUS (112.54%), and ulipristal acetate emergency contraception prescribing (357.97%). Conversely, combined oral contraceptive pills (75.04%), Cu-IUD (83.63%), the implant (81.10%), and levonorgestrel emergency contraception (67.42%) prescribing has decreased. Conclusions COVID-19 vastly decreased contraceptive prescribing during lockdowns in Scotland. Post-COVID-19, changes in contraceptive prescribing within Scottish general practices are reported, with implications for health policy and service delivery planning.

The authors have declared no competing interest.

This research did not receive any specific grant from funding agencies in the public, commercial, or not- for-profit sectors.

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The raw dataset used is also publicly available from the Scottish Health and Social Care Open Data repository (opendata.nhs.scot).

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All code and data used are fully available from Zenodo (doi:10.5281/zenodo.8310085) The raw dataset used is also publicly available from the Scottish Health and Social Care Open Data repository (opendata.nhs.scot).

https://doi.org/10.5281/zenodo.8310085