The Sexual and Reproductive Health of Adolescents and Young Adults During the COVID ‐19 Pandemic

Abstract

The COVID-19 public health crisis is having rapid and profound eff ects on how people around the world are living their lives. Adolescents and young adults (AYA) aged 12-24 in the United States are at low risk for hospitalization and death from COVID-19 compared with other age-groups. * However, the disease may aff ect other aspects of their physical, mental and social health. Sexual and reproductive health (SRH) touches upon all of these domains, and involves intimate relationships, sexual activity, contraceptive use and abortion care. Evidence of the SRH impacts of previous large-scale disruptions in the United States, including natural disasters 1 and the 2008 recession, 2 suggests that the current pandemic will have serious and sustained eff ects on young people. AYA will experience the current pandemic in ways that refl ect their unique developmental and cohort situations. 3 In this viewpoint, we review potential immediate and longer term impacts of the COVID-19 pandemic on the SRH needs and behaviors of AYA, and provide direct evidence of COVID-19 impacts where available. Impact on Sexual and Reproductive Health Adolescents' and young adults' sexual and reproductive health is being and will continue to be impacted by the COVID-19 pandemic through both distal and proximal pathways (Figure 1). The pandemic has brought about dramatic social and economic changes, including social distancing, a period of stay-at-home requirements, nearly universal school closures, increased engagement with parents or other household members, and growing economic insecurity. Among older AYA, college closings, fi nancial issues and the desire to be with family have brought some back into their parents' household after a period of having gained some independence. These widespread social and economic shifts have disrupted AYA romantic and sexual relationships, as well as their access to aff ordable and confi dential health care services and resources. We explore how these social, economic and proximal infl uences may aff ect AYA intimate and sexual behaviors and the use of a range of SRH services. • Relationships and sex. The COVID-19 pandemic has interrupted many of the normative aspects of AYA development , a period that should be marked by growing independence 3 and strengthening peer relationships. 4 Many young people currently face increased parental monitoring and reduced privacy. This increased monitoring, diminished independence and reduced physical interaction with peers will likely have yet unknown eff ects on this cohort ' s developmental trajectory, † especially since we don ' t know how prolonged or widespread the disruptions will be, and whether they will recur. For most young people, social distancing and stay-at-home guidelines have likely resulted in less partnered sex. However, during the pandemic ' s initial peak, about one-third of 13-17-year-olds in a national survey reported that they were still meeting close friends in person. ‡ 5 Some AYA will continue to engage in partnered sexual behaviors, either in established relationships (including cohabiting ones) or with new partners. Online social connections are also important. Today ' s youth are digital natives who are frequently online for entertainment, learning and socializing , and these digital interactions off er options to connect despite the social disruptions inherent in physical distancing and stay-at-home orders. 4 In fact, as a result of social distancing during the pandemic, 65% of teenagers were texting with friends and family, or interacting with them via social media, more often than usual. 5 These forms of digital communication also off er a means for romantic or sexual interactions, including conversations, online dating, sexting, virtual sex and other online activities. 6 For AYA in established or new relationships, physical separation may infl uence relationship quality or stability. For some, physical distancing from partners results in less sexual or physical intimate partner violence (IPV). § For individuals who cohabit with a partner, however, stay-at-home orders may increase the risk of experiencing IPV. Online emotional abuse by a partner may also occur for those who are currently physically separated. Disruptions such as school or workplace closures and reduced access to health care may exacerbate these issues and make it harder for young people to seek support or interventions. 7 • Access to and use of SRH care. The pandemic has imposed economic and logistical barriers to obtaining contraceptive and other SRH services for all ages, but