The CART PREG-Epi Study: Pandemic Reproductive health and health Equity- Guidance from Epidemiology to improve reproductive, perinatal, and maternal mental health and substance use care

From impacted fertility rates due to crisis isolation, intimate partner violence and limited access to contraception, through lesser access to abortion, pre-natal health services, screening for adequate weight gain in virtual visits, and the identification and management of mental health and substance use disorders in pregnancy, the pandemic public health countermeasures and health system adaptations of the COVID-19 pandemic have had unknown and important impacts on the broad range of reproductive health outcomes throughout Canada. Also unknown are important and potentially inequitable impacts on the reproductive health of those among disadvantaged populations. As Public Health policy makers and decision makers leading health systems and services prepare to meet these challenges, data is urgently needed on the unintended effects of the pandemic public health counter measures and the health system responses on the range of reproductive health outcomes and changes to health inequalities. Our cross-jurisdictional, time series study of provincial health administrative data in Ontario, Manitoba and BC, will include targeted qualitative investigations and has engaged strong integrated knowledge translation throughout with key decision makers. Together with the Provincial Public Health Officers and key ministry of health leads in each province, we will compare changes to the range of reproductive health outcomes (both health events (such as pre term birth) and health utilization (such as adequate prenatal care)), before, during and over each six months period through the pandemic. Results will provide vital timely information to nimbly and iteratively inform ongoing pandemic planning, for use now and in future pandemics, to ensure people across Canada have the best reproductive health outcomes.