Background: The COVID-19 pandemic and related restrictions caused major disruptions to health services, including sexual and reproductive health (SRH) services. This led to the implementation of changes and adaptations across diverse settings to maintain SRH service delivery. This aim of this study was to identify and analyse strategies used to ensure continuous delivery of SRH services during the COVID-19 pandemic. Methods: In partnership with the World Health Organization, Human Reproductive Programme (WHO, HRP), we conducted a systematic review and a global crowdsourcing open call. The review employed methods by the Cochrane Handbook, searching health databases including PubMed, EMBASE, and was registered on Prospero (CRD42022329411). The open call used methods by the WHO TDR Guide on Crowdsourcing for Health Research. The call was launched and promoted widely; each submission was screened by five independent reviewers. Across the review and open call, we collected qualitative data, analysed and presented thematically. The GRADE-CERQual methodology was used to assess confidence in the study findings. Results: We identified 10,891 citations, and after screening, 78 studies met the criteria to be included for data extraction and analysis. We received 80 submissions to the open call, and data from 18 contributed to the overall study findings. We received submissions from 42 different countries, most of which were from LMICs (37/42). Tele-medicine, which is the utilization of electronic information and telecommunications technologies to offer care remotely, was one of the main modes of continuing SRH services despite pandemic restrictions (moderate certainty). Tele-abortion, or the provision of medication abortion remotely via tele-medicine, was found to be a safe and effective way to maintain abortion services (95% CI = 95.6 to 99.4%). Self-care and self-testing enabled individuals to test and receive care for STIs/HIV and HPV when in-person services were limited (moderate certainty). Conclusion: The findings suggest that many strategies relied on tele-medicine to enhance SRH service delivery. Self-care interventions and community-based strategies were also leveraged to sustain delivery of SRH services. While these health systems solutions identified can be used to maintain access to SRH services delivery during disruptions, further research is needed to understand the long-term impact and sustainability of these interventions.
