During the COVID-19 pandemic, healthcare providers have worked to balance patients’ access to health services with public health. While professional and public health organizations agreed that contraception is an essential service, providers also had to respond to social distancing mandates, changes in clinic funding and competing demands for COVID-related care. Many aspects of the pandemic increased barriers to birth control, including clinic closures, limited appointments, lack of transportation and economic hardship.
Researchers from Beyond the Pill surveyed clinicians and staff to understand the challenges providers have faced in meetings patients’ needs for birth control and how they adapted clinical care during the pandemic.
Providers adapted in many ways, most importantly via telemedicine—79% offered it during the pandemic, compared to 11% before. On a smaller scale, providers increased use of mail-order pharmacies, curbside contraceptive services, and prescriptions for patients to administer their own contraceptive injections.
Despite using telemedicine, providers continued to experience challenges in offering contraceptive care, especially meeting the needs of underserved communities. Even shutting down on-site services and focusing only on telemedicine didn’t significantly reduce challenges in providing birth control services. Closing on-site services meant that providers continued to find it difficult to see new patients, offer contraceptive counseling and offer the full range of birth control methods. Providers were also concerned about being able to address related health needs including mental health and intimate partner violence, which increased during the pandemic.
Indeed, in recently published qualitative research among reproductive health providers through the US, UCSF researchers found that increased availability of telehealth had several benefits, including accommodating patients who faced challenges attending in-person contraceptive visits. However, many providers noted a lack of patient awareness about availability of telehealth services and disparities in access to technology. Providers shared that there was less personal connection in virtual contraceptive counseling, highlighted challenges with confidentiality, and expressed concern about the inability to provide the full range of contraceptive methods through telehealth alone.
It's critically important to consider who is unable to use telemedicine. There is a digital divide along socioeconomic, racial/ethnic, and geographic lines. Structural disparities made worse by the pandemic impact access to birth control. Early pandemic evidence points to increased barriers among low-income and BIPOC populations. Many patients, including those living in crowded housing, may lack an internet connection or the privacy needed for telemedicine. It’s important not to make assumptions about how patients want to get care, which may be in-person at a clinic.
While telemedicine approaches are promising, person-centered contraceptive care requires in-person visits as well. There may be financial pressures to reduce in-person visits, however access to clinics can be important for hard-to-reach patients and to address related sensitive health needs. Going forward, we need to explore further the health equity implications of telemedicine for contraceptive services and to understand how other new service models can help augment contraceptive access outside of clinical hours.
