Exploring the Impact of Covid-19 on Contraceptive Access
By Lisa Stern
The Covid-19 pandemic has disrupted every facet of daily life, from how we work and learn to how we connect with our family and friends. Healthcare delivery is no exception. Healthcare providers and systems have widely expanded telehealth services to deliver care safely while facing immense decreases in demand and revenue. At the same time, the pandemic has highlighted deep-rooted inequities as communities of color bear the brunt of the impact, both of the virus itself and of resulting economic stresses.
Like all aspects of healthcare, contraceptive access has faced changes and challenges due to Covid-19. Sexual and reproductive health care swiftly moved online, and clinical protocols were adapted to enable less contact – and thus less risk of infection – between health care professionals and patients. Beyond clinical care delivery, deeper aspects of how people think about their reproductive desires, their own futures and those of their families, and their personal and communal stability have shifted. The pandemic stands to affect all of this and more.
Given the multiple changes rapidly unfolding, CECA convened a series of two interdisciplinary strategic discussions on Covid-19 and contraception in October 2020. The purpose of these meetings was to bring together researchers, policy advocates, healthcare delivery experts, clinicians, and community representatives to share learnings, including early research findings; to elucidate common trends; and to identify potential implications for policy and research. This blog post summarizes the major themes discussed and priority implications.
Overall, participants expressed that many of the trends observed in contraceptive care and research were present prior to Covid-19, and were intensified or made more visible in the pandemic. Discussion themes included:
Systems for research and clinical care delivery are poorly-equipped to meet the needs of those experiencing access barriers, including immigrants, people of color, adolescents, and LGBTQ+ people.
The challenges of recruiting important groups for research are exacerbated by limited resources, competing priorities, privacy concerns, and experiences of discrimination within and beyond the health care system.
There is a need to shift definitions of data collection, service provision, and providers.
Rapid initiation of research projects and adaptation of systems is enabled by established partnerships and existing resources (e.g., studies already in progress, staff in place).
Care delivery has been focused on a shift to telehealth, but important questions remain, including: adequacy of reimbursement; the impact of “digital divide” on access; safety for adolescents, people experiencing intimate partner violence (IPV), and others with privacy concerns; and patient and provider experience of telehealth and availability of telehealth technology.
These themes and trends, in turn, suggested a few important take-aways for decisionmakers, including policymakers, funders, and organizational leaders:
Support access to contraception as a fundamental right and part of a broader range of health services that remains even during time of crisis.
Envision and support research that is timely, responsive to the issues at hand, able to capture disruption in services (e.g., longitudinal), and aligned with policies/practices/values/community needs.
Prioritize telehealth as fundamental shift in healthcare infrastructure that requires new investment, innovation.
Center the patient experience by conducting research that addresses patient preferences to inform provider practices, reimbursements, coverage, waivers, etc.; and convening discussions to establish policies, practices, infrastructure around telehealth to ensure patient needs are met.
Remove harmful policies that increase access barriers (e.g., waiting periods for immigrants to access Medicaid, CHIP).
Support provider stability (e.g., general funding, reimbursement rates, shoring up across all SRH services, make waivers that allow providers to alter services permanent, funding for technological infrastructure).
While common understandings emerged, many ongoing questions remain, some of which will be answered by current research projects. CECA is committed to monitoring emerging data and ongoing experiences of patients, providers, and community-based organizations. We will reconvene this group of thought leaders in 2021 and integrate these learnings into our work at CECA.