Assessing differences in contraceptive provision through telemedicine among reproductive health providers during the COVID-19 pandemic in the United States

Abstract

Background Providers faced challenges in maintaining patient access to contraceptive services and public health safety during the COVID-19 pandemic. Due to increased barriers to care, providers increasingly used telemedicine for contraceptive care, curbside services, mail-order pharmacies, and on-line or home delivery of contraceptive methods, including self-administration of subcutaneous depo medroxyprogesterone acetate (DMPA-SQ). To better understand how reproductive health providers adapted service provision during the pandemic, this study assessed clinical practice changes and strategies providers adopted throughout the United States to maintain contraceptive care, particularly when clinics closed on-site, and the challenges that remained in offering contraceptive services, especially to marginalized patient populations. Methods We surveyed U.S. providers and clinic staff (n = 907) in April 2020–January 2021, collecting data on contraceptive service delivery challenges and adaptations, including telemedicine. We assessed clinical practice changes with multivariate regression analyses using generalized linear models with a Poisson distribution and cluster robust standard errors, adjusting for clinic patient volume, practice setting, region, Title X funding, and time of survey. Results While 80% of providers reported their clinic remained open, 20% were closed on-site. Providers said the pandemic made it more difficult to offer the full range of contraceptive methods (65%), contraceptive counseling (61%) or to meet the needs of patients in marginalized communities (50%). While only 11% of providers offered telemedicine pre-pandemic, most offered telemedicine visits (79%) during the pandemic. Some used mail-order pharmacies (35%), curbside contraceptive services (22%), and DMPA-SQ for self-administration (10%). Clinics that closed on-site were more likely to use mail-order pharmacies (aRR 1.83, 95% CI [1.37–2.44]) and prescribe self-administered DMPA-SQ (aRR 3.85, 95% CI [2.40–6.18]). Clinics closed on-site were just as likely to use telemedicine as those that remained open. Among clinics using telemedicine, those closed on-site continued facing challenges in contraceptive service provision. Conclusions Clinics closing on-site were just as likely to offer telemedicine, but faced greater challenges in offering contraceptive counseling and the full range of contraceptive methods, and meeting the needs of marginalized communities. Maintaining in-person care for contraceptive services, in spite of staffing shortages and financial difficulties, is an important objective during and beyond the pandemic.

Perceived Access to Contraception via Telemedicine Among Young Adults: Inequities by Food and Housing Insecurity

“…Health care providers turned to telemedicine to an unprecedented degree to preserve access to reproductive health care during the COVID-19 pandemic. 27 – 29 However, nearly one-quarter of young adults in this study perceived that it would be difficult for them to use telemedicine for contraception. Young adults who were food and housing insecure were particularly likely to perceive limited access to telemedicine for contraception.…”

Associations between unfulfilled contraceptive preferences due to cost and low-income patients’ access to and experiences of contraceptive care in the United States, 2015–2019

“…More research is needed to understand broad contraceptive preferences that go beyond cost considerations and which take into account other factors related to access that may constrain or support people in realizing contraceptive preferences, such as the legacy of racism and xenophobia and discrimination in health care settings [ 26 , 27 ]. Finally, given the COVID-19 pandemic and the resulting impacts on both the delivery of contraceptive care [28] , [29] , [30] and in delays in access to this care [31] , our study highlights the importance of continuing to support evolutions in the health care system that ensure a broad range of contraceptive options are available to enable individuals to realize their contraceptive preferences regardless of site of care or method cost.…”

Financial Instability and Delays in Access to Sexual and Reproductive Health Care Due to COVID-19

“…It is probable that uncertainty and fear regarding COVID-19 transmission played a role in individuals' delayed access to SRH care. 1 Other likely sources of these COVID-19-related access issues seem to be better situated at the health center level, related to clinic shutdowns, staffing shortages, reduced focus on SRH care, and pivots to pandemic-related care, 4–6 and thus solutions to addressing these delays should target these health center-level challenges to reduce impact for patients. During the COVID-19 pandemic and the ensuing delays in accessing SRH care and contraceptive methods, this study documents health care providers offering these services worked to make care more accessible, including offering more virtual and telehealth options for connecting with a health care provider and getting a method.…”

“…However, while the pandemic has affected individuals' desires regarding pregnancy, so too has it impacted how sexual and reproductive health (SRH) care are provided. SRH care providers reported a range of disruptions in how they were able to provide contraception to their patients, including postponing intrauterine device insertions or Depo-Provera ® appointments, 4 , 5 shifting staff away from SRH care toward COVID-related care, and reducing clinic hours or stopping in-person SRH care altogether. 6…”

“…7 , 8 Notably, some providers of SRH care nimbly pivoted in how they provided contraceptive care and methods to their patients, including changes such as establishing virtual/telehealth alternatives for appointments or getting methods to patients in innovative ways such as by mail or parking lot pickups. 4 , 6 , 9 , 10…”