Financial Problems, COVID-19 Tied to Contraceptive Delays
NEW YORK (Reuters Health) – Women and transgender males in New York State who missed a rent or mortgage payment, participated in a government program, or had COVID-19 were more likely to experience delays in accessing contraception in a new study.
“Given barriers to obtaining sexual and reproductive healthcare during the pandemic as well as increased desires to postpone pregnancy, patients’ ability to access contraception and maintain control over their reproductive lives is imperative,” Dr. Meredith G. Manze of the City University of New York Graduate School of Public Health and Health Policy told Reuters Health by email.
The findings may help public-health professionals better understand factors associated with delays to obtaining contraception and enable clinicians to better identify and serve groups at risk of unmet needs for contraception, Dr. Manze and colleagues suggest in Sexual & Reproductive Healthcare.
Between June and July 2020, Dr. Manze and researchers administered a cross-sectional, web-based survey of female and transgender male New York State residents aged 18 to 44. The analysis focused on 953 pregnancy-capable respondents who were not pregnant and were seeking contraception.
Half of the survey respondents reported no contraceptive delays during the pandemic. The rest reported delays due to COVID-19 (39%) or other reasons (11%). Adjusted analyses showed that respondents were significantly more likely to report delays to contraception access due to COVID-19 if they had missed a rent or mortgage payment during the pandemic (adjusted odds ratio, 2.23), participated in a supplemental government program in 2019 (aOR, 1.88), or if they or a household member had COVID-19 (aOR, 1.48).
In a subsample of 317 people who reported COVID-19 as a reason for contraception delays, approximately 63% reported that virtual contraceptive visits were available, while 28% reported unavailable visits and 9% were unsure about the availability of virtual visits. In 42% of respondents, reported delays were related to new prescriptions for the pill, patch, or ring.
Dr. Manze said healthcare and public-health institutions should prioritize ensuring access to contraception during pandemics and other crises.
“Potential solutions include offering and promoting telemedicine visits, allowing prescription refills for a full year, dispensing several months’ supply at a time, and allowing for the provision of contraception from pharmacies or online companies,” she said.
Dr. Lauren Owens, an assistant professor of obstetrics and gynecology at the University of Michigan Medical School, in Ann Arbor, said the findings suggest clinicians should try to meet patients “where they are” and ensure they have access to evidence-based contraceptive care.
Aside from measuring blood pressure, Dr. Owens told Reuters Health by email, initiating or continuing many contraceptive methods does not require an in-person visit.
“In addition to offering virtual visits, clinicians can counsel patients to check their blood pressure at the pharmacy when picking up their birth control,” said Dr. Owens, who was not involved in the new research. “If their blood pressure is elevated, patients can reach out to their healthcare provider to discuss methods that are more suitable for them.”
Echoing Dr. Manze, Dr. Owens suggests that insurance plans could consider covering more than a month’s supply of birth control at a time to reduce the number of trips people make to the pharmacy.
“Some states have legislation ensuring that insurance plans cover a 12-month supply of contraception,” she said. “Ensuring that patients have access to contraceptive methods with minimal co-pay or out-of-pocket cost could improve contraceptive care access.”
Dr. Owens added that even when the pandemic abates, there will still be structural inequities influencing who can access contraceptive care and other types of reproductive healthcare. “We owe it to marginalized groups who face disproportionate barriers to care to identify and deconstruct those barriers in pursuit of more equitable healthcare,” she said.
SOURCE: https://bit.ly/3LD6i4N Sexual & Reproductive Healthcare, online February 5, 2022.
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