EXECUTIVE SUMMARY

Women continue to need access to reproductive health services during a pandemic that is causing American society to shut down, limiting options.

  • Many clinics have to restrict on-site services to emergency care.
  • Family planning providers can practice telemedicine and offer video visits.
  • Providers can give patients prescriptions for several months in advance.

The COVID-19 pandemic has affected every aspect of American life, including nonemergency doctor visits. But from a family reproductive health point of view, the consequences of weeks of social distancing and quarantines can present new challenges.

For instance, too little is known about the transmission of the virus to pregnant women and women who are breastfeeding. Also, people seeking sexual and reproductive healthcare and contraceptive services could face even greater economic and social hurdles than before.

Women facing weeks or even months of being homebound might wish to have a three-month supply of contraception or switch to an intrauterine device (IUD), but the closing of nonessential businesses in various states and cities might make it more difficult for women to access safe contraception when their current supply is exhausted.

“Access to contraception is essential healthcare for women of reproductive age, but many clinics are having to restrict on-site services to emergency care,” says Julie Rabinovitz, MPH, president and chief executive officer of Essential Access Health in Berkeley, CA. “Title X providers in California are exploring and implementing a variety of strategies to best support the family planning needs of their patients and making adjustments based on guidance from local health authorities.”

For example, a Bay Area provider had to temporarily close because of shelter-in-place orders in that county. “They posted information on their doors referring patients to other providers in their area that are still offering services, including emergency contraception and STD treatment,” Rabinovitz says. “Other providers are offering family planning visits and providing contraception/emergency contraception refills by phone, and they’re considering doing drive-through options for receiving contraceptive injections.”

Is Supply Chain Affected?

Another issue involves the supply of contraceptives. International reports suggest that contraceptives manufactured in Asia could be in low supply as many factories were closed during China’s COVID-19 outbreak.

But there is no evidence that the pipeline for the delivery of contraceptive products is compromised or will be, said Michael S. Policar, MD, MPH, professor emeritus of obstetrics, gynecology, and reproductive sciences at the University of California San Francisco School of Medicine. Policar spoke at the National Family Planning & Reproductive Health Association National Conference, held March 8-10, 2020, in Washington, DC. Policar provided a COVID-19 resource list for reproductive health providers and others to access. (The list is available online at: https://www.nationalfamilyplanning.org/file/2020-national-conference/NFPRHA-Resource-List-COVID-19-Links-3.5.2020.pdf.)

“I understand that this is a theoretical concern for certain drugs, but there is no reason to be concerned at this point,” Policar explained. “The essential ingredients in hormonal contraceptives are estrogen and progestins, plus inert binders and coloring, in the case of tablets. My understanding is that the major source of manufacture of these hormones is not China, but other parts of the world.”

More concerning, family planning centers could lose staff due to personal illness, self-isolation, or the need to care for someone who is quarantined or out of work or school, Policar noted. “Family planning clinics were stretched thin for adequate staffing, especially by nurse practitioners and other clinicians, before the outbreak occurred. This will make it far worse,” he said.

Mitigation tactics include:

  • Phone triage. “Clinics can phone triage patients before a scheduled visit to determine whether the visit can be done by telephone visit, or synchronous or asynchronous telemedicine,” Policar said.
  • Advance prescription. Giving patients advance provision or prescriptions for contraceptive products also could help people get through the social distancing/isolation period.
  • Postponing services. Clinics could postpone elective services, including well-woman visits, until the summer or later, Policar noted.

Telehealth is especially important in this time of distancing. “The need for social distancing has brought to light the need to expand access through a broad range of modalities,” Rabinovitz says. “Enhancing provider capacity to deliver services through telehealth is critical.”

For instance, Medicaid and other payers could cover telehealth services. “In California, we successfully advocated for the Medi-Cal [state Medicaid program] and the Family PACT programs to cover and reimburse services delivered through telehealth platforms,” Rabinovitz says. “Providers need additional technical assistance and funding to more fully integrate the provision of sexual and reproductive healthcare through telehealth into their practice.”

California also passed legislation to cover all methods of birth control without cost-sharing or restrictions. Public and private health plans must cover a 12-month supply of self-administered hormonal contraceptives furnished at one time, she says.

“Pharmacists are also allowed to dispense the pill, patch, and ring without a prescription,” Rabinovitz adds. “It’s important for more states to follow suit and for California to continue building on these successes in the coming year.”

Condoms and emergency contraceptives also could be made more readily available during the pandemic crisis. But one contraceptive that might not be as easily handled during this period is the IUD. Family planning clinics that are limited to providing only emergency services will not be able to schedule appointments for IUDs until the crisis is over.

“There won’t be a whole lot of providers inserting IUDs right now,” Rabinovitz says.

If there is an increased demand for IUDs, the industry can meet that demand now and in the future, Policar said.

“The problem is not access to an insertion kit for an IUD or implant,” he explained. “It’s having a family planning or primary care clinic that is open for business, with adequate staffing by qualified clinicians, to perform same-day placements.” It is a staffing challenge, not a hardware problem, he added.