Research suggests that many women have been unwilling to become pregnant and start or increase their families during the COVID-19 pandemic, but they sometimes have faced new contraceptive barriers.1
Beginning in May 2020, researchers recruited reproductive-age women through social media, including Facebook and Instagram, to answer questions about their economic status and pregnancy intentions before and during the pandemic.
“The study took place when everyone started sheltering in place and everything was chaotic,” says Tracy Kuo Lin, PhD, MSc, the study’s lead author and assistant professor of health economics for the Institute for Health and Aging at the University of California, San Francisco. “We asked women specific questions about their economic situation and family planning and pregnancy intentions during the early part of the pandemic.”
The researchers asked women about these factors, both before and during the pandemic:
- Demographics, including age, race/ethnicity, relationship status, number of children, household size, income, state of residence, and employment status;
- Ability to afford food, transportation, and housing;
- Their risk of severe illness from COVID-19 due to comorbid health conditions, such as asthma, heart conditions, lung disease, diabetes, liver disease, immunocompromised status, and dialysis;
- How concerned they were about contracting COVID-19 and the status of their location’s shelter-in-place orders;
- Pregnancy intention/desires, based on the Desire to Avoid Pregnancy scale;
- Contraceptive use, including type of contraceptive, frequency of use in the past three months, and how contraception access was affected by the pandemic;
- Frequency of sexual intercourse in the past 30 days, if they chose to have sex, and why they had sex if it was not their choice.
“We wanted to capture the situation from before and after the pandemic began,” Lin says.
Investigators analyzed respondents’ household income to see if it fell below or above the federal poverty level (FPL). They also asked respondents to indicate how they felt about becoming pregnant and how their desire to bring a child into the world changed during the pandemic.
“We found that there was an increase in food insecurity,” she says. “We also found that those who expressed a reduction in desire to be pregnant also experienced difficulties in accessing contraceptives.”
It turned out that some vulnerable groups of women experienced a reduction in income and a desire to avoid pregnancy, but they had difficulty accessing contraceptives. “It’s a really bad place where you know you have economic difficulties in supporting a child, as much as you want,” Lin says. “You may have lost money in the pandemic and may have a reduced income in the pandemic, but you are having issues accessing contraception, and that includes a barrier to doctor’s appointments or lost healthcare because of the lost employment.”
At the end of the survey, researchers asked women if there was anything else they wanted to share. This elicited some surprising responses.
“Usually, people skip that question, but a lot of women wrote paragraphs about their experience,” Lin says. “They were using contraceptives before the pandemic and were employed with health insurance, and then they lost their job and insurance and were having difficulty paying for the contraceptives they were using prior to the pandemic.”
Some women explained their difficulties making appointments with providers to change their contraceptive method or to have an IUD inserted or removed.
“We also found that there was a disproportionate impact on people of color in the pandemic,” Lin notes. “Those who identified as Latina or African American were more likely to experience difficulty with transportation, food, and housing during the pandemic.”
Based on the data, people who were more vulnerable, including minorities, experienced economic insecurity and barriers to accessing contraceptives even though they wanted to avoid pregnancy.
Some of the women worried about bringing a child into the world during the pandemic — or ever.
“One woman shared, ‘I was about 90% sure I did not want to have children prior to the pandemic. But seeing everything going on with quarantine and the inability to have school and child care and the loss of jobs, plus greater health risk of the pandemic, have solidified any doubt in my mind that I might want to have children,’” Lin says.
Other women expressed concern about their current pregnancies. “One woman wrote, ‘It has been rough being in a state lockdown so close to giving birth, on top of depression and anxiety. I felt so terrified and still do about the current state of everything, and it has made me feel guilty about bringing children into the world at this scary time,’” Lin says.
Women shared feelings of being alone. One woman even said that she found it oddly comforting to take part in the survey because it made her feel as though someone outside of her family cared about her. “It was heartbreaking and difficult reading this at the start of the pandemic,” Lin says.
Using quantitative analysis, researchers assessed respondents’ desire to avoid pregnancy. One in four respondents expressed a decreased desire to become pregnant. But close to one in six respondents said they had difficulty accessing contraceptives.
Women also had unmet reproductive health concerns during the pandemic. One woman said, “‘When under extreme stress, my body tends to internalize it, and my menstrual cycle is off the normal pattern by either skipping a period or having an extra heavy flow,’” Lin recalls.
“She said, ‘I haven’t had my periods since the end of February. As a precaution, I took two pregnancy tests last week, and both were negative. I’m curious — are there any other women experiencing this as well?’” Lin adds.
Almost half of the respondents experienced a loss of income during the pandemic compared to pre-pandemic. The percentage of respondents who said they could not afford basic living needs doubled during the pandemic from 8% to 16%.
Respondents found it harder to obtain a contraceptive prescription or to have a long-acting reversible contraceptive placed, Lin says.
There were some positive reports from the respondents. For example, some women said they received assistance from nonprofit organizations and social networks for their economic needs. “They had commented on how local food banks and community assistance played a huge role in easing food insecurity,” Lin says. “Family planning clinics that offered free healthcare in the pandemic helped them a lot, and some family planning clinics were willing to treat UTIs [urinary tract infections] for free.”
While these community and nonprofit organizations did not completely fill the economic and healthcare gap, they helped a little.
“We really need a healthcare system and health insurance that is not tied to employment, because often when employment goes, people need more healthcare,” Lin says. “In dire situations, people need more care.”
- Lin TK, Law R, Beaman J, Foster DG. The impact of the COVID-19 pandemic on economic security and pregnancy intentions among people at risk of pregnancy. Contraception 2021;S0010-7824(21)00030-5.