Patients Experienced Contraceptive Access Barriers During Early Pandemic
Researchers focused on New York
New research revealed that half of pregnancy-capable people in New York faced barriers to obtaining contraception in the summer of 2020.
- People who missed rent or mortgage payments were more likely to experience delays and barriers to obtaining contraceptives.
- Out-of-pocket costs can be a barrier to patients receiving contraception care, even for people whose insurance covers contraceptives.
- Telemedicine could eliminate the barrier of transportation costs.
Half of people capable of becoming pregnant reported difficulty accessing contraception in June and July 2020. Most attributed their delays to the COVID-19 pandemic, a new study of 1,525 New York state residents revealed.1
“The findings are not generalizable to all pregnancy-capable people, but it stands to reason that delays to obtaining contraception were likely pervasive during the first part of the pandemic in this country,” says Meredith Manze, PhD, MPH, assistant professor in the City University of New York Graduate School of Public Health and Health Policy.
At the beginning of the pandemic, some people postponed their pregnancy desires. This highlights the importance of making contraceptives available to people who want to maintain control of their reproductive lives, even under trying conditions.
“We need to find ways to address the barriers of obtaining contraception that is needed now and after the pandemic subsides,” Manze says.
Manze and colleagues recruited female and transgender male New York residents, ages 18 to 44 years. They focused on people who were not pregnant and who wanted contraception.
“We wanted to look at various factors related to contraception in looking at groups at risk,” Manze says.
The researchers found that people who missed rent or mortgage payments or who received government support before the pandemic were more likely to face delays and barriers to obtaining their contraceptives. Of the people who missed a rent or mortgage payment, 56% reported a delay in obtaining contraception because of the pandemic. Of those who did not miss a rent or mortgage payment, 31% reported a delay in obtaining contraception.
“Also, those who had COVID themselves, or had someone in their house who had COVID, were more likely to report delays in getting contraception because of COVID,” Manze says. “This was a survey-based study. Qualitative work probably is needed to explore more about the causes of the delays.”
Future questions could focus on these barriers:
- Did some providers not offer contraceptives in the early months of the pandemic?
- Were people less able to afford contraceptives because of the pandemic and its effect on employment?
- Was it more challenging for people to travel to the doctor’s office?
- Were some people uncomfortable with or unable to access telemedicine?
“Financial insecurity has always been associated with a lack of access to contraception, but during the pandemic, was it heightened?” Manze asks.
Researchers asked those who reported a delay in obtaining contraception because of COVID-19 what type of contraceptive they used. The methods most frequently reported were new prescriptions or refills for the pill, patch, or ring.
“That could be a function of those being more frequently used methods,” Manze says.
Of people with new prescriptions, 42% said they experienced a delay. Of those with refills, 28% reported a delay.
Nineteen percent of people who sought an insertion, replacement, or removal of an intrauterine device or implant also reported delays.
“We asked about availability of telemedicine appointments for birth control, and it appears that most had telemedicine visits available, but about one-third of those who needed a new prescription either did not have it available or were unsure,” Manze says. “That’s one area where there’s a potential to help offer telemedicine access and help people with availability for those who can afford it.”
The data suggest the benefits of telemedicine visits, especially for contraception care.
“The virtual health visit is conducive to filling a prescription for contraceptives,” Manze explains.
Virtual contraceptive care is helpful, but it is not the only solution to access challenges.
“It’s not a panacea for access to contraception because there are other barriers in terms of people not feeling comfortable or safe discussing those things with a provider and whoever else is in their living area,” Manze adds. “Also, there are financial barriers of not being able to afford contraception itself or copays for visits.”
Other measures should be taken in tandem with expanding telemedicine contraceptive care. For instance, although many people have insurance that covers contraceptives, other costs can create barriers to care. There are copays, travel costs to clinics, and time constraints among people who work long hours and have difficulty obtaining child care for doctors’ visits.
“Telemedicine visits could address one barrier — eliminating transportation costs,” Manze says. “There’s still a lot to know about why those with financial insecurity had more delays due to COVID.”
It could be that if they had to prioritize spending $5 on transportation or a copay vs. using the money for food for their children, they would choose food.
“We need more things like loosening up some of the restrictions on contraception in terms of people being allowed to do prescription refills for a full year and dispensing several months of contraceptives at a time, or dispensing from the pharmacist directly,” Manze suggests. “All of these can expand access, especially during a pandemic when it felt unsafe to leave your house.”
- Manze M, Romero D, Johnson G, Pickering S. Factors related to delays in obtaining contraception among pregnancy-capable adults in New York state during the COVID-19 pandemic: The CAP study. Sex Reprod Healthc 2022;31:100697.
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