Telehealth Contraception Is an Option for Victims of Violence
Patients who experienced intimate partner violence (IPV) reported favorable outcomes for both telehealth contraceptive care and IPV services.1
Studies that focused on the experiences of more than 1,700 women and adolescents found no differences between the group that received supplemental phone counseling and the group that received usual care. Both groups reported similar rates of contraceptive use, sexually transmitted infections (STIs), pregnancy, and abortion.1-3
“Our goal was to conduct a systematic review of evidence to evaluate the instance of telehealth for specific women’s experiences,” says Amy G. Cantor, MD, MPH, an associate professor in the department of medical informatics and clinical epidemiology at Oregon Health & Science University. “Reproductive health — contraception, family planning, and STI testing and counseling — were selected because they are amenable to telehealth services.”
Telehealth was of great interest to researchers during the pandemic when increasing numbers of women sought tele-contraception visits with providers. “We did a systematic review of evidence to evaluate effectiveness of telehealth services in the context of the pandemic and included eight randomized controlled trials, one non-randomized trial, and seven observational studies,” says Cantor, a core investigator of the Pacific Northwest Evidence-Based Practice Center. “We found that when telehealth is used as a supplement to in-person care or as a replacement to in-person care, the outcomes are [the same as] in-person care.” Contraceptive counseling by phone results in the same rates of STIs, pregnancy, and other outcomes as in-person care, she adds.
From a clinician’s perspective, this means they can be assured that patients will receive the same quality of care, whether they meet with the patient through a telehealth visit or in person.
“Telehealth for contraceptive care is becoming more common, and it’s associated with high acceptability,” Cantor says. “If we can offer this care effectively, using telehealth modalities, this is removing a barrier to care. Be mindful of those who may not have the resources or access to certain telehealth modalities.”
The study’s findings do not suggest that clinicians should not offer in-person clinic visits, but it shows that providers could offer patients a choice of either in-person or telehealth visits because they work equally well. “The delivery of care and the way it’s delivered does not change the outcome and use of contraception,” Cantor says.
Cantor and colleagues also evaluated telehealth interventions and services for people who experienced IPV. They looked at whether patients experienced any differences in depressive symptoms, post-traumatic stress disorder, fear of their partner, and coercive control when they received care in person vs. via telehealth services.
“For all of those outcomes, there were no differences between the participants who received services for IPV using a telehealth modality, phone, or some other way to engage with them,” Cantor says.
The trials did not evaluate patients’ preferences or choices for telehealth interventions for IPV.1 “We looked at studies that looked at contraception care and effectiveness and separate questions for IPV,” Cantor explains. “Certainly, you could think about the relationship, but they were evaluated separately.”
Safety Measures Are Needed
As long as safety measures were in place, and patients with a history of IPV had a private space, they felt comfortable using these modalities. “If you offer telehealth counseling, have safe spaces in place,” Cantor suggests. “Make sure those types of visits, whether through the telephone or an interactive tool on a website, are being utilized in a way that makes people feel safe and protected, and it doesn’t put them at more risk.”
Reproductive health providers can keep this in mind when treating patients who are victims of IPV or who are at risk of IPV. “All women should be screened routinely — at least annually — for intimate partner violence,” Cantor says. “You want to normalize [screening] and make sure women feel like they are in a safe space, regardless of the environment.”
One evidence-based method is the Woman Abuse Screening Tool, which uses two quick questions. If the patient’s answers indicate a problem, there are follow-up questions.4,5
“Depending on a clinic’s preference, you would want to use a validated tool for screening [that is] shown to be effective,” Cantor says.
Telehealth is an important tool for reproductive health providers to have available. “The barriers to telehealth would be about safety and knowing patients felt comfortable in spaces where they are asked about something really personal,” Cantor says. “Think about language, age, equity, accessibility, and telehealth feels important.”
It is important to ensure safety measures are in place and privacy is prioritized and recognized. “Overall, we have an initial sense that telehealth can offer an important and equal alternative to in-person care,” Cantor adds.
- Cantor AG, Nelson HD, Pappas M, et al. Telehealth for women’s preventive services for reproductive health and intimate partner violence: A comparative effectiveness review. J Gen Intern Med 2023 Jan 17;1-9. doi: 10.1007/s11606-023-08033-6. [Online ahead of print].
- Berenson AB, Rahman M. A randomized controlled study of two educational interventions on adherence with oral contraceptives and condoms. Contraception 2012;86:716-724.
- Kumar U, Pollard L, Campbell L, et al. Specialist follow-up contraceptive support after abortion — impact on effective contraceptive use at six months and subsequent abortions: A randomised controlled trial. PLoS One 2019;14:e0217902.
- Arkins B, Begley C, Higgins A. Measures for screening for intimate partner violence: A systematic review. J Psychiatr Ment Health Nurs 2016;23:217-235.
- MD CALC. Woman Abuse Screening Tool (WAST). 2023.