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Hall B, Evans TA, Atrio JM, Danvers AA. Social Determinants of Health and Patient-Reported Difficult Discontinuation of Long-Acting Reversible Contraception. J Womens Health (Larchmt) 2024. [PMID: 39034886 DOI: 10.1089/jwh.2023.0857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person's reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one's entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.
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Affiliation(s)
- Bianca Hall
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas A Evans
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA
| | - Jessica M Atrio
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Antoinette A Danvers
- Division of Complex Family Planning, Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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Marcelino AC, da Cunha Pereira P, Charles CM'P, Bahamondes L. A particular epidemiological profile: disparities in access to contraceptive methods in Brazil during the SARS-CoV-2 (COVID-19) pandemic. Sci Rep 2024; 14:14982. [PMID: 38951554 PMCID: PMC11217427 DOI: 10.1038/s41598-024-65946-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
Our objective was to study disparities in access to contraception during the COVID-19 pandemic. We performed a cross-sectional study at the University of Campinas, Brazil using a Google questionnaire applied from December 2021 until February 2022, disseminated via snowball technique. The survey asked about sociodemographic characteristics and contraceptive use, as well as the demand for new methods and difficulties in continuing to use contraceptives during the COVID-19 pandemic. We analyzed 1018 completed questionnaires; in total, 742 (72.9%) were women aged between 20 and 39 years, 746 (73.3%) were White and 602 (59.2%) used contraceptives. During the COVID-19 pandemic, about 23% of respondents changed their method and approximately 20% of respondents looked for new methods. Among the latter, 31.3% reported some difficulty with obtaining guidance on new methods while only 5.3% of the respondents reported some difficulty with continuing their contraceptive. The main difficulty in both cases was the difficulty with getting a healthcare provider appointment. Our results point to a particular epidemiological population, of younger black and biracial women, with lower education and lower income, which suffered health disparities during the COVID-19 pandemic and found difficulties with using contraceptives and accessing family planning services.
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Affiliation(s)
- Ana C Marcelino
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - Paula da Cunha Pereira
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - Charles M 'Poca Charles
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Caixa Postal 6181, Campinas, SP, 13084-971, Brazil.
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3
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Harper CC, Yarger J, Mangurian C, Hopkins K, Rossetto I, Elmes S, Hecht HK, Sanchez A, Hernandez R, Shokat M, Steinberg JR. Mental Health Distress and Delayed Contraception Among Older Adolescents and Young Adults. J Womens Health (Larchmt) 2024; 33:870-878. [PMID: 38465503 PMCID: PMC11302189 DOI: 10.1089/jwh.2023.0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background: Symptoms of mental distress increased sharply during the COVID-19 pandemic, especially among older adolescents and young adults. Mental health distress may make it more challenging for young people to seek other needed health care, including contraception. This study explored the association of symptoms of depression, anxiety, and stress with delays in getting a contraceptive method or prescription. Materials and Methods: Data from a supplementary study (May 15, 2020-March 20, 2023) to a cluster randomized trial in 29 sites in Texas and California were used. The diverse study sample included community college students assigned female at birth of ages 18-29 years (n = 1,665 with 7,023 observations over time). We measured the association of depression (CES-D [Center for Epidemiologic Studies Depression Scale]) or anxiety and stress (DASS-21 [Depression Anxiety Stress Scales]) symptoms with delayed contraceptive care-seeking with mixed-effects multivariable regression with random effects for individual and site. We controlled for age and sociodemographic factors important for access to care. Results: Over one-third of participants (35%) reported they delayed getting the contraceptive method they needed. Multivariable regression results showed increased odds of delayed contraceptive care among participants with symptoms of depression (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.27-1.96). Likewise, delays were associated with anxiety and stress symptoms (aOR 1.46, 95% CI 1.17-1.82). Adolescents were more likely to delay seeking contraception than young adults (aOR 1.32, 95% CI 1.07-1.63). Conclusions: Results showed a strong association between mental distress and delayed contraception. Interventions are needed to increase contraceptive access for young people delaying care, along with supportive mental health care services, including for adolescents who face elevated odds of delay. ClinicalTrials.gov Identifier: NCT03519685.
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Affiliation(s)
- Cynthia C. Harper
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Jennifer Yarger
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Christina Mangurian
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, School of Medicine, University of California, San Francisco, California, USA
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Irene Rossetto
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Sarah Elmes
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Hannah K. Hecht
- Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive Health, School of Medicine, University of California, San Francisco, California, USA
| | - Audrey Sanchez
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | | | - Mitra Shokat
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Julia R. Steinberg
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
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4
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Yarger J, Hopkins K, Elmes S, Rossetto I, Van Liefde D, De La Melena S, Harper CC. Use of telemedicine to obtain contraception among young adults: Inequities by health insurance. Contraception 2024; 134:110419. [PMID: 38467325 PMCID: PMC11191717 DOI: 10.1016/j.contraception.2024.110419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/19/2023] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES The objective of this study was to describe the use of telemedicine for contraception in a sample of young adults and examine differences by health insurance coverage. STUDY DESIGN We analyzed survey data collected from May 2020 to July 2022 from individuals at risk of pregnancy aged 18 to 29 recruited at 29 community colleges in California and Texas. We used multivariable mixed-effects logistic regression models with random effects for site and individual to compare the use of telemedicine to obtain contraception by insurance status, sociodemographic characteristics, and state. RESULTS Our analytic sample included 6465 observations from 1630 individuals. Participants reported using a contraceptive method obtained through telemedicine in just 6% of observations. Uninsured participants were significantly less likely than those privately insured to use contraception obtained through telemedicine (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.31-0.97), as were participants who did not know their insurance status (aOR, 0.54; 95% CI, 0.29-0.99). Texas participants were less likely to use contraception obtained via telemedicine than those in California (aOR, 0.42; CI: 0.25-0.69). CONCLUSIONS Few young people in this study obtained contraception through telemedicine, and insurance was crucial for access in both states. IMPLICATIONS Although telemedicine holds promise for increasing contraceptive access, we found that few young adults were using it, particularly among the uninsured. Efforts are needed to improve young adults' access to telemedicine for contraception and address insurance disparities.
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Affiliation(s)
- Jennifer Yarger
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States.
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, TX, United States
| | - Sarah Elmes
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Irene Rossetto
- Population Research Center, University of Texas at Austin, Austin, TX, United States
| | - Danielle Van Liefde
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Stephanie De La Melena
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Cynthia C Harper
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, United States
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5
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Dozier JL, Burke AE, McMahon HV, Berger BO, Quasebarth M, Sufrin C, Bell SO. "Maybe if we weren't in the pandemic, I would have reconsidered": Experiences of abortion care-seeking during the COVID-19 pandemic in Maryland. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:124-135. [PMID: 38655782 DOI: 10.1111/psrh.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To understand the COVID-19 pandemic's impact on abortion care-seeking in Maryland, a state with Medicaid coverage for abortion, high service availability, and laws supporting abortion rights. METHODS We conducted semi-structured telephone interviews with 15 women who had an abortion between January 2021 and March 2022 at a hospital-based clinic in a mid-sized Maryland city. We purposively recruited participants with varied pandemic financial impacts. Interview questions prompted participants to reflect on how the pandemic affected their lives, pregnancy decisions, and experiences seeking abortion care. We analyzed our data for themes. RESULTS All participants had some insurance coverage for their abortion; over half paid using Medicaid. Many participants experienced pandemic financial hardship, with several reporting job, food, and housing insecurity as circumstances influencing their decision to have an abortion. Most women who self-reported minimal financial hardship caused by the pandemic indicated they sought an abortion for reasons unrelated to COVID-19. In contrast, women with economic hardship viewed their pregnancies as unsupportable due to COVID-19 exacerbating financial instability, even when they desired to continue the pregnancy. All participants expressed that having an abortion was the best decision for their lives. Yet, when making decisions about their pregnancy, the most financially disadvantaged women weighed their desires against the pandemic's constraints on their reproductive self-determination. CONCLUSIONS The pandemic changed abortion care-seeking circumstances even in a setting with minimal access barriers. Financial hardship influenced some women to have an abortion for a pregnancy that-while unplanned-they may have preferred to continue.
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Affiliation(s)
- Jessica L Dozier
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne E Burke
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hayley V McMahon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Blair O Berger
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Madeline Quasebarth
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Suzanne O Bell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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6
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Curtis KM, Kulkarni AD, Nguyen AT, Zapata LB, Kortsmit K, Smith RA, Whiteman MK. Changes in Commercial Insurance Claims for Contraceptive Services During the Beginning of the COVID-19 Pandemic-United States, January 2019-September 2020. Womens Health Issues 2024; 34:186-196. [PMID: 38065719 PMCID: PMC11283820 DOI: 10.1016/j.whi.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 10/08/2023] [Accepted: 10/30/2023] [Indexed: 06/07/2024]
Abstract
OBJECTIVE We describe changes in commercial insurance claims for contraceptive services during the beginning of the COVID-19 pandemic. METHODS We analyzed commercial insurance claims using IQVIA PharMetrics Plus data from more than 9 million U.S. females aged 15-49 years, enrolled during any month, January 2019 through September 2020. We calculated monthly rates of outpatient claims for intrauterine devices (IUDs), implants, and injectable contraception and monthly rates of pharmacy claims for contraceptive pills, patches, and rings. We used Joinpoint regression analysis to identify when statistically significant changes occurred in trends of monthly claims rates for each contraceptive method. We calculated monthly percentages of claims for contraceptive counseling via telehealth. RESULTS Monthly claims rates decreased for IUDs (-50%) and implants (-43%) comparing February 2020 with April 2020 but rebounded by June 2020. Monthly claims rates for injectables decreased (-19%) comparing January 2019 with September 2020, and monthly claims rates for pills, patches, and rings decreased (-22%) comparing July 2019 with September 2020. The percentage of claims for contraceptive counseling occurring via telehealth was low (<1%) in 2019, increased to 34% in April 2020, and decreased to 9-12% in June-September 2020. CONCLUSIONS Substantial changes in commercial insurance claims for contraceptive services occurred during the beginning of the COVID-19 pandemic, including transient decreases in IUD and implant claims and increases in telehealth contraceptive counseling claims. Contraceptive claims data can be used by decision makers to identify service gaps and evaluate use of interventions like telehealth to improve contraceptive access, including during public health emergencies.
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Affiliation(s)
- Kathryn M Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Aniket D Kulkarni
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Antoinette T Nguyen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruben A Smith
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maura K Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Borges ALV, Roman Lay AA, Duarte LS, Chofakian CBDN, Hall JA, Barrett G. Changes in contraceptive use during the second COVID-19 lockdown in Brazil: A web-based survey. Contraception 2024; 131:110359. [PMID: 38159791 DOI: 10.1016/j.contraception.2023.110359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE We assessed contraceptive use changes during the second lockdown due to COVID-19 in Brazil and their associated factors. STUDY DESIGN This was a longitudinal web-based study in which 725 non-pregnant Brazilian women aged 18 to 49 completed an online structured survey about their contraceptive practices in two rounds in 2021. Multivariate multinomial logistic regression was used to analyze factors associated with contraceptive use changes during COVID-19. RESULTS Sixty percent reported they changed their contraceptive use during COVID-19, especially starting to use a method or switching to a more effective one (32%). In adjusted analysis, women who were ambivalent about a future pregnancy were more likely to switch to a more effective method (adjusted odds ratio [aOR] 2.33, 95% CI 1.42-3.83) and to stop using contraceptive (aOR 3.64, 95% CI 1.91-6.91). Women with a partner were less likely to switch to a more effective method (aOR 0.61, 95% CI 0.39-0.93) and to stop using contraceptive (aOR 0.53, 95% CI 0.31-0.93), but more likely to switch to a less effective method (aOR 2.25, 95% CI 1.16-4.34). Age was also associated with contraceptive use changes. CONCLUSIONS Contraceptive use among Brazilian women during COVID-19 depended on their age and partnership status. During the period of the highest peak in the number of cases and deaths in the country, ambivalence towards a future pregnancy increased changes in contraceptive use. IMPLICATIONS Contraceptive changes were observed during a two-wave web-survey in Brazil depending on women's age and partnership status. Ambivalence towards a future pregnancy increased changes in contraceptive use and should be considered in future studies regarding sexual and reproductive health and COVID-19 as well as in family planning program implementation.
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Affiliation(s)
| | | | | | | | | | - Geraldine Barrett
- EGA Institute for Women's Health, University College London, London, UK
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8
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Reilly K, Ebersole A. Confidentiality and privacy considerations for adolescents receiving contraceptive health services via telemedicine: A narrative review. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241233126. [PMID: 38424665 PMCID: PMC10908226 DOI: 10.1177/17455057241233126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
Confidential medical care for adolescent patients is essential as they are likely to forgo needed care if privacy cannot be maintained. The use of telemedicine for adolescent health has rapidly expanded due to the COVID-19 pandemic and can increase access to important services like reproductive care; however, it has raised challenges for providers, patients, and their parents/guardians related to confidentiality and privacy. Health care providers are often uncertain about the laws and regulations that govern confidential services including the 21st Century Cures Act. Through a narrative review of studies on confidentiality and telemedicine, this article seeks to summarize the available evidence and provide recommendations on maintaining privacy during virtual encounters and identify current best practices for prescribing contraception via telemedicine.
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Affiliation(s)
| | - Ashley Ebersole
- The Ohio State University College of Medicine, Division of Adolescent Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
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9
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Envall N, Gemzell Danielsson K, Kopp Kallner H. The use and access to contraception in Sweden during the COVID-19 pandemic period. EUR J CONTRACEP REPR 2023; 28:275-281. [PMID: 37902288 DOI: 10.1080/13625187.2023.2260516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/12/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE Explore perceived access to, the need for, use of, and satisfaction with telemedicine services for contraceptive counselling and prescription-renewal-only during the COVID-19 pandemic, and the impact of the COVID-19 pandemic period on the choice and use of contraceptives. MATERIALS AND METHODS Internet-based e-survey of Swedish women of fertile age, 16-49 years. RESULTS In total, 1016 participants completed the survey. Most participants (69.7%) rated their access to contraceptive services 'as usual'. Among the remaining participants, a higher proportion rated their access as deteriorated (73.4%) compared to improved (26.6%; p < 0.001). In total, 38.0% reported a need for contraceptive counselling, whereof 14.0% had used telemedicine for counselling and reported high satisfaction. Telemedicine for prescription-renewal-only was used by 15.1% of the total population. Two per cent reported use of another contraceptive than their intended, whereof long-acting reversible contraceptives were the most common intended method. The proportion of current contraceptive users was lower than in 2017 (62.4% vs 71.1%, p < 0.001), and current users of long-acting reversible contraception decreased from 30.6% to 19.3% (p < 0.001). CONCLUSIONS During the COVID-19 pandemic period, most women found their access to contraceptive services unaffected, but more women felt that it had deteriorated than improved. The use of telemedicine was low, and the use of contraception overall fell. Efforts are needed to raise awareness of available services, and TM-provided interventions for maintained quality of care and informed decision-making remain to be evaluated.SHORT CONDENSATIONThe COVID-19 period imposed a change in contraceptive service provision, and efforts are needed to raise awareness of available services, including telemedicine. Access to all contraceptives, including LARCs, is crucial and telemedicine-provided interventions need evaluation.
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Affiliation(s)
- Niklas Envall
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
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10
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Kus LH, Paul R, Nigaglioni Rivera A, Zeal C, Madden T. Improvement in contraceptive knowledge after using an online educational resource. Contraception 2023; 126:110095. [PMID: 37331460 PMCID: PMC10760799 DOI: 10.1016/j.contraception.2023.110095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES To measure the change in contraceptive knowledge after interaction with a web-based contraception education resource in an online cohort of potential users. STUDY DESIGN We conducted a cross-sectional online survey of reproductive-aged, biologically female respondents using Amazon Mechanical Turk. Respondents provided demographic characteristics and responded to 32 contraceptive knowledge questions. We assessed contraceptive knowledge before and after interaction with the resource and compared the number of correct answers using Wilcoxon signed-rank test. We used univariate and multivariable logistic regression to identify respondent characteristics associated with an increase in the number of correct answers. We calculated System Usability Scale scores to assess ease of use. RESULTS A convenience sample of 789 respondents were included in our analysis. Prior to resource use, respondents had a median of 17/32 correct contraceptive knowledge responses (interquartile range [IQR] 12-22). The number of correct answers increased to 21/32 (IQR 12-26, p < 0.001) after viewing the resource; 556 (70.5%) had an increase contraceptive knowledge. In adjusted analyses, respondents who were never married (adjusted odds ratio [aOR] 1.47, 95% CI 1.01-2.15), or thought decisions about birth control should be made by themselves (aOR 1.95, 95% CI 1.17-3.26) or in conjunction with a clinician (aOR 2.09, 95% CI 1.20-3.64) were more likely to have an increase in contraceptive knowledge. Respondents reported a median system usability score of 70 out of 100 (IQR 50-82.5). CONCLUSIONS These results support the effectiveness and usability of this online contraception education resource among this sample of online respondents. The educational resource could effectively augment contraceptive counseling in the clinical setting. IMPLICATIONS Use of an online contraception education resource improved contraceptive knowledge among reproductive-age users.
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Affiliation(s)
- Lauren H Kus
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Rachel Paul
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Adriana Nigaglioni Rivera
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Carley Zeal
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Department of Obstetrics and Gynecology, Mercy Health, Beloit, WI, United States
| | - Tessa Madden
- Divisions of Family Planning & Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States.
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11
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Congdon JL, Bardach NS, Franck LS, Brindis CD, Boscardin WJ, Carrasco Z, Cabana MD, Dehlendorf C. Postpartum Family Planning in Pediatrics: A Survey of Parental Contraceptive Needs and Health Services Preferences. Acad Pediatr 2023; 23:1417-1425. [PMID: 36958531 PMCID: PMC11166476 DOI: 10.1016/j.acap.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Infant well-child visits are increasingly being explored as opportunities to address parental postpartum health needs, including those related to reproductive health. To inform potential pediatric clinic-based interventions, this study assessed postpartum contraceptive needs and health services preferences. METHODS We surveyed postpartum individuals attending 2 to 6-month well-child visits at three Northern California pediatric clinics (2019-20). We examined unmet contraceptive needs; the acceptability of contraceptive education, counseling, and provision at well-child visits; and sociodemographic and clinical correlates. We conducted univariate and multivariable regression modeling to assess associations between sociodemographic and clinical variables, the status of contraceptive needs, and acceptability measures. RESULTS Study participants (n = 263) were diverse in terms of race and ethnicity (13% Asian, 9% Black, 37% Latinx, 12% Multi-racial or Other, 29% White), and socioeconomic status. Overall, 25% had unmet contraceptive needs. Unmet need was more common among participants who had delivered more recently, were multiparous, or reported ≥ 1 barrier to obtaining contraception; postpartum visit attendance, education, race, and ethnicity were not associated with unmet need. Most participants deemed the following acceptable in the pediatric clinic: receiving contraceptive information (85%), discussing contraception (86%), and obtaining a contraceptive method (81%). Acceptability of these services was greater among participants with unmet contraceptive needs, better self-rated health, and private insurance (all P < .05). CONCLUSIONS A quarter of participants had unmet contraceptive needs beyond the early postpartum period. Most considered the pediatric clinic an acceptable place to address contraception, suggesting the pediatric clinic may be a suitable setting for interventions aiming to prevent undesired pregnancies and their sequelae.
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Affiliation(s)
- Jayme L Congdon
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Naomi S Bardach
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies (JL Congdon and NS Bardach), University of California San Francisco.
| | - Linda S Franck
- Department of Family Health Care Nursing (LS Franck), University of California San Francisco, School of Nursing.
| | - Claire D Brindis
- Adolescent and Young Adult Health National Resource Center and Philip R. Lee Institute for Health Policy Studies (CD Brindis), University of California, San Francisco.
| | - W J Boscardin
- Departments of Medicine and Epidemiology and Biostatistics (WJ Boscardin), University of California San Francisco.
| | - Zoe Carrasco
- School of Nursing (Z Carrasco), University of California San Francisco.
| | - Michael D Cabana
- Department of Pediatrics (MD Cabana), Albert Einstein College of Medicine and the Children's Hospital at Montefiore (CHAM), Bronx, NY.
| | - Christine Dehlendorf
- Department of Family and Community Medicine (C Dehlendorf), University of California San Francisco.
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Rezaei F, Amiri-Farahani L, Haghani S, Pezaro S, Behmanesh F. The impact of the COVID-19 pandemic on contraceptive methods, abortion, and unintended pregnancy: a cross-sectional study. BMC Womens Health 2023; 23:357. [PMID: 37403093 DOI: 10.1186/s12905-023-02512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND AND AIM By creating an international emergency, the COVID-19 pandemic may have led to compromised reproductive health care, including family planning services, and thus increased unintended pregnancies and unsafe abortions. This study was conducted to compare methods of contraception, abortion, and unintended pregnancies in those served by the health centers of Babol city in Iran, both before and during the COVID-19 pandemic. METHODS A cross-sectional study was conducted including 425 participants registered to the health centers of Babol city, Mazandaran province, Iran. Using a multi-stage method, 6 urban health centers and 10 rural centers were selected for inclusion. Proportional allocation method was used for sampling those who met the inclusion criteria. A questionnaire was used to collect data in relation to individual characteristics and reproductive behaviors via 6 questions focused upon methods and preparation of contraception, number and type of abortions, and number and causes of unintended pregnancy from July to November 2021. The data were analyzed using SPSS software version 26. Significance level was considered to be p < 0.05 in all tests. RESULTS Most participants aged between 20 and 29 years old had a diploma level of education, were housewives and lived in the city. Prior to the pandemic, 32.0% used modern contraceptive methods and 31.6% used these during the pandemic. No change in the combination of contraceptive methods used was observed between these two periods. Approximately two-thirds used the withdrawal method in both periods. The majority of participants in both periods purchased their contraceptives from a pharmacy. Unintended pregnancy increased from 20.4% prior to the pandemic to 25.4% during the pandemic. Abortions increased from 19.1% prior to the pandemic to 20.9% during the pandemic, although these findings were not found to be statistically significant. Contraceptive methods had a statistically significant relationship with age, education, spouse's education, spouse's occupation, and place of residence. The number of unintended pregnancies had a significant relationship with age, the educational level of both participants and their spouses and socio-economic status, and the number of abortions had a statistically significant relationship with the age and education level of the spouse (p > 0.05). CONCLUSION Despite there being no change in contraceptive methods compared to the pre-pandemic period, an increase in the number of unintended pregnancies, abortions and illegal abortions was observed. This may be indicative of an unmet need for family planning services during the COVID-19 pandemic.
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Affiliation(s)
- Fatemeh Rezaei
- MSc in Midwifery, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Shima Haghani
- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- PhD in Midwifery, The Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Fremantle, Australia
| | - Fereshteh Behmanesh
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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13
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Merz-Herrala AA, Kerns JL, Logan R, Gutierrez S, Marshall C, Diamond-Smith N. Contraceptive care in the United States during the COVID-19 pandemic: A social media survey of contraceptive access, telehealth use and telehealth quality. Contraception 2023; 123:110000. [PMID: 36871620 PMCID: PMC9985539 DOI: 10.1016/j.contraception.2023.110000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To examine demographic, socioeconomic, and regional differences in contraceptive access, differences between telehealth and in-person contraception visits, and telehealth quality in the United States during the COVID-19 pandemic. STUDY DESIGN We surveyed reproductive-age women about contraception visits during the COVID-19 pandemic via social media in July 2020 and January 2021. We used multivariable regression to examine relationships between age, racial/ethnic identity, educational attainment, income, insurance type, region, and COVID-19 related hardship, and ability to obtain a contraceptive appointment, telehealth vs in-person visits, and telehealth quality scores. RESULTS Among 2031 respondents seeking a contraception visit, 1490 (73.4%) reported any visit, of which 530 (35.6%) were telehealth. In adjusted analyses, lower odds of any visit was associated with Hispanic/Latinx and Mixed race/Other identity (aOR 0.59 [0.37-0.94], aOR 0.36 [0.22-0.59], respectively), the South, Midwest, Northeast (aOR 0.63 [0.47-0.85], aOR 0.64 [0.46-0.90], aOR 0.52 [CI 0.36-0.75], respectively), no insurance (aOR 0.63 [0.43-0.91]), greater COVID-19 hardship (aOR 0.52 [0.31-0.87]), and earlier pandemic timing (January 2021 vs July 2020 aOR 2.14 [1.69-2.70]). Respondents from the Midwest and South had lower odds of telehealth vs in-person care (aOR 0.63 [0.44-0.88], aOR 0.54 [0.40-0.72], respectively). Hispanic/Latinx respondents and those in the Midwest had lower odds of high telehealth quality (aOR 0.37 [0.17-0.80], aOR 0.58 [0.35-0.95], respectively). CONCLUSIONS We found inequities in contraceptive care access, less telehealth use for contraception visits in the South and Midwest, and lower telehealth quality among Hispanic/Latinx people during the COVID-19 pandemic. Future research should focus on telehealth access, quality, and patients' preferences. IMPLICATIONS Historically marginalized groups have faced disproportionate barriers to contraceptive care, and telehealth for contraceptive care has not been employed equitably during the COVID-19 pandemic. Though telehealth has the potential to improve access to care, inequitable implementation could exacerbate existing disparities.
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Affiliation(s)
- Allison A Merz-Herrala
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States.
| | - Jennifer L Kerns
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States
| | - Rachel Logan
- University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States
| | - Sirena Gutierrez
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
| | - Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Nadia Diamond-Smith
- University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States
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Breman RB, Neerland C, Iobst SE, Bradford LL, Barr E, Malloy S, Burgess A. Survey of Postpartum People in the United States During the First Wave of the COVID-19 Pandemic to Explore Their Perspective on Support After Discharge. J Perinat Neonatal Nurs 2023; 37:196-204. [PMID: 37494688 DOI: 10.1097/jpn.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
INTRODUCTION The purpose of this study was to capture the experiences of postpartum people during the first wave of COVID-19, specifically their access to contraception and lactation support. METHODS This cross-sectional study surveyed individuals in the United States who used the Ovia Pregnancy and Parenting app. The survey was administered via an email Web link sent to postpartum people who gave birth between March 1, 2020, and June 11, 2020. Quantitative and qualitative analyses were conducted. RESULTS A total of 388 postpartum people completed the survey. Most participants had just given birth to their first baby (68.5%; n = 261) at term gestation (37-41 weeks) (92.9%; n = 355). From the qualitative data, using content analysis, we derived 6 themes and 2 subthemes: quarantine, changes in postpartum care, loneliness and isolation, stress, resource changes, and positive impact. The theme loneliness and isolation had 2 subthemes: depression/sadness/hopelessness and anxiety. DISCUSSION The experience of being postpartum during the COVID-19 pandemic brought unforeseen challenges. Providing care and support to postpartum people during a pandemic, specifically during a time of quarantine, should be reimagined. Increased use of virtual postpartum care services and expanded mental health support could serve to fill the gaps identified by participants.
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Affiliation(s)
- Rachel Blankstein Breman
- Department of Partnerships, Professional Education and Practice, University of Maryland School of Nursing, Baltimore (Dr Breman); University of Minnesota School of Nursing, Minneapolis (Dr Neerland); Department of Nursing, Towson University College of Health Professions, Towson, Maryland (Dr Iobst); Department of Family and Community Medicine, University of Maryland Medical Center, Baltimore (Dr Bradford); University of Maryland, School of Nursing, Baltimore(Mr Barr); Ovia Health, Boston, Massachusetts (Ms Malloy); and Maryland Patient Safety Center, Elkridge (Dr Burgess)
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15
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Trope LA, Congdon JL, Bruce JS, Chung PJ, Dehlendorf C, Chamberlain LJ. Meeting the Needs of Postpartum Women: Provider Perspectives on Maternal Contraceptive Care in Pediatric Settings. Acad Pediatr 2023; 23:821-828. [PMID: 36067921 PMCID: PMC11189802 DOI: 10.1016/j.acap.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/08/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Closely spaced, mistimed, and unwanted pregnancies are common among postpartum women and can lead to adverse maternal and perinatal outcomes. Women inconsistently attend postpartum obstetric visits, though they reliably interface with pediatric providers during the postpartum months, presenting novel opportunities to identify and address unmet family planning needs. METHODS We conducted a qualitative study to explore pediatric provider perspectives on addressing maternal family planning in three settings: a neonatal intensive care unit, a primary care clinic, and a high-risk infant follow-up clinic. RESULTS Pediatric providers were generally open to incorporating postpartum family planning screening and counseling into a pediatric encounter, if given appropriate training and implementation support. Providers largely agreed that contraceptive provision to women was not feasible in their practices, and they shared ideas for utilizing the pediatric encounter to connect women with comprehensive contraceptive care. CONCLUSION Pediatric providers perceived postpartum family planning screening and counseling, and not contraceptive provision, as potentially acceptable and feasible in their practice settings. These exploratory findings justify further investigation to assess their generalizability and to develop postpartum family planning interventions for pediatrics.
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Affiliation(s)
- Lee A Trope
- Department of Pediatrics, Santa Clara Valley Medical Center (LA Trope), San Jose, Calif.
| | - Jayme L Congdon
- Department of Pediatrics, University of California, San Francisco (JL Congdon)
| | - Janine S Bruce
- Department of Pediatrics, Stanford University (JS Bruce), Palo Alto, Calif
| | - Paul J Chung
- Health Systems Science, Kaiser Permanente School of Medicine (PJ Chung), Pasadena, Calif
| | - Christine Dehlendorf
- Department of Family and Community Medicine, University of California, San Francisco (C Dehlendorf)
| | - Lisa J Chamberlain
- Department of Pediatrics, Stanford University (LJ Chamberlain), Palo Alto, Calif
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16
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Key K, Wollum A, Asetoyer C, Cervantes M, Lindsey A, Rivera RZ, Flint JR, Zuniga C, Sanchez J, Baum SE. Challenges accessing contraceptive care and interest in over-the-counter oral contraceptive pill use among Black, Indigenous, and people of color: An online cross-sectional survey. Contraception 2023; 120:109950. [PMID: 36641098 DOI: 10.1016/j.contraception.2023.109950] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine challenges accessing contraception in the past year and their association with interest in using an over the counter (OTC) oral contraceptive pill (OCP) among Black, Indigenous, and people of color (BIPOC) in the United States. STUDY DESIGN From May 2021 to March 2022, a collaborative research team conducted a cross-sectional online survey using convenience sampling to recruit people who identify as Asian American, Native Hawaiian, or Pacific Islander, Black or African American, Indigenous, or Latina/Latinx and used or wanted to use a contraceptive method in the past year. Respondents were recruited through reproductive justice and community-based organizations. RESULTS Among 727 respondents, 45% reported experiencing at least one challenge accessing contraception in the past year of which 37% reported a logistical challenge, and 20% reported an interpersonal challenge. Sixty-seven percent of respondents said they were likely to use an OTC OCP. Respondents who reported experiencing at least one challenge accessing contraception in the past year were more likely to say they would use an OTC OCP. Fifty-seven percent of respondents who were not using a contraceptive method in the past year reported they were likely to use an OTC OCP. CONCLUSION Among people in this study, interest in an OTC OCP is high, particularly among those who have faced challenges accessing contraception, and among those who are not currently using a contraceptive method. IMPLICATIONS Availability of an OCP OTC has the potential to address challenges accessing contraceptive care among BIPOC in the United States, who are often impacted by structural inequities and racism. Findings from this study can inform future OTC implementation strategies to ensure OTC access addresses logistical and interpersonal challenges.
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Affiliation(s)
- Katherine Key
- Ibis Reproductive Health, Cambridge, MA & Oakland, CA, United States.
| | - Alexandra Wollum
- Ibis Reproductive Health, Cambridge, MA & Oakland, CA, United States
| | - Charon Asetoyer
- Native American Community Board, Lake Andes, SD, United States
| | - Maricela Cervantes
- California Latinas for Reproductive Justice, Los Angeles, CA, United States
| | - Alyssa Lindsey
- National Asian Pacific American Women's Forum, Chicago, IL, United States
| | | | | | - Carmela Zuniga
- Ibis Reproductive Health, Cambridge, MA & Oakland, CA, United States
| | - Jessica Sanchez
- Ibis Reproductive Health, Cambridge, MA & Oakland, CA, United States
| | - Sarah E Baum
- Ibis Reproductive Health, Cambridge, MA & Oakland, CA, United States
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17
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Vazzano A, Briggs S, Kim L, Parekh J, Manlove J. Adapting Family Planning Service Delivery in Title X and School-Based Settings during COVID-19: Provider and Staff Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3592. [PMID: 36834286 PMCID: PMC9963328 DOI: 10.3390/ijerph20043592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic introduced urgent and unique challenges to family planning providers and staff in ensuring continued access to high-quality services, particularly for groups who experience greater barriers to accessing services, such as women with systemically marginalized identities and adolescents and young adults (AYA). While research has documented key adaptations made to service delivery during the early phase of the pandemic, limited studies have used qualitative methods. This paper draws on qualitative interview data from family planning providers and staff in Title-X-funded clinics and school-based clinics-two settings that serve populations that experience greater barriers to accessing care-to (a) describe the adaptations made to service delivery during the first year of the pandemic and (b) explore provider and staff experiences and impressions implementing these adaptations. In-depth interviews were conducted with 75 providers and staff between February 2020 and February 2021. Verbatim transcripts were analyzed via inductive content analysis followed by thematic analysis. Four key themes were identified: (1) Title-X- and school-based staff made multiple, concurrent adaptations to continue family planning services; (2) providers embraced flexibility for patient-centered care; (3) school-based staff faced unique challenges to reaching and serving youth; and (4) COVID-19 created key opportunities for innovation. The findings suggest several lasting changes to family planning service delivery and provider mindsets at clinics serving populations hardest hit by the pandemic. Future studies should evaluate promising practices in family planning service delivery-including telehealth and streamlined administrative procedures-and explore how these are experienced by diverse patient populations, particularly AYA and those in areas where privacy or internet access are limited.
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Affiliation(s)
- Andrea Vazzano
- Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814, USA
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18
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Steiner RJ, Zapata LB, Curtis KM, Whiteman MK, Carvalho Guimarães MA, Fasula AM, Tromble EE, Brittain AW, Nguyen A. Is the COVID-19 Pandemic Continuing to Impact Sexual and Reproductive Health Services for Adolescents? Findings From a 2021 Survey of US Physicians. J Adolesc Health 2023; 72:696-702. [PMID: 36775748 PMCID: PMC9916602 DOI: 10.1016/j.jadohealth.2022.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE We examined the impact of the COVID-19 pandemic in Fall 2021 on sexual and reproductive health (SRH) services among physicians whose practice provided these services to adolescents just before the pandemic. METHODS Data were from the DocStyles online panel survey administered September-November 2021 to US physicians who reported their practice provided SRH services to adolescent patients before the pandemic (n = 948). We calculated prevalence of service delivery challenges (e.g., limited long-acting reversible contraception services) and use of strategies to support access (e.g., telehealth) in the month prior to survey completion, compared these estimates with prevalence "at any point during the COVID-19 pandemic", and examined differences by physician specialty and adolescent patient volume. RESULTS Fewer physicians reported their practice experienced service delivery challenges in the month prior to survey completion than at any point during the pandemic. About 10% indicated limited long-acting reversible contraception and sexually transmitted infection testing services in the prior month overall; prevalence varied by physician specialty (e.g., 26% and 17%, respectively by service, among internists). Overall, about 25% of physicians reported reductions in walk-in hours, weekend/evening hours, and adolescents seeking care in the prior month. While most practices that initiated strategies supporting access to services during the pandemic used such strategies in the prior month, some practices (22%-37% depending on the strategy) did not. DISCUSSION Findings suggest some physicians who serve adolescents continued to experience challenges providing SRH services in the Fall 2021, and some discontinued strategies to support access that had been initiated during the pandemic.
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Affiliation(s)
- Riley J. Steiner
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia,Address correspondence to: Riley J. Steiner, M.P.H., Ph.D., Senior Director, Research and Evaluation, Power to Decide
| | - Lauren B. Zapata
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Kathryn M. Curtis
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Maura K. Whiteman
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | | | - Amy M. Fasula
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Erin E. Tromble
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia
| | - Anna W. Brittain
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Antoinette Nguyen
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
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Yarger J, Hopkins K, Elmes S, Rossetto I, De La Melena S, McCulloch CE, White K, Harper CC. Perceived Access to Contraception via Telemedicine Among Young Adults: Inequities by Food and Housing Insecurity. J Gen Intern Med 2023; 38:302-308. [PMID: 35657468 PMCID: PMC9165539 DOI: 10.1007/s11606-022-07669-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Telemedicine expanded rapidly during the COVID-19 pandemic, including for contraceptive services. Data are needed to understand whether young people can access telemedicine for contraception, especially in underserved populations. OBJECTIVE To compare young people's perceived access to telemedicine visits for contraception during the COVID-19 pandemic by food and housing insecurity. DESIGN Supplementary study to a cluster randomized controlled trial in 25 community colleges in California and Texas. Online surveys were administered May 2020 to April 2021. Mixed-effects logistic regression models with random effects for site were used to examine differences in access to contraception through telemedicine by food and housing insecurity status, controlling for key sociodemographic characteristics, including race/ethnicity, non-English primary language, health insurance status, and state of residence, and contraceptive method used. PARTICIPANTS 1,414 individuals assigned female at birth aged 18-28. MAIN MEASURES Survey measures were used to capture how difficult it would be for a participant to have a telemedicine visit (phone or video) for contraception. KEY RESULTS Twenty-nine percent of participants were food insecure, and 15% were housing insecure. Nearly a quarter (24%) stated that it would be difficult to have a phone or video visit for contraception. After accounting for sociodemographic factors and type of method used, food insecure (adjusted odds ratio [aOR], 2.17; 95% confidence interval [CI], 1.62-2.91) and housing insecure (aOR, 1.62; 95% CI, 1.13-2.33) participants were significantly more likely to report that it would be difficult to use telemedicine for contraception during the pandemic. CONCLUSIONS Underserved patients are those who could benefit most from the expansion of telemedicine services, yet our findings show that young people experiencing basic needs insecurity perceive the greatest difficulty accessing these services for essential reproductive care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03519685.
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Affiliation(s)
- Jennifer Yarger
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Sarah Elmes
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Irene Rossetto
- Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Stephanie De La Melena
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Kari White
- Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
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20
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Marshall C, Gutierrez S, Hecht H, Logan R, Kerns J, Diamond-Smith N. Quality of prenatal and postpartum telehealth visits during COVID-19 and preferences for future care. AJOG GLOBAL REPORTS 2023; 3:100139. [PMID: 36465317 PMCID: PMC9699818 DOI: 10.1016/j.xagr.2022.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND At the start of the COVID-19 pandemic, telehealth practices for pregnancy-related care were rapidly implemented. Telehealth for pregnancy-related care is likely to continue after the pandemic. In order for health systems and clinicians to provide person-centered pregnancy-related care via telehealth, it is critical to understand patients' telehealth experiences and their preferences regarding the use of telehealth moving forward. OBJECTIVE This study aimed to describe perceived quality of prenatal and postpartum telehealth visits during COVID-19 and to examine the association between telehealth quality during the pandemic and future telehealth preferences. STUDY DESIGN We used data from of an online sample of US women aged 18 to 45 years seeking reproductive health care during COVID-19. Two cross-sections of survey data were collected in July 2020 and January 2021. This analysis included those who sought prenatal (n=1496) or postpartum (n=482) care during the pandemic. Among those who had a prenatal or postpartum telehealth visit, we used multivariable logistic regression to examine the association between a measure of perceived telehealth quality and openness to future telehealth visits, adjusting for sociodemographic characteristics. RESULTS A total of 57.5% of prenatal and 52.9% of postpartum respondents had a telehealth appointment. Respondents agreed with most statements about the quality of their telehealth appointments, with ≥80% reporting that they were convenient, easy, safe, and provided good information. Lower-ranked quality items were related to visits feeling personal and the patient feeling cared for. A total of 35.2% of prenatal (n=816) and 43.3% of postpartum (n=231) respondents expressed openness to telehealth visits in the future. Prenatal and postpartum respondents reporting higher telehealth quality had increased odds of being open to telehealth in the future (prenatal: adjusted odds ratio, 1.2; 95% confidence interval, 1.2-1.3; postpartum: adjusted odds ratio, 1.2; 95% confidence interval, 1.1-1.3). CONCLUSION Prenatal and postpartum respondents with better telehealth experiences were more likely to express openness to telehealth in the future, although most preferred future in-person visits. As pregnancy-related telehealth continues, it is important to offer appointment options that match patient preferences, especially populations that face barriers in access to care, and to explore ways to personalize care and support positive patient-provider relationships.
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Affiliation(s)
- Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA (Dr Marshall and Ms Hecht)
- Corresponding author: Cassondra Marshall, DrPH, MPH
| | - Sirena Gutierrez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (Ms Gutierrez and Dr Diamond-Smith)
| | - Hannah Hecht
- School of Public Health, University of California, Berkeley, Berkeley, CA (Dr Marshall and Ms Hecht)
| | - Rachel Logan
- Department of Family and Community Medicine, Person-Centered Reproductive Health Program, University of California, San Francisco, San Francisco, CA (Dr Logan)
| | - Jennifer Kerns
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Dr Kerns)
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (Ms Gutierrez and Dr Diamond-Smith)
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21
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Voutskidou A, Kirkou G, Dagla M, Orovou E, Sarella A, Palaska E, Iliadou M, Antoniou E. COVID-19 Pandemic and Its Impact on the Quality of Women's Sexual Life: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11020185. [PMID: 36673553 PMCID: PMC9858633 DOI: 10.3390/healthcare11020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
The COVID-19 pandemic has had far-reaching effects, including onphysical and mental health and wellbeing. The aim of this study was to investigate the effect of the COVID-19 pandemic on women's health, especially on women's sexual life includingdesire, arousal, orgasm and satisfaction. The initial research in PubMed/Medline, Google Scholar and Scopus yielded 573 articles from Europe (Portugal, Poland, Italy, Greece), America (U.S, Brazil) and Africa (Egypt), of which 14 met the inclusion criteria and were included in the review. Results from the studies suggest that the pandemic negatively affected sexual functioning and satisfaction, while it increased sexual distress, sexual avoidance and solitary sexual approach behaviors. The desire to have children decreased during the pandemic, but so didthe use of contraception. There is conflicting evidence as to whether or not the pandemic has had an impact on sexual desire and frequency among women. However, some major factors associated with sexual life were psychological factors and working status. It is well documented that the pandemic has had a great psychological impact. Therefore, both of these factors are expected to significantly affect women's sexual life.
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22
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Chin E, Leung K, Moore Simas TA, Kumaraswami T. Changes in postpartum contraception utilization rates during the early stage of the COVID-19 pandemic. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231175311. [PMID: 37334467 DOI: 10.1177/17455057231175311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND The first wave of the COVID-19 pandemic was associated with restricted access to reproductive care including delayed abortion and female sterilization procedures, in addition to altered maternity care experiences. Given high rates of unintended and short-interval pregnancies in the United States in general and negative obstetric outcomes specifically associated with COVID-19, access to all effective pregnancy prevention methods during the pandemic was crucial. OBJECTIVES To investigate changes in contraception utilization rates prior to delivery discharge, at outpatient postpartum visits, and at 10 weeks' postpartum, at the largest healthcare system in Central Massachusetts, during the first wave of the COVID-19 pandemic (15 March to 15 May 2020), compared to the same period in 2019. DESIGN Retrospective cohort review. METHODS Compared perinatal individuals (n = 495) who received prenatal care and delivered at UMass Memorial Medical Center from mid-March to mid-May in both 2019 (non-pandemic) and 2020 (COVID-19 pandemic). Receipt of contraception prior to delivery discharge and at outpatient postpartum visit was estimated and compared between the two time periods using the Chi-square test for categorical variables (or Fisher's exact test when cell counts were < 5) and Student's t-test for continuous variables. Multivariable logistic regression was performed to adjust for confounders. RESULTS The proportion of individuals who used long-acting reversible contraception before delivery discharge was 4% in 2019 and 13% in 2020 (p = 0.01). Modes of outpatient postpartum visit contraception did not vary from 2019 to 2020, (p = 0.06). Overall, there were no differences in contraception utilization rates at 10 weeks' postpartum from 2019 to 2020, (p = 0.50). CONCLUSION Compared to a year prior, immediate postpartum long-acting reversible contraception use increased during the first wave of the COVID-19 pandemic, while overall contraception use at 10 weeks' postpartum remained unchanged. The evaluation of contraceptive use during the most restrictive time of COVID-19 pandemic can help identify opportunities to increase access to effective contraception, such as the immediate postpartum period prior to hospital discharge.
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Affiliation(s)
- Emily Chin
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Katherine Leung
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, USA
| | - Tara Kumaraswami
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School/UMass Memorial Health, Worcester, MA, USA
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23
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Burke KL, Sierra G, Lerma K, White K. Service delivery at Title X sites in Texas during the COVID-19 pandemic. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:198-207. [PMID: 36336334 DOI: 10.1363/psrh.12211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
CONTEXT The important role of Title X sites in supporting publicly funded reproductive healthcare was elevated during the COVID-19 pandemic, as many people experienced economic uncertainty and changed their fertility preferences. In this study, we assessed changes in service delivery during the first year of the COVID-19 pandemic at Title X-supported sites in Texas, a large state with a high uninsured rate and a diverse Title X network. METHODS Using surveys of Title X-funded organizations in Texas from April and November 2020, we examined the percentage of organizations reporting service modifications. With administrative data on 507,947 client encounters between March 2019 and March 2021, we assessed change in client volume at the onset of the pandemic and evaluated the association between regional COVID-19 case rates and the provision of key Title X services. RESULTS In April 2020, most organizations (78%) limited in-person operations while implementing telehealth (74%) and contactless contraception (67%). Network-wide encounter volume declined by 26% at pandemic onset (incidence rate ratio [IRR] = 0.74, 95% confidence interval [CI] = 0.65, 0.84). Health departments experienced the steepest declines in encounter volume (IRR = 0.43, 95% CI = 0.36-0.50). Weekly encounters, particularly for long-acting reversible method placement/removal and sexually transmitted infection testing, decreased as COVID-19 rates increased. CONCLUSIONS Investment in public health infrastructure, including providing robust support to health departments as well as rebuilding and expanding the Title X network, is essential to safeguarding access to publicly funded reproductive healthcare during and after the pandemic.
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Affiliation(s)
- Kristen Lagasse Burke
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
| | - Gracia Sierra
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Klaira Lerma
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Kari White
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
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24
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Koenig LR, Smith Hughes C, Gemmill A, Diamond-Smith N. Unequal impacts of the COVID-19 pandemic on women's fertility preferences: Evidence from a longitudinal cohort in the United States. SSM Popul Health 2022; 20:101305. [PMID: 36467514 PMCID: PMC9705005 DOI: 10.1016/j.ssmph.2022.101305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022] Open
Abstract
•The COVID-19 pandemic suppressed fertility desires among US women.•Impacts on fertility preferences persisted from summer 2020 to early 2021.•The fertility preferences of younger women, women of color and those facing financial stress were most impacted.
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Affiliation(s)
- Leah R. Koenig
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Carolyn Smith Hughes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Alison Gemmill
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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25
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Tres J, Damaso EL, de Nadai MN. Impact of COVID-19 on the prescription of contraceptives in a city in São Paulo. Rev Assoc Med Bras (1992) 2022; 68:1765-1768. [PMID: 36449808 PMCID: PMC9779952 DOI: 10.1590/1806-9282.20220999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE In the beginning of the pandemic, measures, such as social distancing, lockdown strategies, and restrictions on mobility, as well as the fear of transiting through health facilities, raised concerns about the impact of COVID-19 on women's ability to continue using contraceptives. METHODS This is a retrospective cohort study, which evaluated reports of medication distribution spreadsheets in Bauru - SP, from January 2019 to June 2021. RESULTS Our study showed that the municipal dispensation of contraceptives in the SUS was markedly impacted by the COVID-19 pandemic, suffering reductions that can impact on an increase in unplanned pregnancy rates. It is possible to note a significant decrease in the distribution of combined oral contraceptives (44.18%), combined injectable contraceptives (47.58% reduction), and medroxyprogesterone acetate (13.98%). This fact may be associated with the reduction in offers of face-to-face consultations in gynecology, due to the social isolation necessary at the time of the pandemic. CONCLUSION Ensuring access to contraceptives during health emergencies should be a public health policy priority. Thus, it is essential to draw up strategic plans to encourage full access to reproductive planning services even in times of health emergency, so that the occurrence of unplanned pregnancies can be adequately prevented.
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Affiliation(s)
- Julia Tres
- Universidade de São Paulo, Faculdade de Odontologia de Bauru – Bauru (SP), Brazil
| | - Enio Luis Damaso
- Universidade de São Paulo, Faculdade de Odontologia de Bauru – Bauru (SP), Brazil
| | - Mariane Nunes de Nadai
- Universidade de São Paulo, Faculdade de Odontologia de Bauru – Bauru (SP), Brazil.,Corresponding author:
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26
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Hall B, Atrio J, Moore S, Lorvick J, Cropsey K, Ramaswamy M. Perceived healthcare quality and contraception utilization among persons recently incarcerated. JOURNAL OF CRIMINAL JUSTICE 2022; 83:101974. [PMID: 37663234 PMCID: PMC10473011 DOI: 10.1016/j.jcrimjus.2022.101974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Purpose Previously incarcerated women have specific gender and physiologic needs that are poorly addressed on community re-entry. The objective of this study is to evaluate the relationship between contraception use and perceived healthcare quality post-incarceration. Additionally, we examine the association between social determinants of health and contraception use post-incarceration. Methods A secondary analysis of a cross-sectional study of reproductive-aged women with a history of criminal-justice involvement in three cities (n = 383) was performed. Questions related to demographics, social determinants of health, sexual and reproductive health practices, health services use, and healthcare quality were analyzed. Bivariate analysis and logistic regression examined associations between these variables and contraception utilization among persons recently incarcerated. Results 35% of the participants used a method to prevent pregnancy. There were no significant differences noted between contraceptive users and non-users in perceived healthcare quality. Participants who were not using a contraceptive method were more likely to lack health insurance and experience food insecurity when compared to contraceptive users. Conclusions Although there was no difference in perceived healthcare quality between contraceptive users and non-users, significant barriers to contraceptive access on community re-entry exist. More studies are warranted to explore the sexual and reproductive health of previously incarcerated women.
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Affiliation(s)
- Bianca Hall
- Department of Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, NY, USA
| | - Jessica Atrio
- Department of Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, NY, USA
| | - Shawana Moore
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer Lorvick
- RTI International Community Health and Implementation Research Program, Berkeley, CA, USA
| | - Karen Cropsey
- Department of Psychiatry, University of Alabama, Birmingham, AL, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas, Kansas City, KS, USA
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McCool-Myers M, Grasso D, Kozlowski D, Cordes S, Jean V, Gold H, Goedken P. The COVID-19 pandemic’s intersectional impact on work life, home life and wellbeing: an exploratory mixed-methods analysis of Georgia women’s experiences during the pandemic. BMC Public Health 2022; 22:1988. [PMCID: PMC9619013 DOI: 10.1186/s12889-022-14285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Women have been especially impacted by the COVID-19 pandemic. This exploratory study aimed to characterize women’s adverse experiences related to their work, home lives, and wellbeing during the height of the COVID-19 pandemic and to describe demographic differences of those lived experiences. Methods Using the validated Epidemic-Pandemic Impacts Inventory, we collected data from reproductive-aged women in the state of Georgia about their exposure to adverse events during the pandemic. A latent class analysis (LCA) was performed to identify subgroups of women reporting similar adverse experiences and describe their sociodemographic characteristics. An optional open-ended question yielded qualitative data that were analyzed thematically and merged with subgroup findings. Data were collected from September 2020 to January 2021. Results 423 individuals aged 18–49 completed the survey with 314 (74.2%) providing qualitative responses. The LCA yielded 4 subgroups: (1) a “low exposure” subgroup (n = 123, 29.1%) with relatively low probability of adverse experiences across domains (e.g. financial insecurity, health challenges, barriers to access to healthcare, intimate partner violence (IPV)); (2) a “high exposure” subgroup (n = 46, 10.9%) with high probability of experiencing multiple adversities across domains including the loss of loved ones to COVID-19; (3) a “caregiving stress” subgroup (n = 104, 24.6%) with high probability of experiencing challenges with home and work life including increased partner conflict; and (4) a “mental health changes” subgroup (n = 150, 35.5%) characterized by relatively low probability of adverse experiences but high probability of negative changes in mental health and lifestyle. Individuals in subgroups 1 and 4, which had low probabilities of adverse experiences, were significantly more likely to be non-Hispanic white. Individuals in subgroup 2 were more likely to identify with a sexual or racial/ethnic minority population. Inductive coding of qualitative data yielded themes such as stress, mental health, financial impact, and adaptation/resilience, providing context for pandemic-related adversity. Conclusion Though many individuals in our sample experienced hardship, minority populations were unequally impacted by pandemic-related adversity in work life, home life, and wellbeing. Recovery and future emergency preparedness efforts in Georgia must incorporate support mechanisms for mental health and IPV, focusing especially on the intersectional needs of racial, ethnic, and sexual minorities. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-14285-4.
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Affiliation(s)
- Megan McCool-Myers
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Damion Grasso
- grid.63054.340000 0001 0860 4915Department of Psychiatry, University of Connecticut Health, Connecticut, USA
| | - Debra Kozlowski
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Sarah Cordes
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Valerie Jean
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Heather Gold
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
| | - Peggy Goedken
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University School of Medicine, 46 Armstrong St SE, 30303 Atlanta, GA USA
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28
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Dozier JL, Sufrin C, Berger BO, Burke AE, Bell SO. COVID-19 impacts on abortion care-seeking experiences in the Washington, DC, Maryland, and Virginia regions of the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:68-79. [PMID: 35790127 PMCID: PMC9349554 DOI: 10.1363/psrh.12202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Many people wanted to avoid or delay childbearing during the COVID-19 pandemic. This study sought to examine the extent COVID-19 influenced abortion care-seeking in a region that did not enact policy restricting abortion due to the pandemic, has high service availability, and few abortion-restrictive policies. METHODOLOGY We conducted telephone surveys with adults (n=72) requesting abortion appointments between September 2020 and March 2021 at five clinics in Washington, DC, Maryland, and Virginia. We used χ2 tests to compare sociodemographic, reproductive history, service delivery characteristics, and pandemic-related life changes by whether COVID-19 influenced abortion care-seeking. RESULTS Most respondents (93%) had an abortion at the time of the survey, 4% were awaiting their scheduled appointment, and 3% did not have an appointment scheduled. Nearly 40% of people reported COVID-19 influenced their decision to have an abortion. These individuals were significantly more likely to report "not financially prepared" (44% vs. 16%) as a reason for termination compared to people reporting no influence of COVID-19. They were also more likely to have lost or changed their health insurance due to pandemic-related employment changes (15% vs. 2%), report substantial money difficulties due to COVID-19 (59% vs. 33%), and report that paying for their abortion was "very difficult" (25% vs. 2%). CONCLUSION COVID-19 influenced many people to have an abortion, particularly those financially disadvantaged by the pandemic. Expansion of Medicaid abortion coverage in Washington, DC and Virginia could reduce financial barriers to care and help people to better meet their reproductive needs amid future crises.
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Affiliation(s)
- Jessica L. Dozier
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Carolyn Sufrin
- Department of Gynecology and ObstetricsJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Health, Behavior, and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Blair O. Berger
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Anne E. Burke
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Gynecology and ObstetricsJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Suzanne O. Bell
- Department of Population, Family and Reproductive HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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29
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McCool-Myers M, Kozlowski D, Jean V, Cordes S, Gold H, Goedken P. The COVID-19 pandemic's impact on sexual and reproductive health in Georgia, USA: An exploration of behaviors, contraceptive care, and partner abuse. Contraception 2022; 113:30-36. [PMID: 35489392 PMCID: PMC9042735 DOI: 10.1016/j.contraception.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Assessing access to sexual and reproductive health care during the COVID-19 pandemic, experiences with intimate partner violence (IPV), and exploring sociodemographic disparities STUDY DESIGN: From September 2020 to January 2021, we recruited 436 individuals assigned female at birth (18-49 years.) in Georgia, USA for an online survey. The final convenience sample was n = 423; a response rate could not be calculated. Survey themes included: sociodemographic and financial information, access to contraceptive services/care, IPV, and pregnancy. Respondents who reported a loss of health insurance, difficulty accessing contraception, barriers to medical care, or IPV were characterized as having a negative sexual and reproductive health experience during the pandemic. We explored associations between sociodemographic variables and negative sexual and reproductive health experiences. RESULTS Since March 2020, 66/436 (16%) of respondents lost their health insurance, and 45% (89/436) reported income loss. Of our sample, 144/436 people (33%) attempted to access contraception. The pandemic made contraceptive access more difficult for 38/144 (26%) of respondents; however, 106/144 (74%) said it had no effect or positive effect on access. Twenty-one respondents reported IPV (5%). COVID-19 amplified negative views of unplanned pregnancy. Seventy-six people (18%) reported at least 1 negative sexual and reproductive health experience during the pandemic; people in an urban setting and those identifying as homo/bisexual were more likely to report negative experiences (24%, 28% respectively). CONCLUSION Urban and sexual minority populations had negative sexual and reproductive health experiences during COVID-19 more than their counterparts. The pandemic has shifted perspectives on family planning, likely due to the diverse impacts of COVID-19, including loss of health insurance and income. IMPLICATION Females across Georgia reported varying impacts of the COVID-19's pandemic on their sexual and reproductive health care. These findings could be utilized to propose recommendations for care and intimate partner violence support mechanisms, tailored to urban and sexual minority populations.
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Affiliation(s)
- Megan McCool-Myers
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, Atlanta GA, United States
| | - Debra Kozlowski
- Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States
| | - Valerie Jean
- Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States
| | - Sarah Cordes
- Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States
| | - Heather Gold
- Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States,Corresponding author at: Emory University School of Medicine, University Faculty Office Building, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, United States. Phone: not available, Fax: not available
| | - Peggy Goedken
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University School of Medicine, Atlanta GA, United States,Department of Gynecology and Obstetrics, Family Planning Division, Emory University School of Medicine, Atlanta GA, United States
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30
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Stifani BM, Madden T, Micks E, Moayedi G, Tarleton J, Benson LS. Society of Family Planning Clinical Recommendations: Contraceptive Care in the Context of Pandemic Response. Contraception 2022; 113:1-12. [PMID: 35594989 PMCID: PMC9113767 DOI: 10.1016/j.contraception.2022.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has posed a burden to healthcare systems around the world and has changed the way people access health services, including contraception. This document sets forth guidance from the Society of Family Planning for providing contraceptive care in the context of the COVID-19 pandemic, including when access to healthcare is restricted due to pandemic response. It also outlines the role of telehealth for providing contraceptive care beyond the pandemic. Clinicians can use synchronous telemedicine visits and other forms of telehealth to provide many aspects of contraceptive care. Both audio-video and audio-only visits are acceptable forms of telemedicine. Access to permanent contraception should be maintained, especially in the postpartum period. Combined hormonal contraceptive (CHC) users who have asymptomatic or mild COVID-19 infection may continue their contraceptive method, while those admitted to the hospital with severe infection should suspend CHC use until they are clinically recovered. CHC users who take Paxlovid for mild-moderate COVID-19 infection can consider a back-up contraceptive method for the duration of therapy, but clinically relevant drug interactions are unlikely. Future research should examine contraceptive outcomes in people who receive care via telemedicine; and access to telemedicine among historically excluded populations such as adolescents, people of color, people of low socioeconomic status, disabled people, or people who do not speak English as a primary language.
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Affiliation(s)
- Bianca M. Stifani
- New York Medical College, Valhalla, NY, USA,Corresponding Author: Bianca M. Stifani, 19 Bradhurst Ave Suite 2700S, Hawthorne, NY, USA
| | - Tessa Madden
- Washington University School of Medicine, St Louis, MO, USA
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Leon-Larios F, Silva Reus I, Lahoz Pascual I, Quílez Conde JC, Puente Martínez MJ, Gutiérrez Ales J, Correa Rancel M. Women’s Access to Sexual and Reproductive Health Services during Confinement Due to the COVID-19 Pandemic in Spain. J Clin Med 2022; 11:jcm11144074. [PMID: 35887838 PMCID: PMC9318611 DOI: 10.3390/jcm11144074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The COVID-19 pandemic has created a challenge for women’s sexual and reproductive health care. The objective of this research was to analyse access to sexual and reproductive health services during confinement in Spain. (2) Methods: A descriptive and cross-sectional study was conducted with a random sample that was stratified by age in July and August 2020. (3) Results: A total of 1800 women were invited to participate, obtaining a response rate of 98.72%. The frequency of sexual relationships reduced during confinement. Counselling was offered both in person (30.7%) and telematically (39%), although there were also women who experienced access problems (30%). Of those women who required some LARC, only half had access to it, mainly due to the contact difficulties as a result of the limited number of consultations with their prescribing physicians. The use of emergency oral contraception and the use of services for the voluntary interruption of pregnancy were considerably reduced. The women who stated having been victims of gender-based violence were those that lived with their aggressors during confinement and had children. (4) Conclusions: It is necessary to ensure sexual and reproductive rights in confinement times and, for such a purpose, telemedicine can be a good tool that helps to avoid unmet contraceptive needs and unplanned pregnancies.
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Affiliation(s)
| | - Isabel Silva Reus
- Centro de Salud Sexual y Reproductiva de Villena, 03400 Alicante, Spain;
| | | | | | | | | | - Marta Correa Rancel
- Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain;
- Departamento de Obstetricia-Ginecología, Pediatría, Preventiva, Medicina Legal y Forense, Microbiología, Parasitología, Universidad de la Laguna, 38200 Santa Cruz de Tenerife, Spain
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Lindberg LD, Mueller J, Haas M, Jones RK. Telehealth for Contraceptive Care During the COVID-19 Pandemic: Results of a 2021 National Survey. Am J Public Health 2022; 112:S545-S554. [PMID: 35767798 PMCID: PMC10490317 DOI: 10.2105/ajph.2022.306886] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate trends in the use and quality of telehealth for contraceptive care during the COVID-19 pandemic in the United States. Methods. The 2021 Guttmacher Survey of Reproductive Health Experiences is a national online survey of 6211 people assigned female at birth, aged 18 to 49 years, and that ever had penile‒vaginal sex. We used weighted bivariable and multivariable logistic regressions to analyze the use of telehealth for contraceptive care and the quality of this care. Results. Of the respondents, 34% received a contraceptive service in the 6 months before the survey; of this group, 17% utilized telehealth. Respondents who were uninsured at some point in the 6 months before the survey had greater odds of using telehealth for this care. Respondents had lower odds of rating the person-centeredness of their care as "excellent" if they received services via telehealth compared with in person (25% vs 39%). Conclusions. Telehealth has helped bridge gaps in contraceptive care deepened by COVID-19. More work is needed to improve the quality of care and reduce access barriers to ensure telehealth can meet its full potential as part of a spectrum of care options. (Am J Public Health. 2022;112(S5):S545-S554. https://doi.org/10.2105/AJPH.2022.306886).
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Affiliation(s)
- Laura D Lindberg
- At the time of this work, all of the authors were with the Guttmacher Institute, New York, NY
| | - Jennifer Mueller
- At the time of this work, all of the authors were with the Guttmacher Institute, New York, NY
| | - Madeleine Haas
- At the time of this work, all of the authors were with the Guttmacher Institute, New York, NY
| | - Rachel K Jones
- At the time of this work, all of the authors were with the Guttmacher Institute, New York, NY
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Montanaro E, Bowling J, Farris S, Scarborough A, Moody B, Rawitz N. “Sex as a way to gain some control”: Sexual subjectivity during the COVID-19 pandemic. SEXUALITIES 2022:136346072210973. [PMCID: PMC9082099 DOI: 10.1177/13634607221097342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The COVID-19 pandemic has shifted dynamics of sexual health, including sexual subjectivity, or the way in which someone thinks of themself as a sexual being and feels entitled to pleasure. This study examines how adults in the US perceive changes in their sexual subjectivity related to the pandemic. We conducted an online survey ( N = 326), and included thematic analyses related to open-ended questions. The following themes emerged: intentional self-reflection, control of change, control of perspective, control of relationships, control of communication, and control of sexual behavior. Our findings have implications for psychological and public health approaches. We find large overlap of “capacity and engagement in self-reflection” across other themes. The implications and durability of these changes are unknown.
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Bach S, Heavey E. How NPs can eliminate practice barriers to intrauterine device use. Nurse Pract 2022; 47:22-30. [PMID: 35470331 DOI: 10.1097/01.npr.0000827120.41973.df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT Barriers to intrauterine device use include cost, absence of qualified providers, the lack of simplified insertion protocols, cultural hesitation, and misconceptions of appropriateness of use. This article outlines how NPs can eliminate practice barriers to intrauterine device use and prevent unintended pregnancy.
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Experiences of access and use of contraceptive care during COVID-19 lockdown in the UK: a web-based survey. BJGP Open 2022; 6:BJGPO.2021.0218. [PMID: 35487583 DOI: 10.3399/bjgpo.2021.0218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The first wave of lockdown measures to control the covid-19 pandemic in the United Kingdom (UK) resulted in suspension of "non-essential" services including contraception. AIM To examine women's perceptions and experiences of contraceptive care in the UK during the first lockdown. DESIGN & SETTING Cross-sectional survey during lockdown period from March to June 2020. METHOD We designed an online questionnaire asking women aged 16-54 their experiences of contraceptive care during lockdown. Questions were based on Maxwell's evaluation framework on access, acceptability, relevance, and equity. It was promoted on social media from 27th May to ninth June 2020. We conducted descriptive analysis of quantitative data and thematic analysis of free text data. RESULTS 214 responses were analysed. General practice was the source of contraception for 43% and 52% of respondents before and during the lockdown respectively. 55% (118/214) of respondents including regular and new users were uncertain where or how to get contraception during the pandemic. Respondents reported reduced access to contraception during lockdown, some thought sexual health clinics and general practices were closed.Remote consultations and electronic prescriptions facilitated contraceptive access for some respondents. Long-acting reversible contraception (LARC) was unavailable in some areas due to restrictions, alternatives were not acceptable to those who used methods for non-contraceptive benefits to treat medical conditions e.g., menorrhagia. CONCLUSIONS Our study highlighted the need for better information and signposting for contraception during lockdown. Contraception including LARC should be reframed as an essential service with robust signposting for pandemic planning and beyond.
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Ellison J, Cole MB, Thompson TA. Association of Telehealth Reimbursement Parity With Contraceptive Visits During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e226732. [PMID: 35404462 PMCID: PMC9002337 DOI: 10.1001/jamanetworkopen.2022.6732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jacqueline Ellison
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Megan B. Cole
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
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Gutierrez S, Logan R, Marshall C, Kerns J, Diamond-Smith N. Predictors of COVID-19 Vaccination Likelihood Among Reproductive-Aged Women in the United States. Public Health Rep 2022; 137:588-596. [PMID: 35238243 PMCID: PMC9109534 DOI: 10.1177/00333549221081123] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Vaccination for COVID-19 is an effective method of preventing complications; however, studies suggest that public attitudes toward the vaccine are heterogeneous. The objective of our study was to identify predictors for low likelihood of COVID-19 vaccination among women in the United States and determine whether reasons for low intention were modified by race, ethnicity, or other characteristics to better understand the factors that shape attitudes toward the COVID-19 vaccine and help inform multilevel interventions. METHODS In January 2021, we used social media to recruit a cross-section of reproductive-aged women in the United States (N = 5269). Our primary outcome was self-reported low vaccination likelihood (responses of unlikely or very unlikely on a 5-item scale). Our secondary outcome was concerns influencing vaccination decision that participants selected from a list of 19 items. We estimated multivariable logistic regression models and controlled for respondents' sociodemographic characteristics. RESULTS Overall, race and ethnicity, educational attainment, health insurance type, annual household income, partnership status, and US region were associated with low vaccine likelihood. The adjusted odds of reporting low likelihood were 1.83 (95% CI, 1.45-2.32) times greater among non-Hispanic Black than among non-Hispanic White participants. Among pregnant or postpartum participants, breastfeeding status was the strongest predictor (adjusted odds ratio = 2.77; 95% CI, 2.02-3.79). CONCLUSIONS Vaccine hesitancy and concerns may exacerbate existing COVID-19 health disparities in racial and ethnic groups and highlight the need to target messaging to specific populations, including pregnant and breastfeeding women, because these populations are at high risk for COVID-19 complications.
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Affiliation(s)
- Sirena Gutierrez
- Department of Epidemiology and
Biostatistics, University of California, San Francisco, San Francisco, CA, USA,Sirena Gutierrez, MPH, University of
California, San Francisco, Department of Epidemiology and Biostatistics, 550
16th St, 2nd Fl, San Francisco, CA 94158, USA.
| | | | - Cassondra Marshall
- Division of Community Health Sciences,
School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Jennifer Kerns
- Department of Obstetrics, Gynecology
and Reproductive Sciences, University of California, San Francisco, San Francisco,
CA, USA
| | - Nadia Diamond-Smith
- Department of Epidemiology and
Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Kons KM, Wood ML, Peck LC, Hershberger SM, Kunselman AR, Stetter C, Legro RS, Deimling TA. Exclusion of Reproductive-aged Women in COVID-19 Vaccination and Clinical Trials. Womens Health Issues 2022; 32:557-563. [PMID: 36075817 PMCID: PMC9197956 DOI: 10.1016/j.whi.2022.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION We analyzed the exclusion of pregnant and breastfeeding individuals and those capable of pregnancy in COVID-19 vaccine and clinical treatment trials. METHODS Inclusion and exclusion criteria were extracted from all listed COVID-19 vaccine and treatment clinical trials from May 1, 2020, to October 31, 2020, using the U.S. National Library of Medicine database. We report rates of rates of exclusion for pregnant and lactating individuals and requirements for contraception for pregnancy-capable participants in COVID-19 vaccine and treatment clinical trials. The analysis included the association between clinical trial exclusion and vaccine and treatment type, study location, sponsor, and phase. RESULTS Pregnant and lactating individuals were explicitly excluded from most COVID-19 vaccine and treatment clinical trials. Of the 90 vaccine trials, 88 (97.8%) excluded pregnant individuals, 73 (81.1%) excluded lactating individuals, and 56 (62.2%) required contraception use. Of the 495 treatment trials, 350 (70.7%) excluded pregnant individuals, 269 (54.3%) excluded lactating individuals, and 91 (18.4%) required contraception use. Although vaccine type was not associated with pregnancy exclusion, it was associated with lactation exclusion (p = .01) and contraception requirement (p < .001). Treatment type was associated with pregnancy exclusion, lactation exclusion, and contraception requirement (all p < .001). CONCLUSIONS COVID-19 vaccination and treatment clinical trials mirrored historical trends restricting participation owing to pregnancy, lactation, and contraception nonuse, despite known safety profiles. People of childbearing potential should be considered for and afforded the same opportunity as males to make informed decisions on study participation, particularly in the setting of a global pandemic.
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Affiliation(s)
- Kelly M. Kons
- Penn State Milton S. Hershey Medical Center, Department of Obstetrics and Gynecology, Hershey, Pennsylvania
| | - Megan L. Wood
- Penn State Milton S. Hershey Medical Center, Department of Obstetrics and Gynecology, Hershey, Pennsylvania
| | - Lindsey C. Peck
- Penn State Milton S. Hershey Medical Center, Department of Obstetrics and Gynecology, Hershey, Pennsylvania
| | - Sarah M. Hershberger
- Penn State Milton S. Hershey Medical Center, Department of Obstetrics and Gynecology, Hershey, Pennsylvania
| | - Allen R. Kunselman
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Christina Stetter
- Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Richard S. Legro
- Penn State Milton S. Hershey Medical Center, Department of Obstetrics and Gynecology, Hershey, Pennsylvania,Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Timothy A. Deimling
- Penn State Milton S. Hershey Medical Center, Department of Obstetrics and Gynecology, Hershey, Pennsylvania,Correspondence to: Timothy A. Deimling, MD, University of Pittsburgh Physicians, Division of Gynecologic Specialties, UPMC West Shore Medical Building 1, 2025 Technology Parkway, Mechanicsburg, PA 17050. Phone: (717) 926-8563
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