Factors related to delays in obtaining contraception among pregnancy-capable adults in New York State during the COVID-19 pandemic: The CAP study

Does telemedicine hold the key for reproductive health care? A quantitative examination of women's intentions toward use and accurate information disclosure

OBJECTIVE

To investigate women's perceptions of telemedicine for reproductive health care services, focusing on how perceived benefits and privacy risks influence their intentions to adopt telemedicine and their willingness to disclose personal health information.

STUDY SETTING AND DESIGN

A cross-sectional survey was conducted. The study applied the privacy calculus theory to the context of telemedicine for reproductive health, using adapted, validated variables to develop the survey. Outcome variables included intentions to adopt telemedicine and willingness to disclose accurate personal health information.

DATA SOURCES AND ANALYTIC SAMPLE

Data were collected in May and June 2023 using Qualtrics online panel services, targeting women across the United States who had not used telemedicine for reproductive health. The sample comprised 847 women aged 18 and older. Structural equation modeling was employed using AMOS v28.0 to test the hypothesized relationships between perceived benefits, perceived risks, and adoption intentions. The analysis controlled for age, household income, political affiliation, religious views, and prior births.

PRINCIPAL FINDINGS

Perceived benefits were positively related to intention to adopt telemedicine for reproductive care (β: 0.600, p < 0.001), and willingness to disclose accurate personal health information (β: 0.453, p < 0.001). Unexpectedly, perceived privacy risks were positively related to adoption intentions (β: 0.128, p < 0.001), but negatively related to willingness to disclose (β: -0.282, p < 0.001). Intentions to adopt were positively associated with willingness to disclose (β: 0.089, p < 0.05). Lastly, older women and women located in states with abortion restrictions expressed lower intentions to adopt. The model explained 40.2% of variance in intention to adopt and 38.3% of variance in willingness to disclose.

CONCLUSIONS

The study demonstrates the importance of perceived benefits and privacy risks in driving telemedicine adoption and disclosure intentions among women in the reproductive health context. These findings suggest the need for targeted strategies to address privacy concerns and support telemedicine adoption, particularly in restrictive regulatory environments.

Mental Health Distress and Delayed Contraception Among Older Adolescents and Young Adults

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.

Delays in Obtaining Abortion and Miscarriage Care Among Pregnant Persons in New York State During the COVID-19 Pandemic: The CAP Study

Background

We sought to investigate delays obtaining abortion and miscarriage care during the COVID-19 pandemic, compared with before the pandemic, among pregnant persons in New York State (NYS).

Methods

We administered a cross-sectional survey in June-July 2020 to NYS residents aged 18-44 years who identified as female or transgender male (N = 1,525). This analysis focused on a subsample who had an abortion or miscarriage during COVID-19, were seeking an abortion at the time of the survey, or had an abortion or miscarriage before COVID-19 (n = 116). We conducted bivariate analyses to determine differences in delays to seeking or obtaining an abortion or miscarriage during versus before the pandemic, as well as consideration of abortion among those pregnant during versus before the pandemic. We also asked open-ended questions about miscarriage and abortion experiences.

Main Findings

Of the 21 respondents who sought or were seeking an abortion during the COVID-19 pandemic, 76.2% (n = 16) reported experiencing a delay in obtaining abortion care, compared with 18.2% (n = 4) of those who experienced a delay before the pandemic (p < 0.001). A significantly higher proportion of respondents who were pregnant during the pandemic considered abortion, compared with those who gave birth before the pandemic (39.1% vs. 7.6%; p < 0.001). Of the 39 respondents who miscarried during the pandemic, 35.9% (n = 14) delayed care, compared with 5.9% (n = 2) before the pandemic (p < 0.01). Some respondents also commented on the difficulty of accessing miscarriage services during COVID-19 in open-ended responses.

Principal Conclusions

Those who sought abortion or miscarriage care during the COVID-19 pandemic experienced significant delays in getting care. These are essential services that must be available during public health emergencies, and yet access to these services is now severely limited in many states due to the Dobbs vs. Jackson Women's Health Organization decision.

Contraceptive care in the United States during the COVID-19 pandemic: A social media survey of contraceptive access, telehealth use and telehealth quality

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.

Privacy and Security Risk Factors Related to Telehealth Services - A Systematic Review

The objective of the study is to identify challenges and associated factors for privacy and security related to telehealth visits during the COVID-19 pandemic. The systematic search strategy used the databases of PubMed, ScienceDirect, ProQuest, Embase, CINAHL, and COCHRANE, with the search terms of telehealth/telemedicine, privacy, security, and confidentiality. Reviews included peer-reviewed empirical studies conducted from January 2020 to February 2022. Studies conducted outside of the US, non-empirical, and non-telehealth related were excluded. Eighteen studies were included in the final analysis. Three risk factors associated with privacy and security in telehealth practice included: environmental factors (lack of private space for vulnerable populations, difficulty sharing sensitive health information remotely), technology factors (data security issues, limited access to the internet, and technology), and operational factors (reimbursement, payer denials, technology accessibility, training, and education). Findings from this study can assist governments, policymakers, and healthcare organizations in developing best practices in telehealth privacy and security strategies.

Birth Control Use and Access Including Pharmacist-Prescribed Contraception Services during COVID-19

The COVID-19 pandemic influenced health care with effects on contraception access emerging. The study objectives were to analyze pandemic impacts on birth control (BC) use and access; and evaluate perceptions of pharmacist-prescribed BC. A 50-item survey was distributed by 31 Michigan community pharmacies to women aged 18-45 over a three-month period. The survey link was also posted on two websites. 147 surveys were analyzed. Respondents were 29 ± 7.9 years old, primarily white (77%) and straight (81%). Fifty-eight percent of respondents used prescription BC, mostly to prevent pregnancy (84%) with oral pills (76%) being the most common formulation. Some BC users (25%) were worried about BC access and 27% had difficulty taking BC regularly. Half of the respondents (50%) would likely use pharmacist-prescribed BC if available, with advantages being more convenient than visiting a doctor's office (71%) and easier access (69%). The major concern about pharmacist-prescribed BC was women not receiving PAP smears and screenings (61%). Respondents reported high confidence (72%) in pharmacist-prescribed BC and believe it would help prevent unintended pregnancies (69%). Some respondents experienced altered BC use and access. Half of the respondents supported pharmacist-prescribed BC. Pharmacist-prescribed BC could help solve pandemic-related access problems.

"I totally didn't need to be there in person": New York women's preferences for telehealth consultations for sexual and reproductive healthcare in primary care

BACKGROUND

Expanding telehealth in the United States during the COVID-19 pandemic supported patients with needed sexual and reproductive healthcare (SRH) for continuity of care and reproductive autonomy. While telehealth for SRH is feasible and acceptable, studies have not explored patient preferences towards telehealth SRH from primary care settings.

OBJECTIVE

We explore New York women's preferences for telehealth SRH in primary care.

METHODS

In 2021, we conducted 5 focus groups and 8 interviews with New York women of reproductive age who had a consultation with a primary care provider in the last year as part of a larger study on assessing SRH quality in primary care. We queried on experiences with telehealth for SRH and perceptions of measuring SRH quality in primary care telehealth consultations. We employed reflexive thematic analysis.

RESULTS

We recruited 30 participants. They preferred telehealth for "basic" SRH conversations, such as contraceptive counselling, and desired in-person consultations for "complex" topics, like pregnancy and preconception, especially if nulliparous. Telehealth benefits included convenience, simplicity of some SRH needs, and alleviating power dynamics in patient-provider relationships. Challenges included lack of one-on-one connection, seriousness of pregnancy discussions, privacy, and internet access. Measuring quality of telehealth SRH should include fostering positive and engaging environments.

CONCLUSION

Participants find telehealth SRH in primary care preferable, underscoring the importance of offering and expanding this care. As telehealth SRH expands, providers should strengthen quality by building rapport to facilitate conversations on "serious" topics and their ability to help patients remotely.

Women’s Access to Sexual and Reproductive Health Services during Confinement Due to the COVID-19 Pandemic in Spain

(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.