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

doi:10.1016/j.contraception.2023.110000

. 2023 Jul:123:110000.

doi: 10.1016/j.contraception.2023.110000. Epub 2023 Mar 5.

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

Allison A Merz-Herrala¹, Jennifer L Kerns², Rachel Logan³, Sirena Gutierrez⁴, Cassondra Marshall⁵, Nadia Diamond-Smith⁴

Affiliations

¹ University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States. Electronic address: allison.merz@ucsf.edu.
² University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States.
³ University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States.
⁴ University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States.
⁵ School of Public Health, University of California, Berkeley, Berkeley, CA, United States.

PMID: 36871620
PMCID: PMC9985539
DOI: 10.1016/j.contraception.2023.110000

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

Allison A Merz-Herrala et al. Contraception. 2023 Jul.

. 2023 Jul:123:110000.

doi: 10.1016/j.contraception.2023.110000. Epub 2023 Mar 5.

Authors

Allison A Merz-Herrala¹, Jennifer L Kerns², Rachel Logan³, Sirena Gutierrez⁴, Cassondra Marshall⁵, Nadia Diamond-Smith⁴

Affiliations

¹ University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States. Electronic address: allison.merz@ucsf.edu.
² University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA, United States.
³ University of California, San Francisco, Department of Family and Community Medicine, San Francisco, CA, United States.
⁴ University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, United States.
⁵ School of Public Health, University of California, Berkeley, Berkeley, CA, United States.

PMID: 36871620
PMCID: PMC9985539
DOI: 10.1016/j.contraception.2023.110000

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.

Keywords: COVID-19; Contraception; Region; Telehealth.

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References

1. Keesara S., Jonas A., Schulman K. Covid-19 and health care’s digital revolution. N Engl J Med. 2020;382(23):e82. doi: 10.1056/NEJMp2005835. - DOI - PubMed
1. Stifani B.M., Avila K., Levi E.E. Telemedicine for contraceptive counseling: an exploratory survey of US family planning providers following rapid adoption of services during the COVID-19 pandemic. Contraception. 2021;103(3):157–162. doi: 10.1016/j.contraception.2020.11.006. - DOI - PubMed
1. Raymond E.G., Chong E., Hyland P. Increasing access to abortion with telemedicine. JAMA Intern Med. 2016;176(5):585–586. doi: 10.1001/jamainternmed.2016.0573. - DOI - PubMed
1. Thompson T.A., Sonalkar S., Butler J.L., Grossman D. Telemedicine for Family Planning: A Scoping Review. Obstet Gynecol Clin North Am. 2020. 2020;47(2):287–316. doi: 10.1016/j.ogc.2020.02.004. - DOI - PMC - PubMed
1. Sundstrom B., DeMaria A.L., Ferrara M., Meier S., Billings D. “The Closer, the Better:” the role of telehealth in increasing contraceptive access among women in rural South Carolina. Matern Child Health J. 2019;23(9):1196–1205. doi: 10.1007/s10995-019-02750-3. - DOI - PubMed

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[1] Keesara S., Jonas A., Schulman K. Covid-19 and health care’s digital revolution. N Engl J Med. 2020;382(23):e82. doi: 10.1056/NEJMp2005835. - DOI - PubMed

[2] Keesara S., Jonas A., Schulman K. Covid-19 and health care’s digital revolution. N Engl J Med. 2020;382(23):e82. doi: 10.1056/NEJMp2005835. - DOI - PubMed

[3] Stifani B.M., Avila K., Levi E.E. Telemedicine for contraceptive counseling: an exploratory survey of US family planning providers following rapid adoption of services during the COVID-19 pandemic. Contraception. 2021;103(3):157–162. doi: 10.1016/j.contraception.2020.11.006. - DOI - PubMed

[4] Stifani B.M., Avila K., Levi E.E. Telemedicine for contraceptive counseling: an exploratory survey of US family planning providers following rapid adoption of services during the COVID-19 pandemic. Contraception. 2021;103(3):157–162. doi: 10.1016/j.contraception.2020.11.006. - DOI - PubMed

[5] Raymond E.G., Chong E., Hyland P. Increasing access to abortion with telemedicine. JAMA Intern Med. 2016;176(5):585–586. doi: 10.1001/jamainternmed.2016.0573. - DOI - PubMed

[6] Raymond E.G., Chong E., Hyland P. Increasing access to abortion with telemedicine. JAMA Intern Med. 2016;176(5):585–586. doi: 10.1001/jamainternmed.2016.0573. - DOI - PubMed

[7] Thompson T.A., Sonalkar S., Butler J.L., Grossman D. Telemedicine for Family Planning: A Scoping Review. Obstet Gynecol Clin North Am. 2020. 2020;47(2):287–316. doi: 10.1016/j.ogc.2020.02.004. - DOI - PMC - PubMed

[8] Thompson T.A., Sonalkar S., Butler J.L., Grossman D. Telemedicine for Family Planning: A Scoping Review. Obstet Gynecol Clin North Am. 2020. 2020;47(2):287–316. doi: 10.1016/j.ogc.2020.02.004. - DOI - PMC - PubMed

[9] Sundstrom B., DeMaria A.L., Ferrara M., Meier S., Billings D. “The Closer, the Better:” the role of telehealth in increasing contraceptive access among women in rural South Carolina. Matern Child Health J. 2019;23(9):1196–1205. doi: 10.1007/s10995-019-02750-3. - DOI - PubMed

[10] Sundstrom B., DeMaria A.L., Ferrara M., Meier S., Billings D. “The Closer, the Better:” the role of telehealth in increasing contraceptive access among women in rural South Carolina. Matern Child Health J. 2019;23(9):1196–1205. doi: 10.1007/s10995-019-02750-3. - DOI - PubMed

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

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

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