COVID-19 Limited Access to Contraception

Megan Kavanaugh, PhD, MPH

A recent investigation found that access to contraception was limited due to the COVID-19 pandemic and prominently affected individuals who experienced employment and financial instability.

Investigators noted that the disruptions in care coincided with national conversation regarding if contraceptive care and sexual and reproductive health (SRH) in general should be deemed essential health care resources.

At the same time, patients were reporting concerns of seeking non-COVID-19 health care (68% of US adults) and experiencing delays and cancellations in getting contraceptive care in the first few months of the pandemic (33% of cisgender women).

Potential effects of delayed access including pregnancies, complications related to undetected/untreated sexually transmitted infections, inflammatory diseases, and more.

As such, investigators led by Megan Kavanaugh, PhD, MPH, Guttmacher Institute, New York, documented the prevalence of patient reports of delays in SRH access dur to the COVID-19 pandemic.

The Methods

The study featured data from ongoing longitudinal data collection activities with family planning patients in Arizona, Iowa, and Wisconsin. The data were part of a broader study called the Reproductive Health Impact Study.

Patients were eligible for the present study if they reported they were assigned female on their birth certificate, were 15 years or older, sought family planning care at an eligible site, and did not have a confirmed pregnancy at the time of their appointment.

Eligible sites in Iowa served over 100 family planning patients annually, and Arizona and Wisconsin served 200 or more patients annually. Surveys were made available across all eligible sites, with a total of 58 sites participating.

Respondents who completed the self-administered baseline survey were offered the opportunity to receive monthly and bi-annual surveys through short message service texts and/or email survey links for 2 years after the baseline survey.

The analysis was limited to data from respondent who answered at least 1 of the 4 COVID-19 questions on either a monthly or bi-annual survey between May 2020 and May 2020 and completed the fourth biannual survey in Iowa, the second biannual survey in Arizona, or the first biannual survey in Wisconsin.

The Findings

Investigators observed that over half of respondents in Arizona (57%), 38% in Iowa, and 30% in Wisconsin indicated that they were either unable to access or delayed accessing SRH care or a contraceptive method due to the COVID-19 pandemic.

In multivariable models, respondents in Arizona and Wisconsin who had experienced financial instability due to being out of work, having fallen behind on key life payments, or because of a job reduction or loss due to COVID-19 had increased odds of experiencing COVID-19-related SRH care delays (Arizona adjusted odds ratio [aOR] = 2.6, p = 0.01 and Wisconsin aOR = 6.0, p < 0.001).

Investigators added that their findings supported the push for greater access to broad SRH care in the US, especially given the disproportionate impact of the pandemic on the employment and economic positions of women, LGBTQ people, and individuals experiencing financial instability.

“Importantly, our findings highlight only a small piece of the larger picture of how individuals' reproductive autonomy was impeded due to the pandemic,” the team wrote. “Further research regarding the extent to which these COVID-19-related delays resulted in subsequent negative consequences for individuals—such as having to rely on less preferred methods of contraception, forego contraception all together, and/or experience unwanted pregnancies—is warranted.”

The study, "Financial Instability and Delays in Access to Sexual and Reproductive Health Care Due to COVID-19," was published online in the Journal of Women's Health.