Shutdowns and restrictions early in the COVID-19 pandemic disrupted contraceptive services, abortion access, and other sexual and reproductive health care across the globe, new research shows.
In many places, providers shifted toward telemedicine; in the United States, more women received medication abortions. But women from disadvantaged groups faced more obstacles to receiving care as the pandemic took root.
Contraceptive Services Initially Deemed Nonessential
A recent review of 24 studies covering 29 countries finds that contraceptive access decreased as countries prioritized pandemic response over sexual and reproductive health care.1 Goleen Samari and colleagues at the Columbia Population Research Center examined peer-reviewed studies published through May 31, 2021, illuminating care disruptions during the pandemic’s first year.
Clinics in many countries reduced or eliminated non-urgent care, including contraceptive services, the researchers report. These disruptions disproportionately impacted women who relied on the pill and other short-acting methods; women using long-acting reversible contraceptives (LARCs), including intrauterine devices (IUDs) and implants, were somewhat less affected.
In addition, telemedicine played a major role in contraceptive provision, particularly in the United States during the pandemic, the researchers note. They point to one U.S. survey of family planning providers in which 91% of respondents reported providing contraceptive counseling and prescriptions via telemedicine, and over half (53%) referred patients for in-person contraceptive services.2
Citing longstanding inequities in technology access affecting women from disadvantaged groups, the researchers conclude with a call for policies to ensure “equitable, timely access to quality [sexual and reproductive health] services for women and girls, despite quarantine and distancing policies.”
Women With Social, Economic Disadvantages Saw More Barriers to Contraceptive Care
The equity concerns raised by the Columbia University team are well founded.
In the United States, COVID-19 complicated access to contraception, particularly for women from disadvantaged groups. More than half of women surveyed who sought contraceptive care said they faced barriers during the pandemic, reports a research team including Cassondra Marshall of the University of California, Berkeley Population Center.3
The share of women who said they would be using a different method of birth control if not for the pandemic rose from 14% in July 2020 to 22% six months later. And women who reported experiencing income loss and food insecurity were most likely to face barriers to care and to not be using their preferred contraceptive method, as were women who identified as Black, Indigenous, or people of color, the researchers found.
The most commonly reported barriers to contraceptive care were the inability to bring a support person to appointments; closed clinics; fear of going to the clinic; shelter-in-place requirements; and time constraints due to child care or household responsibilities. The survey recruited English- and Spanish-speaking women ages 15 to 45 using Facebook ads.
The researchers conclude that the pandemic intensified existing structural inequities in health care, urging providers and policymakers to develop new solutions to provide equitable contraceptive care during COVID and future crises.
COVID Disruptions Spurred More Medication Abortions
At the onset of the pandemic in 2020, the governor of Texas suspended non-emergency medical procedures, including most abortions, for a month (beginning in late March). That April, the number of surgical and medication abortions performed in the state declined by 38%, according to research supported by the Population Research Center (PRC) at the University of Texas at Austin.4
But that doesn’t mean people weren’t receiving abortions. In the same time period, the number of Texans going out-of-state for an abortion increased by more than 700%, the research found.5 And within Texas, the share of medication abortions jumped dramatically, doubling from 39% of all abortions in April 2019 to 80% in April 2020.
Abortions at 12 weeks’ gestation or later increased after the governor’s order expired, likely reflecting “delays in care among those who waited for an appointment and facilities’ limited capacity to meet backlogged patient need,” the researchers write.
Although abortions later in pregnancy are very safe, the “second trimester procedures are associated with a somewhat higher risk of complications. Delays disproportionately affect Black and low-income patients, who are more likely to seek later abortion care,” explains lead author Kari White of the University of Texas at Austin.
The drop in abortions in Texas might not have been so profound if the state had not imposed additional restrictions on medication abortion, such as prohibiting providers from using telehealth to determine eligibility and from mailing the necessary medications to patients, White says. Without these restrictions, more people who preferred this abortion method could have received care in early pregnancy, she suggests.
In another study supported by the PRC, women cited the pandemic as the top reason for seeking medication abortion over surgical abortion between April and November 2020.6 The study examined women in New Jersey, New York, and Washington who used an online service that provided asynchronous (not concurrent, similar to email) consultations and screening with family physicians and mailed medications to patients.
These findings suggest that expanding access to medication abortion using family physicians and online platforms can be a safe and effective alternative that can help reduce inequities in access—even beyond the pandemic.
This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded Population Dynamics Research Centers was highlighted: Columbia University (grant P2CHD058486), University of California, Berkeley (grant 2P2CHD073964-05A1), and University of Texas at Austin (grant 5P2CHD042849-18). Rebecca Griffin (Bixby Center for Global Reproductive Health, University of California, San Francisco) contributed to this report.
1.Trena Mukherjee et al., “Reproductive Justice in the Time of COVID-19: A Systematic Review of the Indirect Impacts of COVID-19 on Sexual and Reproductive Health,” Reproductive Health 18, no. 1 (2021): 252.
2. Bianca M. Stifani, Karina Avila, and Erika Levi, “Telemedicine for Contraceptive Counseling: An Exploratory Survey of US Family Planning Providers Following Rapid Adoption of Services During the COVID-19 Pandemic,” Contraception 103, no. 3 (2020): 157-62.
3. Nadia Diamond-Smith et al., “COVID-19’s Impact on Contraception Experiences: Exacerbation of Structural Inequities in Women’s Health,” Contraception 104, no. 6 (2021): 600-5.
4. Kari White et al., “Changes in Abortion in Texas Following an Executive Order Ban During the Coronavirus Pandemic,” JAMA 325, no. 7 (2021): 691-3
5. White et al., “Changes in Abortion in Texas Following an Executive Order Ban During the Coronavirus Pandemic.”
6. Emily M. Godfrey et al., “Family Medicine Provision of Online Medication Abortion in Three U.S. States During COVID-19,” Contraception 104, no. 1 (2021): 54-60.