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

Abstract

ObjectivesTo 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 designWe 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. ResultsAmong 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). ConclusionsWe 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. ImplicationsHistorically 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.