Jimena Criollo Quimbayo doesn’t want to have another baby during a pandemic. But she’s afraid to meet her doctor in-person to renew her prescription and uncomfortable discussing personal issues virtually.
“I’m not using contraception because I’m scared of going to the doctor and exposing myself to the virus,” the 35-year-old said. She lives with her young child and husband in the Washington, D.C. area, where the cost of living and raising a child is exceptionally high.
“My husband and I both work in the service industry, and we can’t afford to stop working due to illness,” said Criollo Quimbayo. “With each day, we do our best to protect ourselves and stay healthy.” Instead of maintaining her own birth control regimen, her husband is now using condoms and practicing the “pull out method.”
During the pandemic, access to birth control has decreased while demand has increased. A recent Guttmacher Institute study found that 33 percent of those polled had trouble accessing their birth control and had to delay or cancel a medical visit due to the pandemic. Of those who faced barriers, most were lower-income, Black, Latinx, or queer. A May 2020 poll by the National Family Planning Association (NFPRHA), showed that due to the pandemic, 65 percent of American adults felt that it was a bad time to become pregnant and 52 percent said access to birth control is “more essential” during this time.
Like Criollo Quimbayo, many people are frightened to expose themselves to the virus at medical facilities and do not have access to, or ease with, telehealth to connect with their physicians. In addition, Families USA found that between February and May, an estimated 5.4 million American workers lost their health insurance along with their jobs.
“Unfortunately, many people’s health insurance is tied to their jobs, so it’s not divorced from the economic crisis we’re having,” said Jamille Fields Allsbrook, Director of Women’s Health and Rights at the Center for American Progress. “[COVID-19 has] really exposed the barriers to care and fault lines in our system that already existed, particularly for certain communities, low-income communities, and communities of color.” In addition, she said, "Given unknowns about pregnancy and COVID, people want to prevent pregnancies now more than ever.”
Americans don’t have a universal health care option, and most don't qualify for Medicaid — especially if they live in a state that didn’t adopt expanded income eligibility under the Affordable Care Act. The brief ACA enrollment period can also make it challenging to receive a subsidy for health insurance through the program. “People are more likely to forego preventive care when they don’t have the insurance to cover it or money to pay for it,” she said. For instance, someone who is unemployed may not have the funds to cover a $1,000 out-of-pocket IUD payment.
People are more likely to forego preventive care when they don’t have the insurance to cover it or money to pay for it.Jamille Fields Allsbrook Director of Women’s Health and Rights at the Center for American Progress
At Unity Health Care, a federally-funded clinic under the Title X Family Planning Program in Washington, D.C., Dr. James Huang, the Medical Director of Family Medicine, has seen the effects of the pandemic on patients. While many other providers shuttered when the novel coronavirus began infecting the community, Unity remained open to their patients — both insured and uninsured — for regular visits, COVID-19 testing, and family planning services.
He and his colleagues called frightened patients to reassure them of the clinic’s ramped-up safety protocols. Some had lost their employer-based health insurance and had fallen behind on life-saving medications. He has spoken frankly with patients about the unknown effects COVID-19 might have on a fetus. “People are scared,” he said, “and don’t want to add stress on top of an already stressful situation.”
An Alternative: Telehealth
Telehealth visits have been a solution for many. One of Dr. Huang’s regular patients visited Unity every three months for a Depo-Provera contraceptive injection. She was too frightened to leave her home during the pandemic and risk exposing her two young children to the virus to get her next shot. Dr. Huang met with her virtually and called in a longer-lasting prescription to a pharmacy, which delivered a birth control patch to her home. Through that telehealth visit, Dr. Huang said, “We were able to provide the same things we could in the clinic.”
The Guttmacher Institute study found that 24 percent of women who use the pill switched to telehealth visits during the pandemic to refill prescriptions. National Family Planning and Reproductive Health Association centers have been working overtime to strengthen telehealth infrastructure, even when insurance companies didn’t cover the costs of those services, said Audrey Sandusky, NFPRHA Senior Director of Advocacy and Communications.
Remote visits weren’t reimbursed by insurance companies at Unity before the pandemic, and after the public health crisis is declared over, telephonic visits — which help those without computer access — may again not be covered.
A NFPRHA July 2020 study showed that 68 percent of the 2,200 American adults queried support giving family planning providers additional resources during the pandemic. Two-thirds of respondents believe that it is important for elected officials to support funding and policies that give people affordable health care and information specifically related to reproductive health during the COVID era. “The American public understands that now more than ever we need to see improved access to family planning care,” Sandusky said.
Meanwhile, work is underway to provide numerous channels to birth control and reproductive health care during the pandemic. Those channels include pharmacist-prescribed birth control and investing in family planning providers to fill in service gaps.
“Even amid this pandemic, we’re seeing a strong provider network that is willing to do whatever it can to fulfill family planning needs across the country,” Sandusky said. “There’s this urgent need to prioritize people’s well-being and to prioritize the public’s health, and providing access to family planning care is front and center of that need.”