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Fewer Medical Visits, More Unplanned Pregnancies. How Covid-19 Impacts Reproductive Health.

Covid-19 has caused interruptions in patient care, including routine prenatal visits and women's health screenings. (Shutterstock)
Covid-19 has caused interruptions in patient care, including routine prenatal visits and women's health screenings. (Shutterstock)

While researchers say the coronavirus pandemic is more likely to lead to a baby bust than a baby boom, it’s limiting access to family planning services and contraception.

One-third of American women have reportedly delayed or canceled visiting their provider for reproductive health care services or have had trouble getting their birth control, citing concerns over contracting the virus, and an inability to pay.

The percentage of those delaying care increases among low-income women and minority populations.

“I’m not getting a lot of demand for family planning services, so that’s where I’m worried,” says Dr. Karen Lamp, a physician at Venice Family Clinic in Santa Monica, California.

“I’m seeing a lot of women presenting late in pregnancy.”

On this episode of the podcast, we speak with Dr. Lamp about how the Covid-19 pandemic has impacted her patients’ access to reproductive health care and what that could mean for women as the pandemic continues.

Direct Relief has committed to distribute 45,000 IUD units to safety-net health facilities across the United States, including the Venice Family Clinic. The IUDs have been donated by Bayer to expand women’s access to reproductive health care in underserved communities.

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Transcript:

In the United States, the coronavirus pandemic is more likely to lead to a baby bust than a baby boom. That’s according to researchers at the Brookings Institution. They say women are likely to delay pregnancy because of economic uncertainty and concerns about the state of public health.

The result could be up to half a million fewer births within the next year.

Despite these predictions, Dr. Karen Lamp says she’s seen evidence to the contrary: “I’m not getting a lot of demands for family planning. So that’s, that’s where I think I’m, I’m worried.”

Lamp is a physician at Venice Family Clinic in Santa Monica, California. She says there’s been an uptick in unplanned pregnancies among her patients during the pandemic. “I’m seeing a lot of women presenting late in pregnancy.”

According to a survey conducted by the Guttmacher Institute, one-third of women have had to cancel or delay visiting a provider for reproductive health care services or have had trouble getting their birth control during the pandemic.

For Latinx women—who make up the ethnic majority of Venice Family Clinic’s patients—barriers to care have been even more significant. Nearly 50% have reportedly delayed services because of an inability to pay or a fear of exposing themselves to the virus.

While the LA-based health center has continued to provide services throughout the pandemic, Dr. Lamp says, in the beginning, many patients didn’t know they were open.

“It wasn’t until we sent out a message on people’s cell phones saying, ‘We’re open and we’re opening for more services,’ and then our phones really started ringing. I think people were just really sheltering in place.”

And others were dealing with changes brought about by the pandemic.

“I mean, people who are working have a lot of anxiety because they don’t feel safe at work, or if they’re not working, they don’t know how they’re going to pay the rent, or they have so many of our families live in, you know, with an extended family and one person sick and the whole issue of isolation and quarantine. I mean, just so many other things take taking precedent.”

The health center quickly shifted appointments to telemedicine which has helped providers like Lamp easily reach patients that can’t get to the clinic. While it’s easy to refill a prescription or prescribe a new birth control over the phone, other needs have been harder to meet. According to Lamp, cancer screenings have taken a backseat.

“They’ve all dropped in the last couple months — breast cancer screening, cervical cancer screening, colorectal cancer screening, biopics–about 6 to 7%.”

But patients aren’t necessarily the ones opting out of these appointments. “Honestly we have discouraged them from coming in,” she says.

According to Lamp, the risk may not be worth the benefit. That means she must assess each patient individually to determine which screenings are crucial and which ones can wait.

“We look at something like cervical cancer, which develops over a very, very long period of time. So we thought, well, if this is, if we’re delaying it by six months or nine months, which initially of course we thought, okay, it was four or five months, but now we’re looking further down the road. And we think that that’s okay to do, um, You know, you look at something like breast cancer and you kind of have to individualize the woman’s risk for that.”

The health center also provides prenatal care as part of their suite of reproductive health services. Before the pandemic, they held group classes for expectant mothers. Now, those are canceled and about half of all prenatal visits are being done over the phone. During these over-the-phone checkups, providers often rely on the mothers to report on how they and the baby are doing.

“We just ask them if the baby’s moving, have they had any bleeding, contractions, anything like that, but then you always have a low threshold. If there’s any concern you bring them in.”

The health center has given blood pressure monitors to high-risk moms, who are older or have had complications during previous pregnancies. Despite these precautionary measures, Lamp says there are still risks that come with virtual care.

“If you have somebody who maybe doesn’t give you a great history or downplaying something, you can miss cues.”

With health care being delivered over the phone, patients have a greater role to play in the quality of care they receive. But sometimes, stepping into that role can be a lot to ask.

Women have so many other responsibilities, Lamp says. Reproductive health care isn’t always front and center.

This transcript has been edited for clarity and length.

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