Since the Covid-19 pandemic started, Dr. Daniel Cruz Galarza said he’s seen more pregnant women, not fewer.
“There is less distraction, less activities to do outside the home…[and an] increased number of pregnancies in my clinic related to the lockdown,” said Cruz, a physician at COSSMA in Cidra, Puerto Rico.
Those pregnancies are often unplanned. Cruz explained that many of his patients are between the ages of 14 and 18, and many don’t have the economic resources to care for a child.
“We help these people to have a plan, to try to get out of that cycle” of unplanned pregnancies, Cruz said.
For some of COSSMA’s patients, a LARC – that’s “long-acting reversible contraception,” such as an implant or intrauterine device – is a great choice. “You put them in and they forget them,” Cruz said.
But LARCs can be cost prohibitive – both the device and, in most cases, the insertion, which requires the skilled work of a doctor or nurse practitioner. Cruz said that in Puerto Rico, an intrauterine device (IUD) may cost as much as $200 to insert. But at COSSMA, “the insertion is free, and the expensive thing is the device.”
That’s where Direct Relief, partnering with the pharmaceutical company Bayer, comes in. As part of a multi-year effort, Bayer has donated IUDs to Direct Relief for distribution to nonprofit women’s health care providers across the United States. COSSMA is one of 300 providers in 45 states and territories to receive Bayer IUDs since 2020.
All across the country, health care providers have seen Covid-19 affect reproductive health with more unplanned pregnancies. More sexually transmitted infections (STIs). Patients – many of them adolescents or those in unstable living situations – dropping through the cracks.
Debrisha Johnson, a nurse practitioner and the chief medical officer of Bee Busy Wellness Center in Houston, Texas, said that reproductive health visits at many health care providers were frequently pushed back early in the pandemic, as they weren’t considered essential services.
When those services were available again, the demand at Bee Busy surged – and Johnson said she saw increases both in pregnancy and STI rates.
“It really opened our eyes to how important those services are,” she said. “They’re not life threatening but they’re life altering.”
But despite – and sometimes because of – the pandemic, providers say that many women are asking for long-term contraception options like the IUD, and that being able to offer the device to their low-income patients has made a significant difference to their lives.
At Bee Busy, which has also received IUDs through the Direct Relief/Bayer program, Johnson said the supply of devices has made a huge difference to her patients. “We weren’t able to do this,” she said. “When you have a person [for whom] an IUD is the best choice based on their health history…this [program] has allowed us to do that.”
An “Empowering” Option
Dr. Hei-Hah Wong, the associate medical director at Los Angeles’s Saban Community Clinic, said the IUD has always been a great option – and during the pandemic, that’s even more the case.
With an IUD, which requires a one-time insertion rather than repeated visits, “you don’t have to come in, you minimize your exposures,” Wong said. “The IUD has always had that selling point, but I feel like with the pandemic it becomes a little more exciting in that way.”
In part because of the pandemic, Wong has seen a long tradition of what she calls “paternalism” – strict requirements and supervision of women on birth control – relax. “We’re realizing that women are empowered, they have the information they need, we can guide them over the phone,” she said.
Whitney Magowan, a registered nurse and the medical office coordinator at Dream Centers in Colorado Springs, Colorado, said her health center didn’t offer IUDs before receiving the Direct Relief donations.
“To have that option just opened a wonderful door,” she said. “For many of our patients, they do not have stable lifestyles, and so for them to remember to take a daily pill or a regimen of some sort is not on their radar.”
Cruz described a patient who became a mother at the age of 15, eventually having three children. No one had fully informed her about family planning techniques, he said, and an IUD was a great option for her.
Now, she’s a nurse, he said.