How Coronavirus Might Affect Your Reproductive Health
From getting birth control to visiting a gyno, here's what you need to know about what the COVID-19 crisis means for your access to reproductive health care.
There's no doubt that the novel coronavirus has changed lives in ways no one ever imagined.
With stay-at-home orders and the astounding rise in unemployment, many Americans are left wondering if their most essential needs will be met in the coming weeks and months. Reproductive health care is no exception: Will you have access to birth control during this pandemic? Doctors appointments? Fertility treatments? What about abortion services?
Clinics and health care companies are already noticing an increased demand for reproductive health services. Nurx, an app that allows you to access birth control, PrEP for HIV prevention, and STI home test kits, among other health services, has experienced a 50 percent spike in birth control requests alone since early March. "We've had to hire more than a dozen medical providers over the last few months to keep up with the patient demand," says Varsha Rao, CEO of Nurx. "Anecdotally, our patients have been sharing with us that their appointments are getting canceled, and they're nervous about going into the pharmacy." As a result, Nurx has also seen an increased demand for emergency contraception and STI home test kits, adds Rao.
Just like elective surgeries, certain elements of reproductive health care have been deemed "nonessential" for the time being. This delineation is meant to lessen the pressure on hospitals and healthcare providers so they can direct their attention to fighting COVID-19. Problem is, making reproductive healthcare services unavailable will have a lasting impact on the lives and reproductive health of millions of Americans.
Luckily, the American Medical Association released guidelines noting that what qualifies as essential is largely up to doctors, in consultation with their patients. But consensus on what qualifies as essential vs. nonessential health care can vary widely from state to state. "People's access to care today is very dependent on where they live," notes Elisabeth Smith, chief counsel, state policy and advocacy at the Center for Reproductive Rights. "That's always been true, but it's even more true now."
Experts in the reproductive healthcare space are emphatic about one thing: "While the COVID-19 pandemic has created a lot of uncertainty, one thing we know for sure is that access to sexual and reproductive health care is still essential," says Alexis McGill Johnson, acting president and CEO of Planned Parenthood Federation of America. Just because people are staying home and following social distancing guidelines doesn't mean they're not having sex, points out McGill Johnson. "So access to services like birth control, emergency contraception, and safe, legal abortion is just as important as ever," she adds.
While it may be harder to get access to these services in general because of closed clinics or limited appointment slots due to social distancing protocols, some segments of the population are experiencing this to an even greater degree. "The unfortunate reality is the pandemic has increased barriers to care for many of our patients, particularly people of color, LGBTQ people, people who live in rural areas, people with low incomes, and those who are uninsured," explains McGill Johnson. (Not to mention, the U.S. has a shortage of ob-gyns as it is.)
Ahead, reproductive health experts outline what's available right now, what's not, and what to do if you need access to health care ASAP.
Let's start with some good news: "There has not been a single state that has said birth control is non-essential," says Smith. What's more, all stay-at-home orders have noted that people are allowed to leave their homes to seek medication and medical care. So while it might be stressful and scary to leave your house to pick up a birth control prescription or emergency contraception, such as Plan B, at the pharmacy, it's totally allowed.
However, just because it's allowed doesn't mean it's feasible for everyone. In fact, 29 percent of white women, 38 percent of Black women, and 45 percent of Latinas said they were struggling to access birth control because of social distancing forcing doctors offices and pharmacies to close or limit appointments, according to a June 2020 study from the Guttmacher Institute.
If you don't feel comfortable going out of the house, prescription delivery by mail may also be an option, depending on where you live and your health insurance. You can also buy Plan B and other generic versions of the morning after pill online, from places such as Amazon, CVS, and Walgreens. Shipping may take longer than usual because of high demand, though, so if you anticipate needing it, it's best to order ahead of time so you can have it on hand.
What if I need to get a new prescription, refill, or a new method of birth control?
In terms of getting a new prescription or refill, telemedicine is going to be your best option, says Sara Imershein, M.D., M.P.H., F.A.C.O.G., a board-certified ob-gyn at Falls Church Healthcare Center in Falls Church, Va. "Many women can be screened with telemedicine to use the pill, the patch, or the ring," she explains. Direct-to-consumer services like The Pill Club and TwentyEight Health have been prescribing birth control remotely via telemedicine for years and continue to do so now. (Here: How to Get Birth Control Delivered)
But not all methods of birth control can be prescribed remotely. It may be harder to get forms of birth control that require an office visit, such as IUDs, implants, and injections. That said, while Planned Parenthood does recommend calling your local health center before heading in, the organization is working hard to keep all birth control options available while managing safety and resource needs. That means you may be able to get one of the methods of birth control that requires a visit at your local Planned Parenthood, depending on their particular situation.
And there's another catch: The ob-gyn shortage and overall stress on the health system can make it difficult to hop on a face-to-face telemedicine call with a physician—but many states have legislation that forbids doctors from prescribing medicine without having a spoken conversation with the patient. Normally, that seems like a legit protective measure, but in the context of the pandemic, it may keep women from being able to access birth control if they can't get time with a physician. As a result, online birth control providers that use asynchronous telehealth models (read: you aren't speaking to a doctor in real-time) such as Simple Health, Pandia Health, and Project Ruby, can't step in to fill the gap.
What if I just lost my health insurance?
With 17 million people filing for unemployment in the past four weeks, health insurance coverage for birth control is also a concern. If you're in a state with Medicaid expansion, you should be able to enroll in your state Medicaid if you've recently lost employer-based insurance, says Dr. Imershein. "If you have any plan that's associated with the Affordable Care Act, you should be able to get contraception with no copay," she adds. Unfortunately, if you live in one of the 14 states that have not adopted Medicaid expansion, it may be harder to get insured.
Are there really going to be birth control shortages?
There have been reports about supply chain issues impacting the availability of certain forms of prescription birth control and over-the-counter options, such as condoms. Since many condoms and contraceptives are manufactured in Asia, factory closures and shipping delays there could mean shortages in the near future. While shortages are likely global, they're not currently expected in the U.S., says Chris Purdy, CEO of D.C.-based DKT International, one of the world's largest family planning organizations. "For global manufacturers, the U.S. market is a priority, and they will do everything they can to ensure products are available," says Purdy. "However, globally, we are concerned that a combination of factors could impact product availability in general." That said, this is a rapidly-evolving situation, so it's possible that shortages could hit the U.S. at some point.
Though it's not an option for everyone, having an extra supply of your preferred method of birth control is a good idea, says Purdy. "Even under normal circumstances, it's wise to have an extra cycle of oral contraceptives on hand or ensure that you have a backup method like emergency contraception or condoms."
If you're pregnant (or think you might be), it's natural to worry about how you'll receive care during this time. (Also, here's what pregnant people need to know about Coronavirus.)
Will I still have prenatal doctor visits?
"Most ob-gyns and certified nurse midwives are moving many of their routine prenatal care visits to telehealth, recommending in-person visits for those which are combined with a laboratory test or imaging study," explains Jane van Dis, M.D., a board-certified ob-gyn and medical director at MavenClinic, a telehealth solution for women and families.
That means if you need a test to confirm you're pregnant or are scheduled to receive a key ultrasound, vaccine, or genetic test, you'll likely be able to have these performed despite stay-at-home orders. Also, if you have high-risk conditions, like high blood pressure or diabetes, your doctor is more likely to opt for in-person visits over virtual ones, says Dr. van Dis. To get an overview of what to expect, she recommends the University of Michigan's patient resource on prenatal care during COVID-19 as a great place to start.
What will labor and delivery be like?
To be sure, things will be different than usual. "Expect that you will be masked during your stay at the hospital at all times and that you might also be tested for COVID-19 upon admission," notes Dr. van Dis. But despite some hospitals banning partners and supporters in childbirth delivery rooms earlier on in the crisis, policies have changed: "Most hospitals are allowing one support person during admission," now says Dr. van Dis.
What happens if I have a miscarriage?
At least 10 percent of pregnancies end in miscarriage. "If you think you're having a miscarriage, first contact your clinician," recommends Dr. Imershein. Your doctor can help you determine if you're having a miscarriage and discuss your options with you. But if your doctor is sure you're having a miscarriage and if avoiding the hospital is a priority for you right now, it may be wise to consider seeking care via an abortion clinic, if available. That's because, due to FDA restrictions, most ob-gyns don't have mifepristone (a medication that helps pass a miscarriage and is used for abortions) on-hand, and you can't get it by prescription from a pharmacist, explains Dr. Imershein. "Mifepristone (combined with misoprostol, which is widely-available) is the fastest, safest way to manage [miscarriages] safely at home without any hospital, clinic facility, or personal protective equipment," she says. To get these medications, an abortion clinic might be your best bet.
Are fertility treatments considered essential?
Fertility treatments have sadly been put on hold for the time being. The American Society for Reproductive Medicine recommended suspension of fertility treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation (the freezing of eggs, sperm, and embryos), says Dr. van Dis.
Understandably, many people are anxious and disappointed about this. "Hopefully the virus is contained in the shortest possible time, given how time-sensitive many fertility treatments are," she adds. (Related: Answers to All Your Questions About Egg Freezing)
How abortion care is treated from state to state differs widely. Lawmakers in at least five states have deemed abortion a nonessential surgery during the pandemic unless the life of a pregnant person is threatened.
This leaves people who need abortions in a very precarious position. "As a result, people who have made the decision to end their pregnancies are left with very few options," says McGill Johnson. "Depending on their situation, some will need to travel to a nearby state to have the procedure and risk being exposed to COVID-19 along the way, and some may also be forced to continue their pregnancy against their will. Many people do not have the option to travel long distances because they don't have transportation or childcare options or because they're essential workers."
Planned Parenthood and the Center for Reproductive Rights have been successful countering new pandemic-related abortion restrictions in several states, meaning it may be worth verifying the most up-to-date rulings in your state before assuming you can't seek abortion care. (To check the regulations in your state, see the Guttmacher Institute's resource on the topic.)
Notably, Texas lawmakers have fought to keep abortions from being performed during this time. After several weeks of a complete ban (which drove many women to seek abortions out of state), a surprise ruling allowed some types of abortion to go forward. Still, not everyone who needs an abortion is getting one. "We have not been in a situation related to abortion access like the one we're in now," says Smith. "In the past [several] weeks in Texas, people who work in clinics are having horrible conversations with their patients, having to cancel their appointments, and having to see if there's any other place those people can go."
What can I do if I need an abortion?
"If you're pregnant and don't want to be, there are two places you can go," says Dr. Imershein. "Hopefully, you can go first to your primary care doctor or gynecologist, who might be able to take care of you or refer you locally. But wherever you live, you can go to the National Abortion Federation online or call the NAF Hotline referral line at 1-877-257-0012." The NAF can refer you to a local clinic (including Planned Parenthood clinics) and can also help with funding.
Depending on the regulations in your state and how many weeks pregnant you are, it's possible you'll be eligible for a medication abortion, which uses a combination of mifepristone and misoprostol to end a pregnancy. Research indicates medication abortions are extremely safe: Only 0.4 percent of patients end up experiencing complications that require hospitalization. Some clinics are providing them as a no-contact option via telemedicine. (Here's how to get a virtual appointment with Planned Parenthood.)
For those later in their pregnancies, a clinic visit will be required to perform a surgical abortion. (Here's more info on how late in pregnancy you can actually have an abortion, as well as the different procedure options.)
Routine Reproductive Health Care
"Clinics are trying to stay open during COVID-19 but not all are able to," says Dr. van Dis. "Some remain open but with reduced hours or by appointment only. Well-woman care or routine checkups are likely being canceled or postponed at this time."
What if I have an infection or need testing?
If you have a health issue that requires your doctor's attention, such as a yeast infection, urinary tract infection, or even something more serious, like a breast lump, telemedicine with your primary care doctor or gynecologist will likely be your first-line option. If your doctor decides you need testing or an in-person appointment, they'll make that call.
In terms of testing for sexually transmitted infections, it may be harder to get right now because labs are overwhelmed with coronavirus testing. Still, if you suspect you have an STI, it's worth checking in with your doctor to consider your options. At-home STI tests from mail-order services like Everlywell and LetsGetChecked may be a good option depending on your situation.
Can I still get preventative testing?
Dr. van Dis says that preventative tests (such as pap smears and mammograms) are currently being postponed. "But I don't expect that they will be for much longer. We need to provide essential medical care, and cancer screening is essential medical care."
There will likely be a period of "catch up" as screenings get back up to speed, so it's a good idea to be proactive. "Make sure if you were due for a mammogram or pap smear that you don't let this delay in care affect you personally," advises Dr. van Dis. "Reach out and schedule as soon as your doctor's office reopens so that you can make sure cervical cancer or breast cancer isn't an unintended consequence of this virus."
The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it’s possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.