Most US Clinics Offered Virtual Contraceptive Services During Pandemic

A majority of clinics (79 percent) used telemedicine to provide contraceptive services during the COVID-19 pandemic, according to a recent study published in the journal Reproductive Health.

For the study, researchers surveyed 907 US providers and clinic staff between April 10, 2020, and Jan. 29, 2021. They collected data on contraceptive service delivery challenges and strategies, including telehealth. The sample of respondents included physicians (17 percent), advanced practice clinicians (41 percent), registered nurses (16 percent), and health educators and social workers (11 percent).

The respondents practiced in a wide array of care settings, including youth clinics/school-based health centers or college health centers (36 percent), primary care clinics or health departments (29 percent), family planning clinics (22 percent), and independent abortion care clinics (4 percent). They saw, on average, 3,184 contraceptive patients annually.

Though only 11 percent of the clinics offered telemedicine for contraceptive services before the pandemic, this figure shot up to 79 percent after March 2020.

A majority of respondents said the pandemic created several barriers to meeting patients' contraceptive needs, including making it harder to offer contraceptive counseling (61 percent) and offer the full range of contraceptives (65 percent).

Half of the respondents reported that the pandemic made it more challenging to meet the contraceptive needs of patients in marginalized communities specifically, including low-income patients (40 percent), Black, Indigenous, and people of color (30 percent), and those experiencing homelessness (35 percent).

One-third of the respondents (35 percent) said their clinic increased the use of mail-order pharmacies for contraceptive services, while 22 percent said their facility offered drive-through clinics.

Sixty-two percent of respondents said their clinics offered contraceptive services both onsite and via telemedicine visits, but 17 percent said their onsite clinic closed and they only offered services through telemedicine.

Among the clinics that remained open on-site during the pandemic, 81 percent offered oral contraceptives, patches, and vaginal rings, 68 percent provided insertion and removal services for implants, and 65 percent offered intrauterine devices.  

Clinics closed on-site but offering telemedicine were more likely to use mail-order pharmacies and prescribe self-administered subcutaneous depo medroxyprogesterone acetate (DMPA-SQ), an injectable contraceptive method.

Unsurprisingly, clinics that offered telemedicine visits but were closed on-site faced more challenges in seeing new patients, offering contraceptive counseling, providing the full range of services, and caring for marginalized groups than those that stayed open on-site.

"Going forward, there is a need to explore further the health equity implications of telemedicine for contraceptive services, and to understand how other new service delivery modes can help to augment contraceptive access outside of clinical hours," researchers concluded.

As the fate of Roe v Wade — the landmark 1973 case that led to the legalization of abortion in America — hangs in the balance, providers have increasingly turned to telehealth to help them ensure continued access to abortion and contraceptive services.

A survey conducted by the Guttmacher Institute in the summer of 2021 shows that 17 percent of those who received contraceptive care in the prior six months used telehealth or online services.

A more recent Guttmacher report shows telehealth fueled the rise in medication abortions during the pandemic.