Access to Contraception during a Public Health Emergency: what COVID-19 has taught us

July 6th, 2020 | Viewpoint

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The Centers for Disease Control and Prevention (CDC) called access to modern contraception one of the 10 great public health achievements of the 20th century. It has resulted in improvements in educational achievement, career equity, and overall health and wellbeing of women, children, and families. Reproductive autonomy—the ability to control one’s fertility and decide if and when to have children—is fundamental to self-determination. 

Despite the significance of contraception in public health and individuals’ lives, access to contraception is not adequately prioritized in our health care system. This is particularly apparent during the public health emergency (PHE) brought on by COVID-19. Once the pandemic hit, access to contraception and related services was, in many places, curtailed by a lack of preparedness to deliver services safely. Family planning clinics that provide contraception reduced services drastically, and some closed their doors entirely. Federal oversight and funding agencies encouraged family planning providers to use telemedicine and other delivery methods (e.g., curbside pick-up, mailing of supplies) to keep some services going. Despite that, in one informal poll of federally funded family planning clinics, 89% said that the pandemic had resulted in a decrease in the number of clients served.

The gravity of COVID-19 cannot be overstated; more than 500K people worldwide have died (175,000 of them here in the U.S. at this date). But the seriousness of an unintended pregnancy should not be understated either. Almost 300,000 women die from pregnancy- and childbirth-related causes each year. The risk has dropped dramatically in the U.S. over the past 75 years due to widespread availability of caesarean delivery, antibiotics, blood transfusion, and contraception, but during a PHE, other emergency services may not be fully available. Pregnant women who have chronic health conditions are especially vulnerable. And, in the U.S., the risk of adverse pregnancy-related outcomes is more than 3 times higher for women who are Black than for those who are non-Hispanic white. Women who contract COVID-19 while pregnant are also at increased risk for complications that require more intensive care and mechanical ventilation than their nonpregnant peers. 

An unintended pregnancy can be a life-altering event. Many turn into wanted pregnancies, but this is not always the case. For a woman who is pursuing her education, starting a career, or is physically, emotionally, or financially unprepared, an unintended pregnancy can be devastating. COVID-19 has taught us that, especially in times of PHE, we cannot forget how important it is to sustain—and in fact, increase—access to contraception.

Written by: Jennifer Kawatu

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