Even before COVID-19, access to women’s health in the U.S. was arguably in a state of crisis. Now the pandemic has brought with new challenges and avenues for innovation that could effect lasting positive change. While specialties across the industry race to respond accordingly, women’s health is alone in terms of the urgency with which it must answer one question: Will its response ameliorate—or deepen—the inequities present in today’s system?

Access to Women’s Health pre-COVID

In a 2016 study headed by the U.S. Department of Health and Human Services, 22.9% of pregnant women reported receiving no first-trimester prenatal care. According to the CDC, pregnancy-related deaths per 100,000 births in the U.S. rose from 7.2 in 1987 to 16.9 in 2016. While these statistics alone offer a grim snapshot of pre-COVID reproductive healthcare in the U.S., the picture becomes even more sobering when given demographic perspective: Black (-15.8%), American Indian or Alaska Native (-19.3%), Native Hawaiian or other Pacific Islander (-30.4%), and Hispanic (-10.3%) women were less likely to receive first-trimester prenatal care than white women. The pregnancy-related mortality ratio was 3.2 times higher for Black women and 2.3 times higher for American Indian or Alaska Native women compared to white women.

Reproductive Healthcare During the Pandemic

The Brookings Institution estimates that there could be 300,000 to 500,000 fewer births in the U.S. next year. While this calculation is based on a number of COVID-related factors, a new report from Guttmacher Institute leaves little doubt that womens’ attitudes surrounding reproductive healthcare—particularly in terms of patient access—would contribute to such a decline.  

According to the report:

  • 28% of women surveyed said that COVID-19 had caused them increased worry about their access to sexual and reproductive healthcare
  • 34% said they were more careful about using contraception
  • 34% said they want to delay having children or want fewer children overall
  • 33% said that the pandemic had caused them difficulty in obtaining their birth control—or that it had caused them to delay or cancel a visit to a sexual and reproductive healthcare provider. 

This last statistic is consistent with a recent Kaiser Family Foundation report, which found that, “Within reproductive health, large declines in patient encounters have been observed, particularly for preventive health services, infertility care, contraception and sexually transmitted infections.” Again, these numbers harbor stark demographic discrepancies, with Black, Hispanic, and queer women disproportionately represented on all counts. 

Turning to Telehealth

The American College of Obstetricians and Gynecologists has recommended “the use of telehealth across as many aspects of prenatal care as possible,” making reproductive healthcare one of many specialties to turn to telehealth to bridge gaps in patient access. Though social distancing guidelines have largely necessitated this shift, some experts, including Dr. David Nash, Founding Dean Emeritus at Jefferson School of Population Health, believe that telehealth could also help overcome some of the inequities we now see across healthcare. 

“The tools of digital health, the marginal cost, is going to go way down,” Dr. Nash said in a recent interview with DocASAP CEO Puneet Maheshwari. “That means, from a population health perspective, we can provide these services to a much broader population and even to populations with whom we don’t usually connect.” 

While undoubtedly true, simply adopting a new care-delivery system won’t remove all of the obstacles faced by underserved populations. 

“We need a new approach,” says Dr. Nash. “We know we’ve had inequities…Now it’s time for a whole new generation to look at these issues and say, ‘We’re just not going to put up with it anymore.’”

A New Approach Starts with Patient Access

Any new approach to telehealth must begin with better patient access—and the understanding that meeting even modest patient expectations, in many cases, constitutes improvement. For example, in a recent InStyle article examining racial and socioeconomic disparities in virtual maternal care, Tejumola M. Adegoke, MD, MPH, stated that “Any telemedicine model needs to have an avenue for a person to say, ‘I really need to be seen in person.”

Or, if virtual visits aren’t addressing the same important measurements, milestones, and concerns as in-person visits, Dr. Adegoke continued, “It’s time to start thinking about alternative places to receive care.” 

Improving access to women’s health using telemedicine will take a great deal of research, collaboration, and time. In the interim, however, simply allowing patients to search for providers based on their own criteria, directly schedule appointments online, and easily communicate with their provider would give them the agency necessary to achieve Dr. Adegoke’s vision. As more specialties virtualize their practices, patients will grow to expect streamlined access to reproductive healthcare in the new normal.

Next steps

To learn about shifting consumer preference for care, patient satisfaction with telemedicine, and the most in-demand digital tools, view our eBook, Telehealth: Taking the Healthcare Consumer’s Pulse in the New Normal.


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