The COVID-19 pandemic has changed the landscape of women’s health care delivery. Amidst clinic closures and reduced services, one group from the University of Toronto has developed an online map to ensure that women continue to have access to the care they need.
Access to contraception and abortion care is fundamental to women’s autonomy and self-determination. During a pandemic, this is especially important. Evidence from previous humanitarian crises such as the Rwandan genocide shows that decreased access to sexual and reproductive health services has major downstream effects on women’s health. This ranges from unintended pregnancy and unsafe abortion to post-traumatic stress disorder and depression.
The UNFPA, the United Nations’ sexual and reproductive health agency, has estimated that 44 million women globally could lose access to contraception, resulting in 1 million unintended pregnancies if major COVID-19 disruptions to family planning health services continue for three months.
In Canada, women are already finding it more difficult to access birth control and abortion care. As the health care system has had to re-organize and prepare for an influx of COVID-19 patients, some hospitals have limited their abortion programs. While many physicians are providing virtual care for contraception, some offices have closed entirely and services such as intra-uterine device (IUD) insertion may not be offered by those that are open
Dr. Tali Bogler, academic family physician who practices low-risk obstetrics in Toronto, says that “for post-partum women, contraception (particularly an IUD) was often addressed in person at the six-week postpartum visit, which is now done virtually, resulting in a missed opportunity.” Medication and supply shortages may also restrict ability to refill prescriptions for medications like the birth control pill.
Bogler adds that “pharmacies are only dispensing one month of contraception, which means women have to go out more often to the pharmacy and need to pay the monthly dispensing fee.” These barriers to access increase the risk of unintended pregnancy and result in delays that can have serious health effects.
The social and economic implications of the COVID-19 pandemic have made access even more difficult for some women. For example, financial hardship due to loss of work, limited options for childcare and fear about attending in-person health care appointments have made access to contraception particularly challenging. Additionally, social isolation is a dangerous situation for many women, evidenced by the increasing rates of intimate partner violence. Women also may be more likely to face reproductive coercion and have trouble seeking discrete care in accessing abortion or contraception. These new challenges exacerbate many of the pre-existing inequities in social-economic status and geographical location that have historically impacted access to abortion and contraceptive care.
To help counteract some of the barriers to accessing sexual and reproductive health services, the Society of Obstetricians and Gynaecologists of Canada (SOGC) has developed a new guideline called “Guidance for Induced Abortion Care during Pandemics and Periods of Social Disruption.” It specifies that medical abortions can be provided safely and effectively based only on a home pregnancy test and date of last menstrual period if the patient is a good candidate. These newly developed “no touch” medical abortion protocols allow for virtual or telemedicine appointments and avoid the additional step of obtaining an ultrasound, not only allowing for faster access to abortion while respecting social distancing guidelines. The SOGC also suggests that mifegymiso, the “abortion pill,” can be offered up to 77 days after a missed period, which is beyond the usual limit of 63 days. These recommendations are intended to expand access so that patients can more reasonably get the care they need within an appropriate time frame.
COVID-19’s social and economic impact is felt more strongly by women and other marginalized groups. In this period of unique social disruption and uncertainty, it is vital that women maintain reproductive choice. This inspired Obstetrics and Gynaecology resident physicians at the University of Toronto to break down some of these barriers and collaborate with the Covid-19 Women’s Initiative to create an interactive map that allows patients to see clinics and services by location and to search for their nearest provider.
As Dr. Marta Cybulsky, a Toronto resident physician explains, “Our hope is that this interactive tool will reduce the legwork patients need to do to get access to timely contraception and abortion care during the pandemic.” The group has already had interest from other advocates across the province to extend this map to cities including Ottawa and Hamilton.
The Covid-19 Women’s initiative is a group of 110 passionate medical students and volunteers whose goal is to advocate for gender equity during this pandemic. It was founded by Karlee Searle and Aman Dhaliwal, who says “(We) feel strongly about reducing gender inequities … so we started CWI to intervene early and raise awareness in an attempt to mitigate long-term consequences for women.”
While this map may help patients find the services they need, this is just the beginning. Other initiatives are coming down the pipeline, including a campaign to get full government funding for birth control for all Ontario women. The hope is that these initiatives will not only help women access services during this public health crisis but may also have a lasting impact beyond COVID-19.