US Women’s Sexual and Reproductive Health Trends

Contemporary OB/GYN Journal, Vol 66 No 6, Volume 66, Issue 06

Consortium | <b>Sexual Health</b>

Nearly a third of women in poor or fair health have been without health care during the COVID-19 pandemic. Even more worrisome, only half of uninsured women have been to an ob/gyn provider over the past 3 years.

These findings are from the Kaiser Family Foundation’s (KFF) national 2020 Women’s Health Survey.

During a webinar, held on April 21, experts discussed the implications for practice and policy, how the pandemic is reshaping women’s sexual and reproductive health care, and how it will affect family planning and those who use it in the future.

The survey, which was conducted mainly online in English and Spanish from November 19 through December 17, included a sample of 3661 women aged 18 to 64 years along with a companion survey for 1144 men aged 18 to 64 years for results comparison. Women aged 18 to 49 years made up almost 74% of respondents (2695) and study authors said there was an oversample of respondents who were uninsured, Asian, and identified as lesbian. Researchers reported a margin of sampling error of +/-2% for the entire sample and higher in subgroups.

Overall Health

Usha Ranji, MS, associate director for women’s health policy at KFF, presented key findings on overall health. The survey revealed that many women have been without health care during the pandemic, with women in poor or fair health reporting the highest rates (23% for all women versus 32% for women in poor/fair health). This included skipping a medical test or treatment recommended by a provider and preventative services such as routine tests and yearly checkups (38% for all women versus 46% for women in poor/fair health). In comparison, 15% of men reported skipping treatments or tests and 26% missed routine services.

The pandemic brought an increase in telehealth use among women. However, telehealth was used less among uninsured and younger women. Most women gave their telehealth visits ratings of excellent or very good in the categories of mental health (90%), chronic illness management (91%), symptoms related to COVID-19 (90%), and annual wellness visits (89%).

Additionally, survey results revealed that the pandemic was responsible for women having trouble paying medical bills, with 26% reporting that COVID-19 was the reason for financial difficulty. Ranji explained that 42% reported preexisting financial difficulties and 31% reported preexisting difficulties and COVID as factors.

More than half (51%) of women reported that the pandemic has negatively affected their mental health compared with 34% of men. The rates were higher in mothers than in fathers (54% versus 35%, respectively). Negative mental health effects were highest among White women (54%) compared with Asian women (50%), Hispanic women (48%), and Black women (42%).

Sexual Health, STIs, and Contraception

Questions on sexual and reproductive health were also asked in KFF’s survey. Brittani Frederiksen, PhD, MPH, senior policy analyst for women’s health policy at KFF explained that in the past 3 years, only 50% of uninsured women have visited an ob/gyn provider. Rates were higher for women on Medicaid (72%) and with private insurance (80%). Younger women aged 18 to 25 years were less likely to have visited a provider than women aged 26 to 34 years (79%) and women aged 35 to 49 years (76%). Black women were most likely to have visited a provider (78%) while Asian women (65%) were least likely. Seventy-three percent of White and Hispanic women visited a provider.

Most women had discussed contraception with their doctors (68%), but conversations on topics such as HIV (26%), other sexually transmitted infections, or STIs, (28%), and intimate partner violence (38%) were less likely brought up. White women (22%) were least likely to discuss HIV compared with Asian women (26%), Hispanic women (31%), and Black women (32%). For other STIs, White women once again had the lowest rates (25%), followed by Asian women (27%), Black women (30%), and Hispanic women (31%). Intimate partner violence was least discussed by Asian women (25%) followed by Black women (33%) and Hispanic and White women (40% each).

During the past year, 29% of women who were sexually active who did not use birth control reported a dislike of side effects or concern, Frederiksen explained. Twenty-three percent reported not wanting to use birth control; the same percentage said they did not mind if they got pregnant. Eleven percent said they did not think they could conceive. At least 1 method of birth control was used by 62% of women over the past year; 8% were trying to conceive or were pregnant, 14% were not using contraception at all, and 16% were women or partners who were unable to conceive. Forty-eight percent of women not trying to conceive said it was very important for them not to get pregnant over the next month, Frederiksen added. That number was 70% in women who were actively using contraception.

Women who seek contraceptive care most often go a doctor’s office (74%) compared with Planned Parenthood or other family clinic (8%).Hispanic and Black women seek contraceptive care at family clinics at a higher rate than White women (20% and 16% versus 8%, respectively).

The survey also asked about the quality of 4 points of care when women have a contraceptive visit with providers: if the woman felt respected as a person, if she felt she had a say in what mattered to her for birth control, if the woman felt the provider took her seriously about her preferences, and if the provider gave her adequate information to make the best decision about contraception. Less than half of all women (44%) said they received excellent care across this 4-point rating system. The number was lower for Hispanic (38%) and Black (36%) women. Forty-nine percent of White women reported excellent care.

Nearly 1 in 5 women were not using their preferred method of birth control, according to survey results, with 18% of women aged 18 to 49 years reporting that if any contraceptive method were available, they would want to use a different method than their current type. That number was highest among uninsured women (27%) followed by those on Medicaid (20%) and private insurance (16%). A quarter (25%) of women said the main reason they are not using their preferred method was because they could not afford the cost. Other reasons included their provider recommended a different type (20%), medical conditions that prevented the use of the preferred type (10%), the woman’s partner didn’t want her to use her preferred type (9%), or her preferred method was not available (8%). Twenty percent of women responded with reasons that were placed in an “other” category.

For women with private insurance, 20% paid out of pocket for the cost of contraception, Frederiksen said. Insurance covered the full cost for 64% of women and part of the cost for 21%. Five percent reported no coverage for birth control and 2% had insurance coverage but paid the entire cost themselves.

Overall, 65% of all women were comfortable with pharmacists prescribing contraception, and 70% were comfortable with making birth control available over the counter. Rates in these categories were higher in Democrats (72% and 78%, respectively) and Independents (63% and 70%, respectively) than Republicans (58% and 59%, respectively).

Reference

  1. Ranji U, Frederiksen B, Salganicoff A,et al. The sexual and reproductive health landscape in the US: current trends and the impact of the pandemic. Kaiser Family Foundation webinar. April 21, 2021. Accessed April 21, 2021.