Contraception for Young Adults Is 'Essential' Care During COVID-19

By Carolyn Crist

May 16, 2020

(Reuters Health) — Contraception should be considered essential health care during the coronavirus pandemic and its provision lends itself to telehealth, a group of health professionals argues.

Adolescents and young adults in particular may need more guidance during this time, and the need for family planning services could be greater due to changes in their environment, such as parental supervision or daily structure, the authors write in a viewpoint article in JAMA Pediatrics.

"There have been a lot of examples already of how reproductive health care needs have been deemed 'non-essential,' and although a vast majority of those were focused around abortion access, there are trickle-down impacts on all reproductive health care," said coauthor Dr. Tracey Wilkinson of the Indiana University School of Medicine in Indianapolis.

"Unfortunately, just because there is a pandemic does not mean those reproductive health care needs have gone away - in fact, they likely have increased," she told Reuters Health by email. "Access to contraception is essential health care, and it is important that we assure our patients' reproductive health care needs are not impacted."

Many services can be performed virtually, the authors write, including contraception counseling, provision of regular and emergency contraception and sexual at-risk counseling. To safely provide contraception, doctors can rely on a patient's history and don't need a physical exam or screenings for sexually transmitted infections or cervical cancer. Even blood pressure trends and contraindications can be determined through the patient's history.

However, telehealth poses a few challenges. Patient privacy could be a concern, for example, if adolescents don't have a private space to discuss their needs, and healthcare providers may not be able to assess whether an adolescent is able to respond freely. Doctors should use their clinical judgement to decide whether to ask about sensitive information, the authors write, and simple yes/no questions about sexual history and pregnancy screening could be helpful.

"It is vital for all clinicians, but especially those that take care of adolescents and young adults, to assure their patients have access to contraception regardless of the changes happening to the medical care delivery systems," Dr. Wilkinson said.

Healthy young people without underlying medical conditions and no medications can safely take reversible contraceptives, the authors note. Pills, patches and vaginal rings can be refilled or started on the day of the telehealth appointment and provide a 12-month supply. Counseling about contraception can be done virtually with photos and videos, they add.

Intramuscular or subcutaneous injections of progestin are typically given every three months in a doctor's office, but during the pandemic, providers may consider extending the interval to 15 weeks or exploring creative approaches, such as curbside injections or self-administration at home with guidance by video.

Doctors should also counsel their patients interested in intrauterine devices, and either set up an appointment or provide short-term contraception while waiting for in-person placement.

Emergency contraception pills may be prescribed as well, and doctors should encourage consistent condom use for sexually transmitted infection prevention, backup birth control and dual protection, the authors write.

"During past health crises, we have seen reduced access to family planning, with an increase in unintended pregnancy rates," said Ashley Meredith of the Purdue University College of Pharmacy in West Lafayette, Indiana. Meredith, who wasn't involved with the viewpoint article, has written about expanding adolescent access to contraception.

"Continue to focus on the needs of your patients. Get creative and adapt to the current delivery environment," she told Reuters Health by email. "Young people, in particular, are well connected with technology and receptive to new ways to access care. Don't shy away from reproductive health care - birth control can be safely prescribed without the need for a physical exam."

SOURCE: JAMA Pediatrics, online May 7, 2020.