Family planning providers across the country are adapting to the COVID-19 crisis and continuing to meet patients’ sexual and reproductive health needs by introducing innovative ways of delivering care. Providers’ resiliency in the face of adversity has been honed over years of contending with inadequate funding and restrictive state and federal political environments. Most recently, the Trump administration finalized the Title X "domestic gag rule," which undermines the integrity of the program. As Jamie Burch of Planned Parenthood North Central States noted, "We’re prepared for hardship in all times….We’ve been able to innovate because we’ve had to do this all along."
The coronavirus pandemic has only exacerbated pressures on family planning clinics and health centers, who are now facing shortages in medical supplies, increased demands on their time and expertise, and health risks to patients and staff, among other challenges. Despite the enormous difficulties of providing care during a pandemic, family planning providers are working hard to ensure that their patients have access to affordable and high-quality sexual and reproductive health care. According to presentations and interviews with providers across the country, it is clear that they are introducing inventive new practices and expanding existing ones in order to meet patients’ needs and keep patients and staff safe.
Social distancing guidelines have forced providers to rethink where they are offering services and under what conditions. To ensure patients’ and employees’ safety and continue offering services in the context of the continuing pandemic and stay-at-home orders in many localities, providers have developed numerous strategies to minimize time spent in the clinic and make their care accessible from patients’ homes.
Home-based care. Although telehealth was increasingly popular before the pandemic, the COVID-19 crisis has motivated many providers and lawmakers to quickly expand the scope and nature of telehealth services. Mel Barnes of Planned Parenthood of Wisconsin noted that the pandemic has "pushed us to quickly expand our telehealth services in new and innovative ways, making critical reproductive health care available to patients in their own homes." Providers are using telehealth to offer screening and treatment for urinary tract infections and STIs, as well as HIV prevention services. Contraceptive care that covers the standard range of options and considerations particular to this time (for example, at patients’ request, offering guidance on keeping IUDs in place longer than originally intended and self-administering injectable contraceptive shots), is also increasingly available to patients in their homes. Providers are also mailing medications and medical supplies to patients’ homes, such as multimonth supplies of birth control pill packs, contraceptive patches and rings, and STI tests.
Some family planning providers are expanding telehealth services even further to mental health services, such as talk therapy and medication management for anxiety and depression, and to gender-affirming hormone therapy for transgender patients. Jason Burkhiser Reynolds of Planned Parenthood North Central States shared that gender-affirming care "has been the most rewarding service via telehealth, because there are just so many barriers for patients."
Family planning providers’ method of delivering telehealth care is also changing. For example, some providers that once offered telehealth services using the site-to-site model (in which provider and patient call from different clinics) now use a model in which the patient is at home and the provider is either in a clinic or their own home. To care for patients who have limited Internet bandwidth, some clinics are also offering phone-only appointments, where and when that is legally permitted. Some providers are also waiving fees for certain telehealth visits, such as those to renew a birth control prescription or obtain emergency contraception. Others have cancelled any requirement of an office visit for birth control renewal, in line with guidance from the Centers for Disease Control and Prevention. Other providers are expanding telehealth at large: In April, Planned Parenthood expanded telehealth options to its clinics in every state.
These providers are taking advantage of recent actions by policymakers to loosen rules around telehealth. Bré Thomas of Arizona Family Health Partnership noted that the relaxing of these regulations to accommodate the unique safety concerns of COVID-19 "created opportunities to develop innovative strategies to provide clinical services." Several states are temporarily suspending outdated and medically unnecessary policies, such as requiring both the patient and provider to be in a health facility during a telehealth call. Further, some states are passing emergency measures that require private insurers to reimburse telehealth appointments as they would in-person appointments or allow providers to offer telehealth care to patients in underserved areas of neighboring states. On the federal level, the Centers for Medicare and Medicaid Services has waived several reimbursement and procedural guidelines related to telehealth for the duration of the health crisis. Another branch of the U.S. Department of Health and Human Services has also temporarily loosened privacy-related restrictions on types of telehealth platforms, allowing use of some commercial audio and video products.
Curbside and in-clinic care. In cases where patients must come to the clinic for care or it is impossible to mail supplies, some providers are shifting traditional in-clinic activities to patients’ cars and offering curbside pickup. For example, patients in some states are completing intake forms, receiving injectable contraceptive shots and having their blood pressure taken from the safety of their own cars parked outside the clinic. (It is important to note that these services are only available to patients who own or have access to a car.)
When it is necessary for a patient to enter a clinic, providers are adjusting their office procedures in an attempt to keep patients and staff safe. For example, some providers are routinely screening both patients and staff for COVID-19 symptoms, requiring that their patients wear face coverings, allowing just one patient in the waiting room at any time, and creating one-way hallways through the clinic.
Clinical procedures must be rethought and adapted to patients’ unique and changing needs. For example, one clinic is calling patients with upcoming appointments and working out a personal action plan to ensure that they get the care they want and need while minimizing time inside the clinic.
Building on the Momentum
Thanks to the expertise, energy and ingenuity of family planning providers, clinics have introduced creative ways of offering care during the COVID-19 crisis. Many of these new procedures—like expanded telehealth and offering self-administered contraceptives—are common-sense solutions that have been shown to remove barriers to reproductive health care, and could increase access even after the pandemic eases. This flexibility would benefit all patients, but it is particularly important for those who face barriers such as lacking reliable transportation, living far away from any clinic, not having time to visit a clinic, or having disabilities that clinics are not set up to accommodate. Providers cannot anticipate all of the unique barriers to care that patients face, but by offering a wider and more flexible menu of health care options, they increase the likelihood that patients will be able to get care, no matter their circumstances.
Family planning providers have proven time and again that they have the knowledge and creativity to continue to meet patients’ needs even in challenging environments. Their response to the COVID-19 pandemic is just the latest example of providers stepping up to the plate to ensure that their patients are able to access essential sexual and reproductive health care. As Catriona Reynolds of Kachemak Bay Family Planning Clinic noted, "Title X agencies and small family planning clinics have to adapt quickly and implement new things rapidly." With COVID-19, just like all challenges, "we had to look for what the opportunities were."
While family planning providers should be lauded for their ingenuity and dedication to their patients during these times, they need more than our gratitude. They deserve comprehensive and enduring structural supports including—at a minimum—a complete reversal of the domestic gag rule, and robust and sustained funding for the national clinic network.