Across the United States, millions have been infected by the novel coronavirus and more than 140,000 have died from COVID‐19. Beyond these numbers, however, the pandemic has affected the country in countless other ways. In this issue of Perspectives, we have gathered viewpoints from clinicians, researchers and public health experts to highlight the widespread effects of this continuing crisis on individuals’ access to necessary sexual and reproductive health services. These four essays focus on the following COVID‐19–related consequences: increased restrictions on abortion access, and on the ability of providers and clinics to legally offer the procedure; the growing barriers to immigrants’ access to sexual and reproductive health care, driven by migration status, race, socioeconomic position and xenophobia; the immediate and long‐term effects on the ability of adolescents and young adults to obtain confidential and affordable STI testing and treatment, contraceptive care, HPV vaccinations and sex education; and the growing threat to individuals’ reproductive autonomy, both in the United States and globally. In each piece, the authors describe the current and projected consequences of the COVID‐19 pandemic and associated public health responses, and then offer recommendations for addressing the identified challenges to achieving more equitable and comprehensive sexual and reproductive health.
Also in This Issue
• Although many studies have examined women's and (less commonly) men's pregnancy intentions, little is known about reproductive decision making within couples. Stephanie Arteaga and colleagues interviewed a diverse sample of 50 young adult heterosexual couples to explore how they had formed their prospective pregnancy intentions (see article). The couples—who had been together for at least two months, and in most cases more than a year—described myriad decision‐making processes. Nearly half had engaged in joint decision making, in which their pregnancy intentions became aligned (even if their current pregnancy desires differed) through negotiation, communication and, in some cases, compromise. The other participants had formed their pregnancy intentions individually, without consulting their partner; sometimes partners’ intentions coincided by chance, but for some couples, relationship difficulties and lack of communication resulted in one partner being unaware of—or even mistaken about—the other's desires and intentions.
• Intimate partner violence (IPV) among sexual minority young adults has received limited research attention. To help fill this gap, Alison Swiatlo, Nicole Kahn and Carolyn Halpern examined data from 24–32‐year‐old women and men who participated in Wave 4 of the National Longitudinal Study of Adolescent to Adult Health, and found that IPV perpetration and victimization varied by sexual orientation (see article). Compared with those who self‐identified as heterosexual, women and men who identified as mostly heterosexual were more likely to have perpetrated or been a victim of physical IPV, and to have threatened their partner with violence. Bisexual males had an elevated risk of being a victim of physical IPV, and both a perpetrator and victim of forced sex. The authors conclude that identifying the "mechanisms underlying partner violence among people of all orientations" would inform and support IPV prevention and intervention efforts.
• With the growth of religiously affiliated health care systems in the United States, the need to understand how religious restrictions limit or hamper patients’ access to abortion services has become increasingly critical. In their examination of abortion policies and patient care, Lee Hasselbacher and colleagues interviewed providers, administrators, chaplains and ethicists with experience working in Catholic, Protestant or secular hospitals (see article). While few restrictions were reported in secular hospitals, Catholic hospitals prohibited most abortions, and Protestant ones banned those deemed "elective." Respondents also described the role of ethics committees, and how hospitals handled the referral and transfer of patients for care elsewhere. As a result of religiously influenced policies, patients experienced delays in obtaining abortion, financial obstacles and restricted care options. The authors write that "governmental policies that privilege institutional religious freedom over patient access to comprehensive care may exacerbate the risk of harm to patients," and suggest that greater transparency regarding health care restrictions is needed.
• Differentials in female sterilization rates by socioeconomic status, race and ethnicity have been examined, but educational differentials in the use of this method are poorly understood. In a longitudinal study using data from the National Survey of Family Growth, Sarah Hayford, Alexandra Kissling and Karen Benjamin Guzzo employed demographic standardization to assess whether compositional changes in marital status and age at first birth contributed to aggregate changes in sterilization prevalence among 40–44‐year‐olds (see article). Among women with a high school education, the prevalence of sterilization increased from 38% to 44% between 1982 and 2011–2015, and was only weakly related to changes in birth timing and marital status. In contrast, among college‐educated women, prevalence declined over this period from 32% to 19%, a trend largely attributable to delayed fertility. The researchers believe these differentials by education level may reflect differences in contraceptive preferences and access, and possibly socioeconomic disparities that affect women's health and well‐being.
• Sexual concurrency—or overlapping sexual partnerships—among women has been associated with various adverse health outcomes, so understanding its prevalence is necessary to inform harm‐reduction efforts. Abigail Weitzman and Yasamin Kusunoki analyzed weekly journal data from women aged 18–22 who participated in the Michigan‐based Relationship Dynamics and Social Life study, and examined two types of concurrency using a social‐ecological framework (see article). Twenty percent of women had had vaginal sex with two partners in one week, and 14% had had sex with a second partner during an ongoing relationship. The likelihood of reporting both concurrency types was elevated among women who believed they should have sex with a man after seeing him for a while, and it was reduced among those who were more willing to refuse unwanted sex. Concurrency was also related to sexual norms, sex education and relationship status, and the authors argue that interventions to reduce behavioral risks should address the varied social‐ecological aspects of young women's lives.