As a fierce advocate for women negatively impacted by disparities in our healthcare system, Dr. Grossman’s insight on the effect that the coronavirus will have on women is invaluable. Our conversation touched on the ways that we can protect our reproductive and sexual health during a pandemic.
*Responses have been edited for length and clarity*
Steph Black: As you know, we’re in very unprecedented times right now. We hope that folks are staying home, if they’re able, and are quarantining seriously. But that also means folks are staying with their partners or people who might be able to get them pregnant. There is an enormous strain on our health care system currently. So what are some potential issues that folks might face in this time in terms of their sexual and reproductive health? And how can they stay safe?
Dr. Jessica Grossman: A hormonal IUD, also called a long-acting reversible contraception method, is actually a great option for women at a time like this. And I work with a lot of physicians who I’ve been talking with. A lot of people are moving to telemedicine, which is great. I think there’s a big boon here that a lot of people are getting comfortable with and performing routine telemedicine on counseling patients about birth control. There’s a lot of use of telemedicine services and mail order services for some forms of birth control. I checked in with our medical director, whose name is Mitch Crennan, who’s at University of
California, Davis, on what they’re doing in respect to IUD, because as you said, you know, how can you get a long-acting method or a new method if you’re sheltering in place and self-quarantining?
SB: What steps are they taking?
Dr. JG: What they’re doing at their institution, first of all, is a lot of telemedicine. And if a woman wants a long term method, they’re doing all of the counseling online and on video and then having the woman come in because they believe that placing a long-acting method is an essential service at this time. And because they’re using telemedicine and scheduling appointments, patients, doctors, and staff are able to practice physical distancing because the offices aren’t busy. So when a woman does come in, she’s able to get in, get out, there’s nobody in the waiting room.
He said this to me, “At UC Davis, the Department of Obstetrics and Gynecology highly prioritizes women’s desire to avoid pregnancy at all times, including during the current pandemic. We have transitioned completely to video visits for all interactions that do not require an exam, and even have more provider availability as a result, to ensure that women who want short-acting prescription methods can get a prescription ASAP. For women desiring very highly effective methods like IUDs and implants, we are able to provide a rapid video visit to go through counseling and decision-making so that the needed visit is as short as possible. We are ensuring women who desire IUDs and implants access to our clinics for placement so that they can receive the highly effective contraceptive they desire.”
I hope that many providers are practicing that model because I think it would be terrible if women who want a long-acting method at this time weren’t able to access it.
SB: And what about unique barriers that already marginalized folks are facing? What issues might be compounding during this epidemic in regards to their sexual or reproductive health?
Dr. JG: There are already people who are suffering from inequity. Women who are in contraceptive deserts–areas of the country that don’t have a clinic that provides sexual and reproductive healthcare–they are really going to be impacted. Women who are in rural areas. Women who potentially are sheltering in place in an abusive relationship. Those are the things that give me pause and concern me.
It’s important for women to have emergency contraception at home they can get that online. In many cases, there’s a lot of great online birth control services out there. And also, to practice safe sex and use barrier methods if they’re with a new partner or an unknown partner, etc..
SB: What are some actions Lilith readers can take to alleviate some of these barriers?
Dr. JG: I would love for people just to visit our website and social media and learn about Medicines360. We’re a small non-profit organization. We’re also doing work in Africa. So when a woman supports us here in the US, it supports our work in Africa. We donate products and work with Direct Relief to do a free product program.
And we’re also encouraging women to share their stories about reproductive health. We have this great video of a woman called Brittney’s Story. Brittney is an African-American woman in Washington, D.C., who had trouble accessing and affording birth control. And she talks about that. We’re encouraging women to post their own stories about their challenges with access so that we can all hear about this.
Another program we have is an educational campaign online to talk about reproductive health. It’s called #NotAwkward because one of the things that we found is that a lot of women just aren’t comfortable talking about birth control and reproductive health. And there’s still a lot of stigma associated with that. And there’s a lot of women who aren’t talking to their health care providers and are only asking Dr. Google. We want to encourage women to have good conversations with health care providers because these kinds of conversations are health care providers are in family planning are trained to do.
Even a small donation of $50 can help a woman either here in the United States or in Africa get a hormonal IUD. And again, if that’s six years of contraception coverage, that’s an amazing investment.
SB: What else should readers know about reproductive health at this time?
Dr. JG: There are both some positives and negatives in terms of reproductive health care happening right now. One positive is that many states are trying to enact policies that enable telemedicine and medication abortion, which is a wonderful and a much needed and well-utilized service.
But then there’s also the negative of other states trying to restrict surgical abortion, which is a safe practice. They’re using this opportunity to try to restrict access to that.
We have an institutional patient assistance program where we give free products to women with low income. And we’re trying to extend that program into abortion clinics so that women who get an abortion can also at the same time get an IUD for increased pregnancy prevention protection.
The full spectrum of reproductive health care is an essential service. It doesn’t matter if it’s abortion or birth control. It’s essential for women’s health, well-being, safety, economic viability. I think that’s an important point. And there’s an overlap there that maybe we can find some common ground on.