Amid pandemic, NC women need better healthcare access

In the backdrop of the COVID-19 pandemic, family planning for women across the nation is shifting. Hospital protocols to prevent the spread of the coronavirus are creating delays in healthcare appointments. A third of women have had to delay or cancel their visits for reproductive healthcare, including birth control. These numbers are even higher for women of color and queer women.

North Carolina prides itself on world-class access to healthcare with some of the best hospitals in the nation and an innovative plan to reform our healthcare delivery. But COVID-19 has tested our healthcare system and pushed it to its limits. It has exacerbated known gaps and barriers in access. Our fight against the pandemic comes at a time when the country is openly grappling with systemic racism, including within healthcare, and now is our opportunity to make changes to provide women equity in access to care. In both of those fights lies reproductive health.

North Carolina’s reproductive healthcare data is stark: 43% of pregnancies are unintended, the state has the 13th highest infant mortality rate in the nation, and Black women are three to four times more likely to die from pregnancy-related complications. This data, coupled with other social determinants of health and systemic racism, can perpetuate a broad set of negative health, economic, and social outcomes for women, children and families. It’s time for North Carolinians to start focusing on reproductive healthcare as primary care, which includes expanding access to contraception for all.

This ambitious goal cannot be made without also recognizing our past. As North Carolinians, we are reminded of the ugly history of forced sterilization and reproductive coercion. In 1933, the North Carolina Eugenics Board was established to sterilize those it deemed unfit, its justifications underpinned by racism, classism, and sexism. This tragically resulted in the sterilization of roughly 7,600 people, many of whom were female, Black, and poor.

Structural barriers and systemic bias continue to stand in the way of patient-centered contraceptive access. We have to reimagine the way that we handle reproductive care, both before and after patients experience pregnancy. Women across North Carolina should have the right to their birth control method of their choice. As part of our work with the nonprofit organization Upstream USA, our goal is to transform North Carolina’s healthcare system and provide best-in-class contraceptive care across the state by providing training and technical assistance to health centers, integrating reproductive health and primary care.

Most healthcare providers are not trained to manage all contraceptive options. Even if they are, there are often other barriers that limit a patient’s option to choose the one that works best for them and go home with it that day. Appointment slots can be too short to have a full conversation. All methods aren’t stocked on the shelf at all times. It’s not uncommon to hear that patients are required to come back for a second or third appointment to be able to get a particular method due to stocking or billing requirements. This places the burden of taking off work or arranging a babysitter on the patient.

During COVID, providers are seeing that many patients are not returning for postnatal six week appointments. And, before leaving the hospital, there is a possibility they may see a different physician due to blocked schedules created to help lower the risk of COVID-19 transmission. Ideally, pregnant patients would talk to their physician about when and if they would like to become pregnant again, and their preferred birth control method post-delivery. Physicians could then communicate the patient’s care plans to the next rounding physician, as so many hospitals have adopted shift protocols during the pandemic. But the ideal transition for patient care is not regularly occurring, though we’ve already seen it can exist.

As we usher in a new era of healthcare in our state and continue to respond to the challenges of the pandemic, we owe it to North Carolinians to be adaptive, transparent, and respectful about providing reproductive healthcare that prioritizes patient autonomy and choice. Revitalizing our healthcare system to be more innovative and cognizant of patients’ needs and provider bias has never been more important; it’s the only way to break down systemic barriers and provide the world-class care North Carolinians deserve.