Women in the U.S. missed out on a range of essential healthcare services during the pandemic -- from routine health screenings to contraceptive care -- because of public health restrictions and increased financial barriers, researchers found.
Compared with men, more women skipped a recommended medical test or treatment (15% vs 23%, respectively) or missed preventive health services (26% vs 38%, respectively) during the COVID-19 crisis, reported Usha Ranji, MS, and Brittni Frederiksen, MPH, PhD, of the Kaiser Family Foundation (KFF).
Women in fair or poor health were even more likely to miss essential medical care, with 32% skipping recommended tests or treatments and 46% missing preventive care appointments, such as a yearly check-up, the researchers said in a about .
"We found that many women reported skipping healthcare services, and this was higher among women than men," said Ranji, associate director of Women's Health Policy. One of the most concerning patterns, she added, was that women in fair or poor health were even more likely to miss care, leading to more severe health outcomes.
"Over a quarter of women in fair or poor health said their condition got worse because they were unable to get care," Ranji said.
One-fourth of all survey respondents also reported having trouble paying their medical bills in the last 12 months, the survey showed. Of the women who struggled to pay for healthcare expenses, 26% attributed it to their financial situation during COVID-19, 42% said it was something they were already experiencing, and 31% said it was a combination of both.
Approximately 18% of women in fair or poor health did not fill a prescription, cut pills in half, or skipped doses of medicine during the pandemic.
In addition to missed doctors appointments and treatments, a significant portion of women reported struggles with access to contraceptive care during the COVID-19 crisis. Around one in five women (18%) said they were not using their preferred method of birth control in the last 12 months. Of all uninsured women, 27% reported that they were not using their chosen contraceptive method.
Among the women who were not using their preferred contraceptive method, about 25% said it was because they couldn't afford it, while another 20% said it was because their provider recommended something different.
"There were also women that stated accessibility reasons," said Frederiksen, a senior policy analyst at KFF. This includes being unable to get an appointment or to get to a doctor's office -- "which is where tele-contraception could be used to improve accessibility."
Raegan McDonald-Mosley, MD, MPH, CEO of Power to Decide, a non-partisan, non-profit organization that describes itself as working to ensure that all people have the power to decide if, when, and under what circumstances to get pregnant and have a child, said the data in the survey on contraceptive counseling was a signal that there is a need to change how the medical community delivers reproductive healthcare.
"Clearly, there is a need for more person-centered and person-driven quality measures to gauge the effectiveness and high quality of contraceptive counseling care," McDonald-Mosley said in a panel discussion after the briefing.
This was also evident, she noted, in the finding that less than half of all women in the survey said they received excellent care during contraceptive counseling. Among Black women, only 36% reported high satisfaction with their care.
Ranji and Fredericksen also reported findings on telemedicine during the COVID-19 crisis, noting that the number of women who used telehealth services nearly tripled compared with the start of the pandemic.
But equitable access to telehealth was not widespread -- women who used telemedicine were older, had higher educational attainment, were insured, and were more likely to live in a state with expanded Medicaid, the researchers found.
"Technology has the potential to be a game-changer, but we also have to be clear-eyed about who is, and who can be, left behind," McDonald-Mosley said, explaining that thinking about infrastructure and internet access in rural areas, assuring low-technology options, and giving patients the option about how they would like to receive care is critical.
The KFF Women's Health Survey is a nationally representative sample of approximately 4,000 women and 1,000 men between the ages of 18 and 64. The survey, which took place between November and December 2020, was fielded by the National Opinion Research Center at the University of Chicago.
Ranji and Fredericksen noted that they also plan to release findings from the survey about the experiences of LGBTQ women and men during the pandemic.