Barriers to reproductive health care prior to and during the COVID-19 pandemic

During the height of the COVID-19 pandemic, there were significant disruptions in the delivery of reproductive health services in the U.S., creating additional barriers to care that may have resulted in large increases in delayed or skipped appointments. Delaying or forgoing reproductive healthcare can result in morbidity and, in situations such as untreated STIs, can also lead to an in increased risk of more serious complications. This analysis explores whether the COVID-19 pandemic may have impacted barriers to reproductive healthcare services experienced by U.S. women of reproductive age. We conducted an analysis of serial cross-sectional weighted survey data collected in 2017 and 2021 from members of a market research group’s KnowledgePanel, a probability-based sample. Our sample was limited to people assigned female at birth and ages 15 to 49. Of the 29,496 members invited, 7,022 and 6,841 completed the 2017 and 2021 surveys (50% and 45% response rates). In 2017, 40.6% (95% CI, 39.0-42.4) reported experiencing barriers to care in the past three years, increasing to 45.0% (95% CI, 43.2-46.8) in 2021; increases were observed for seven out of the nine barriers listed (p < 0.05). Additionally, multivariable analysis showed that the mean number of barriers experienced by participants in the past three years significantly increased from 1.09 (95% CI, 1.02-1.14) to 1.29 (95% CI, 1.22-1.37) (p < 0.001). Participants from historically marginalized populations – including those identifying as Hispanic, with no high school diploma or equivalent, and living at <100% of the Federal Poverty Level – experienced the greatest increase in the mean number of barriers (p < 0.05). This analysis provides evidence that during the COVID-19 pandemic, women experienced an increase in barriers accessing reproductive health services in the U.S. However, it also illustrates that such barriers existed prior to the pandemic and may persist as the pandemic wanes.