Op-Eds do not reflect the editorial opinion of The Daily Free Press. They are solely the opinion of the author(s).
Shelby Ingerick is a graduate student at the School of Public Health.
In the time of COVID-19, health care systems, including gynecological health services, are rapidly changing. In fact, the effects will last much longer than the pandemic itself. During all of these changes, access to care has been an important and primary concern for many; another concern to think about is the quality of care being given.
Does having appointments through telemedicine decrease the quality of care? How does one achieve person-centered care when many appointments are not in person?
Before the pandemic, person-centered reproductive care was already shown to be an issue. One example of this is the delay in diagnosis of endometriosis. According to the American Journal of Obstetrics and Gynecology, it can take up to 11 years for women with endometriosis to be properly diagnosed. Women who experience delays in endometriosis diagnoses say that they felt their practitioners didn’t listen to their concerns and downplayed their symptoms. Similarly, it takes women with polycystic ovary syndrome, on average, over two years to be diagnosed. Oftentimes, women who report having pain are told their pain is psychosomatic.
This lack of person-centered care has also been shown in other areas of medicine such as contraception. Many women don’t receive adequate counseling and are under-informed about: their contraception choices, how each option works or what to expect with each option. This often leads to women having an unequal role in choosing their contraception.
An absence of person-centered care along with discrimination and bias at all levels of healthcare result in wide racial disparities in reproductive and sexual health. Cervical cancer incidence and mortality due to cervical cancer is higher among black women compared to white women. The rate of unintended pregnancy is more than two times greater for non-Hispanic black women than non-Hispanic white women. These are just some examples of the consequences of women’s health providers neglecting to practice person-centered care principles.
Now, amidst the pandemic, negative outcomes and health disparities due to a lack of person-centered care may be exacerbated. The American College of Obstetrics and Gynecology (ACOG) has given guidance to healthcare providers on how to optimize patient care in the context of COVID-19. However, it’s ultimately up to individual practices to determine which services of care are prioritized over others. Any preventative or routine screenings are suggested to be deferred, whereas most other services can be done remotely. The ACOG only suggests in-person appointments for “situations in which delay would be harmful to patient health and safety.” This can have a wide range of interpretations similar to how some states are declaring abortions as nonessential medical procedures.
For the majority of appointments that are now occurring over telemedicine, is the quality of care being maintained? ACOG says confidentiality is being maintained and that The Drug Enforcement Administration is allowing prescriptions to be issued without needing an in-person medical evaluation. Also, studies that have looked at telemedicine practice’s effects on quality of care show that it actually improves quality. Patients feel that it’s easier to communicate to their providers and ACOG says that telehealth enhances rather than replaces standards of care.
However, these findings are looking at telemedicine practices that were implemented in a different context. Right now, multiple practices have had to rapidly change over to delivering services via telemedicine in order to reduce exposures for patients and providers. Some of these practices didn’t have the foundational infrastructure or experience in practicing telemedicine. Therefore, quality of care may not be as enhanced as some previous studies suggest.
Poor quality of care may also violate human rights. Many COVID-19 response efforts will be disproportionately affecting women as was seen in the Ebola and Zika epidemics. High demand for health systems will likely create a shortage of resources and disrupt global supply chains which can hurt women’s access to contraception or routine maternity care. Domestic Violence has been shown to increase as victims are more limited in their ability to get away from their abusers. Women will likely suffer more unemployment and economic struggles as they make up the majority of the informal work and service industries that have been most affected.
Accessing quality sexual and reproductive health care should not be another contributor to the extensive gender inequities that this pandemic is exacerbating.
While efforts continue in making sure every woman receives access to gynecological health services, quality of care should not be forgotten. It is still hard to tell what reproductive and sexual health outcomes for women will result from this pandemic. However, if person-centered care remains a priority, potential negative outcomes can be mitigated.