Trends in Women’s Sexual and Reproductive Health in the United States
These findings are from the Kaiser Family Foundation (KFF) 2020 National Women’s Health Survey.
During a webinar, held on April 21, experts discussed implications for practice and policy, how the pandemic is reshaping women’s sexual and reproductive health care, and how it will affect planning. family and those who will use it in the future.
The survey, which was conducted primarily online in English and Spanish from November 19 to December 17, included a sample of 3,661 women aged 18 to 64 as well as an additional survey of 1,144 men aged 18 to 64. years for comparison of results. Women between the ages of 18 and 49 made up nearly 74% of respondents (2,695) and the study authors said there was an oversample of uninsured, Asian and lesbian-identified respondents. The researchers reported a margin of sampling error of +/- 2% for the whole sample and higher in the subgroups.
Overall health
Usha Ranji, MS, Associate Director for Women’s Health Policy at KFF, presented key findings on overall health. The survey found that many women have been denied health care during the pandemic, with women in poor or fair health reporting the highest rates (23% for all women versus 32% for women in poor or fair health). health). This included skipping a medical test or provider-recommended treatment and preventive services such as routine tests and annual checkups (38% for all women versus 46% for unhealthy women). In comparison, 15% of men said they skipped treatments or tests and 26% missed routine services.
The pandemic has brought an increase in the use of telehealth among women. However, telehealth was used less among uninsured and younger women. Most women rated their telehealth visits as excellent or very good in the categories of mental health (90%), chronic disease management (91%), symptoms related to COVID-19 (90 %) and annual wellness visits (89%) .
In addition, the survey results revealed that the pandemic was responsible for women’s difficulty in paying their medical bills, with 26% saying COVID-19 was the reason for their financial hardship. Ranji explained that 42% reported pre-existing financial difficulties and 31% reported pre-existing difficulties and COVID as factors.
More than half (51%) of women said that the the pandemic has had negative effects on their mental health compared to 34% of men. Rates were higher among mothers than fathers (54% versus 35%, respectively). Negative mental health effects were highest among white women (54%) compared to Asian women (50%), Hispanic women (48%) and black women (42%).
Sexual health, STIs and contraception
Questions about sexual and reproductive health were also asked in the KFF survey. Brittani Frederiksen, PhD, MPH, Senior Policy Analyst for Women’s Health Policy at KFF explained that in the past 3 years, only 50% of uninsured women have seen an OB/GYN provider. Rates were higher for women on Medicaid (72%) and with private insurance (80%). Young women aged 18-25 were less likely to have consulted a provider than women aged 26-34 (79%) and women aged 35-49 (76%). Black women were the most likely to have consulted a provider (78%) while Asian women (65%) were the least likely. Seventy-three percent of white and Hispanic women saw a provider.
Most women had discussed contraception with their doctor (68%), but conversations about topics such as HIV (26%), other sexually transmitted infections or STIs (28%) and domestic violence (38 %) were less likely at the top. White women (22%) were less likely to discuss HIV than Asian women (26%), Hispanic women (31%) and Black women (32%). For other STIs, white women again had the lowest rates (25%), followed by Asian women (27%), black women (30%) and Hispanic women (31%). Intimate partner violence was least discussed by Asian women (25%), followed by Black women (33%) and Hispanic and White women (40% each).
In the past year, 29% of sexually active women who have not used birth control say they don’t like side effects or worry, explained Frederiksen. Twenty-three percent said they did not want to use contraception; the same percentage said they didn’t mind if they got pregnant. Eleven percent said they didn’t think they could conceive. At least 1 contraceptive method has been used by 62% of women in the past year; 8% were trying to conceive or were pregnant, 14% were not using contraception at all, and 16% were women or partners unable to conceive. Forty-eight percent of women who were not trying to conceive said it was very important to them not to get pregnant within the next month, Frederiksen added. This number was 70% among women who were actively using contraception.
Women seeking contraceptive care most often go to a doctor’s office (74%) compared to Planned Parenthood or another family clinic (8%). Hispanic and black women seek contraceptive care in family clinics at a higher rate than white women (20% and 16% versus 8%, respectively).
The survey also asked about the quality of 4 points of care when women have a contraceptive visit with providers: whether the woman felt respected as a person, whether she felt she had a say in what matters to her when it comes to contraception, whether the woman felt the provider took her seriously about her preferences, and whether the provider had given her adequate information to make her best decision about contraception. Less than half of all women (44%) said they received excellent care in this 4-point rating system. The number was lower for Hispanic (38%) and Black (36%) women. Forty-nine percent of white women reported excellent care.
Nearly one in five women were not using their preferred method of birth control, survey finds, 18% of women aged 18 to 49 said that if a contraceptive method were available, they would want to use a method different from their current type. This number was highest among uninsured women (27%), followed by those with Medicaid (20%) and private insurance (16%). A quarter (25%) of women said the main reason they did not use their preferred method was that they could not afford the cost. Other reasons include that their provider recommended a different type (20%), medical conditions that prevented the use of the preferred type (10%), the woman’s partner did not want her to use her preferred type (9%), or his method was not available (8%). Twenty percent of women responded with reasons that were placed in an “other” category.
For women with private insurance, 20% paid for the cost of contraception out of pocket, Frederiksen said. Insurance covered the full cost for 64% of the women and part of the cost for 21%. Five percent said they had no birth control coverage and 2% had insurance coverage but paid all the costs themselves.
Globally, 65% of all women were comfortable with pharmacists prescribing contraception, and 70% were comfortable with the availability of over-the-counter contraceptives. Rates in these categories were higher among Democrats (72% and 78%, respectively) and Independents (63% and 70%, respectively) than among Republicans (58% and 59%, respectively).
Reference
- Ranji U, Frederiksen B, Salganicoff A, et al. The Sexual and Reproductive Health Landscape in the United States: Current Trends and the Impact of the Pandemic. Kaiser Family Foundation Webinar. April 21, 2021. Accessed April 21, 2021.
