This week, the Kaiser Family Foundation released a report on sexual and reproductive health, with a focus on how the pandemic may have changed things. Wyoming Public Radio's Maggie Mullen spoke with Brittni Frederiksen, a senior policy analyst for the foundation. She said one thing that really shifted — more women are getting certain kinds of care from home.
Brittni Frederiksen: We asked if people had had a telehealth visit prior to the pandemic, and very few had. If we're looking at the urban rural differences, 14% in urban areas said they had, and 13% in rural. So, there were really no differences there. But then, during the pandemic, we asked between the period of March 1, and the survey was fielded in November, December of 2020. And 39% of women in urban areas had used telehealth at that point and 32% in rural areas.
Maggie Mullen: I'm glad you mentioned rural women because I wanted to ask about them. In what other ways did they respond in the survey? Or how were they different than their urban counterparts?
BF: Another interesting finding around telehealth with urban-rural differences where we asked what your primary reason for that was, and the number one reason for rural women was mental health services. 24% of women in rural areas said that they had had a mental health visit as their most recent telehealth visit, and 16% of women in urban areas. We found fewer women had access to telehealth for sexual and reproductive health services. So, those may be services that women are preferring to seek in person. And so I think that is the important thing moving forward, is ensuring that we have both of these options for women. Where telehealth works really well, and it makes it easier to access care, that's great. But for women that may not have a safe place in their home to take a visit or have internet issues, and would rather be seen in person, that that remains an option as well.
MM: And I noticed that rural women were also the least likely to have a Pap test [a test for cervical cancer] in the last two years.
BF: Yeah, so that was an interesting finding. And that could be because there are just fewer reproductive health care providers in rural areas. And we know that this is an important screening. Women only need to have one every three years. But you know, after one year of being at home for an entire year, there goes one year, and then just ensuring that you get in for your regular screenings. And at these visits, they also do breast exams to identify any sort of risk for breast cancers. So, I think we found in our survey that people are going without these preventive care services during the pandemic, especially women and women that are reporting that they're already experiencing poor health. And that may be because they're worried about going into a clinic and being exposed to COVID. But in the end, if we delay these preventive health care services, it could result in a lot more long-term negative health outcomes.
MM: You mentioned these breast exams as something that's not really your primary reason for getting in the door at your doctor's office, but are still really important, which brings to mind these screenings for intimate partner violence and how important those are.
BF: Yeah, definitely. I mean, so many things are covered in a well-woman visit and a lot of contraceptive education happens. And we found that a lot of women had discussed contraception with their provider, but yeah, very few had had a provider ask them about STIs or HIV, and then around 38% said that they'd been asked about intimate partner violence. And this is a recommendation from the US Preventive Services Task Force. So, this is a pretty low percentage. And that could have been exacerbated by the pandemic as well, because women are taking these telehealth calls from their home. And if you're already living in a space, that's not safe, it's a lot more difficult to disclose that you may be experiencing intimate partner violence. And I think the other thing is providers struggle with some of these screenings, these sensitive topics, because you have to have resources available if a woman discloses that she is experiencing intimate partner violence. And providers might not always have those resources on hand.
MM: Right, which reminds me of another part of the survey. There were some questions regarding the interactions between providers and patients. Can you talk a little bit about that?
BF: One question that was asked was around contraceptive counseling. And this was a scale that asked women for questions about their most recent contraceptive counseling experience with their provider. And it's basic things like, "my provider respected me as a person. They let me say what mattered to me about my birth control, they took my preferences seriously. They gave me enough information to make the best decision about my birth control." And only 44% of women rated their provider as excellent on all four of those criteria for items and the percentage of Black and Hispanic women, that percentage was even lower. And then one of the other questions we asked women about negative experiences they had had with their provider. And women were much more likely to say that they had had an experience with the provider, where their provider dismissed their concerns in the last couple of years. So I think that patient-provider counseling and interaction is so incredibly important, and it affects whether women want to come back to see their provider as well.
MM: Well, Dr. Frederickson, thank you so much for your time today.
BF: Okay. Thanks, Maggie.
