COVID-19 Labor Shortages Impacted Reproductive Health Workforce
COVID-19 labor shortages in healthcare already shifted access to contraception and abortion services years before the Roe v. Wade decision.
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By - Access to contraception and abortion services is up in the air after the Supreme Court overturned Roe v. Wade earlier this year, but a new study published in JAMA Network Open suggests that access to these services has been on the line for years because of clinical labor shortages.
For the study, researchers from the Milken Institute School of Public Health at George Washington University analyzed 2019 to 2021 national-level claims from IQVIA to examine changes in the contraception and abortion workforce during that period. The services included in-person contraception, such as intrauterine devices (IUDs), contraceptive implants, and injectable contraception, as well as misoprostol and mifepristone, dilation and curettage, dilation and evacuation, and surgical procedures for abortion services.
The claims data revealed a reduction in contraception and abortion services among specific clinician types. For example, fewer physicians provided contraception and certain abortion services (all exception medication abortions) in 2020 and the number of physicians providing these services did not bounce back to pre-pandemic levels by 2021.
As the number of physicians in the contraception and abortion workflow fell, more advanced practice clinicians delivered the services with the number staying consistent from 2019 through 2020 and even rising above pre-pandemic levels last year. Researchers noted this occurred as the number of advanced practice clinicians grew in primary care and other settings.
Additionally, the study found that contraception services significantly declined from March through May 2020 before being restored to about pre-pandemic levels later in 2020 and through 2021.
Abortion services did not decrease substantially in early 2020. However, procedural abortions did decline (from 8,315 services in January 2019 to 5,665 services in December 2021), while medication abortions steadily increased (14,347 services in January 2019 to 16,074 services in December 2021).
The findings are concerning, researchers explained, because of an “ongoing loss of physicians providing contraception services.”
“Access requires that primary care clinicians offer the full scope of care, including family planning services. Targeted investments in women’s health and primary care clinicians and state-level expanded scope of practice policies may strengthen this segment of the workforce,” they wrote.
The contraception and abortion workforce, though, is up against some serious challenges in a post-Roe v. Wade world. Many physicians fear legal repercussions from providing contraception and abortion services, especially in the more than a dozen states that enacted complete or partial bans on abortion after the Dobbs v. Jackson decisions.
Other research, including a study published in JAMA earlier this week, has already found the number of abortions decreasing following the Supreme Court’s decision. The JAMA study, for example, linked the 2021 abortion ban in Texas with a decrease in total in-state and out-of-state abortions.
Further research will be needed to understand how the current legal landscape will further impact the clinical workforce and access to reproductive health, said Julia Strasser director of the Jacobs Institute of Women’s Health at the Milken Institute School of Public Health.
“The abortion and contraceptive workforce has been consistently losing practitioners for a while, which leaves people with less access to these important services,” Strasser, who is also the lead author of the JAMA Network Open study, said in a press release.
