Leveraging Telehealth’s Role in Sexual and Reproductive Health Equity

The COVID pandemic and shut-down safety regulations across the country created a huge uptick in telehealth services. The health care landscape has rapidly changed to include more permanent policy flexibilities. With the telehealth industry poised for continued growth, there is opportunity to build a telehealth market that expands access to the health care services people of reproductive age need most: sexual and reproductive health (SRH) care.

Why Telehealth for SRH Matters

As state restrictions and bans on SRH care continue, access is increasingly dictated by where a person lives. Industry leaders must double down on efforts to create new ways for people to get the care they need. Telehealth offerings are essential to bridge gaps in SRH access. Some key opportunities include:

• Home STI kits, which can make testing easier and more accessible, helps reduce STI-related stigma and expands private and convenient options for patients to assess their sexual health status.
• Virtual care — for health care like abortion, birth control, and gender-affirming care — helps patients see a provider and get care whenever and wherever is best for them: at home, in a dorm, or in a car during a lunch break.
• Expansions of telehealth coverage, particularly audio-only care, can support efforts to address maternal inequities by ensuring that more people can get timely, high-quality prenatal care.

Limited SRH access and health outcome disparities are disproportionately felt by communities that already face outsized barriers to care — as a result of systemic racism and historical discrimination — necessitating urgent action. Consider, for example:

• More than half of states have banned or restricted abortion services, with stipulations like mandatory ultrasounds and other medically unnecessary requirements. While the loss of abortion access affects everyone, the people most harmed include Black, Latino and other people of color, as well as individuals with low incomes, trans and non-binary people, immigrants, adolescents, and those living with disabilities.
• Sexually transmitted infection (STI) rates are at epidemic levels, with more than 2.5 million cases of chlamydia, gonorrhea, and syphilis recorded in 2021 alone. At the core of the skyrocketing STI rates is a health equity crisis: a third of all cases of were among Black people, nearly half of syphilis cases and nearly a third of gonorrhea cases were among gay and bisexual men, and the highest rate of congenital syphilis cases was among American Indian and Alaska Native people.
• At least 19 million women in need of publicly funded contraception (i.e., those with incomes less than 250% of the federal poverty level) live in contraceptive deserts or areas lacking reasonable access to providers offering the full range of contraceptive methods. For women in these areas, accessing contraceptive care means traveling long distances and navigating logistical challenges associated with travel, including the social determinants of health, like access to childcare, financial resources, and transportation.
• The U.S. maternal mortality rate is more than ten times higher than the estimated rates of other high income nations and rising, particularly among American Indian and Alaska Native women and Black women, who are two and three times more likely to experience pregnancy-related mortality than white women. With 4 in 5 pregnancy-related deaths preventable, research shows that racism, such as allostatic load (stress related to daily trauma associated with experiencing racism), discrimination by providers, and other systemic barriers to care are significantly driving poor maternal health outcomes.

Driving an Equitable Telehealth for SRH Landscape

Planned Parenthood, is continually expanding a digital footprint to connect people to the care and information they need: including Roo, a sexual health chatbot that fields 200,000 interactions every year; Spot On, a period tracker to empower users to privately and securely track their sexual health; and Planned Parenthood’s website which informs and educates 200 million visitors a year. As a result of the telehealth flexibilities created in response to the COVID-19 pandemic, Planned Parenthood health centers across the nation provide increased access to SRH care via telehealth to help patients get the high-quality care they need. In fiscal year 2021-2022, Planned Parenthood health centers provided over a half million virtual visits for various services, including gender-affirming care, abortion where legal, and other sexual and reproductive health care.

But like other frontline telehealth providers, we know that more must be done to expand access to virtual SRH care. And while Planned Parenthood is ready to do more, stakeholders — including payers and policymakers — must enable us to do so.

There has been progress in expanding some telehealth already, including through addressing coverage and payment for live video interactions in state Medicaid programs. Still, providers face hurdles in integrating the full range of telehealth options for their patients. To truly move the needle on virtual SRH access, payers and policymakers must:

• Remove unnecessary requirements, such as policies requiring patients to visit a provider in person before beginning telehealth and restricting telehealth coverage to specific services.
• Ensure equitable reimbursement for the full range of telehealth models to enable providers to sustainably offer audio-only and asynchronous options to patients who need sensitive services.
• Expand provider capacity amid a health care provider shortage compounded by rising burnout by expanding telehealth provider flexibilities — including abandoning Medicaid’s “four walls rule,” which requires some providers to deliver (or patients to receive) telehealth services while physically located in a health center.
• Invest in frontline telehealth providers who often provide a 360-degree approach to care, maintaining both a virtual platform and brick-and-mortar health care access. These provider types also typically offer sliding scale payment policies and contract with a comprehensive range of health care payers, including Medicaid payers, to ensure everyone can access the care they need.