Access to Family Planning Services Following Natural Disasters and Pandemics: A Review of the English Literature.

BACKGROUND: When natural disasters strike, there is a sudden decrease in access to care due to infrastructure loss and displacement. A pandemic has the similar ability to acutely limit access to care. The relationship between decreased access to care and natural disasters has been previously explored. OBJECTIVE: The purpose of this article is to present a focused review of the available and emerging literature regarding the overall impact of natural disasters and pandemics on unintended pregnancy and decreased care in this setting. METHODS: A literature search was conducted on PubMed, Cochrane, Google Scholar, and Embase databases. The search was restricted to studies that were population-based, prospective or retrospective. Only peer-reviewed articles were considered. The search was further restricted to manuscripts in English or officially translated manuscripts. All qualifying papers from which data were extracted were subjected to a quality assessment conducted by two independent investigators (SK and AA). Each investigator reviewed all nine papers relevant to data collection using the Effective Public Health Practice Project (EPHP). MeSH terms were utilized across various databases. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcomes were the rates of unintended pregnancy. Secondary outcomes included the use of contraception, short interval pregnancy, and access to reproductive services. RESULTS: An initial search yielded 74 papers, of which nine papers were reviewed for qualitative data, examining the subjects affected by natural disasters or pandemics. An additional two papers regarding theoretical data and COVID-19 were analyzed. Although there seems to be a rise in unintended pregnancy and more difficulty accessing care following natural disasters and pandemics, there are variations in the rates based on region and event. CONCLUSIONS: The full effects of the COVID-19 pandemic on the rates of unplanned pregnancies will become apparent in the months and years to come. As obstetrician-gynecologists, we must communicate openly with our patients regarding the use of available contraception, sexual education, and family planning services at times of natural disasters and pandemics.

Access to Family Planning Services Following Natural Disasters and Pandemics: A Review of the English Literature

Background: When natural disasters strike, there is a sudden decrease in access to care due to infrastructure loss and displacement. A pandemic has the similar ability to acutely limit access to care. The relationship between decreased access to care and natural disasters has been previously explored. Objective: The purpose of this article is to present a focused review of the available and emerging literature regarding the overall impact of natural disasters and pandemics on unintended pregnancy and decreased care in this setting. Methods: A literature search was conducted on PubMed, Cochrane, Google Scholar, and Embase databases. The search was restricted to studies that were population-based, prospective or retrospective. Only peer-reviewed articles were considered. The search was further restricted to manuscripts in English or officially translated manuscripts. All qualifying papers from which data were extracted were subjected to a quality assessment conducted by two independent investigators (SK and AA). Each investigator reviewed all nine papers relevant to data collection using the Effective Public Health Practice Project (EPHP). MeSH terms were utilized across various databases. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcomes were the rates of unintended pregnancy. Secondary outcomes included the use of contraception, short interval pregnancy, and access to reproductive services. Results: An initial search yielded 74 papers, of which nine papers were reviewed for qualitative data, examining the subjects affected by natural disasters or pandemics. An additional two papers regarding theoretical data and COVID-19 were analyzed. Although there seems to be a rise in unintended pregnancy and more difficulty accessing care following natural disasters and pandemics, there are variations in the rates based on region and event. Conclusions: The full effects of the COVID-19 pandemic on the rates of unplanned pregnancies will become apparent in the months and years to come. As obstetrician-gynecologists, we must communicate openly with our patients regarding the use of available contraception, sexual education, and family planning services at times of natural disasters and pandemics.

Medical Mistrust in Perinatal Mental Health.

ABSTRACT: Despite the advancement of telemedicine and recent innovations in treatment, minoritized women continue to bear a disproportionate burden of pregnancy-related psychiatric conditions and complications, which the pandemic has further exacerbated. Research demonstrates that medical mistrust and systemic racism play central roles in the underutilization of services by racially and ethnically diverse women during pregnancy and postpartum. To effectively address these disparities, it is imperative to understand the drivers of medical mistrust in perinatal health care systems. This Perspectives article describes the historical context of medical mistrust in psychiatric and obstetric health systems and offers solutions to mitigate mistrust and the impact of systemic racism on perinatal care.

Effect of SARS-CoV-2 Infection on Pregnancy Outcomes in an Inner-City Black Patient Population.

While data have shown that Black populations are disproportionately affected by COVID-19, few studies have evaluated birth outcomes in these understudied populations. This study hypothesized that SARS-CoV-2 infection would confer worse maternal and neonatal outcomes in a predominantly Black and underserved population in Brooklyn, New York City. In particular, SARS-CoV-2 is associated with higher rates of preterm birth, cesarean delivery, postpartum hemorrhage, lower APGAR scores, and neonatal resuscitation. Demographic factors and comorbidities were compared between the SARS-CoV-2 positive and negative groups. A retrospective cohort study was conducted in hospitalized patients who gave birth at Kings County Hospital from April 10 through June 10, 2020. Demographic and clinical data were obtained from the electronic medical record. Patients were categorized based on SARS-CoV-2 infection status and peripartum outcomes were analyzed. We used the Fisher exact test for categorical variables and the Wilcoxon rank-sum test for continuous variables. P < 0.05 was considered significant. There were no differences in obstetric or neonatal outcomes between the SARS-CoV-2 positive and negative cohorts. Most SARS-CoV-2 positive patients were asymptomatic on admission. The rates of maternal comorbidities were similar in the SARS-CoV-2 positive and negative groups. In this predominantly Black population in Brooklyn, SARS-CoV-2 infection did not confer increased risk of adverse obstetric or neonatal outcomes, despite the prevalence of comorbidities. The impact of SARS-CoV-2 infection on pregnancy outcomes is complex and may differ on a community level. Determining how COVID-19 is associated with perinatal outcomes in this minoritized patient population will augment our understanding of health disparities in order to improve care.

Telehealth and the digital divide as a social determinant of health during the COVID-19 pandemic.

Telehealth has been shown to have comparable health outcomes in terms of patient-physician communication, and patient satisfaction and engagement. Nevertheless, the digital divide has exacerbated the social and economic factors that create barriers to health and well-being. It, therefore, maybe a social determinant of health (SDOH). Such issues as decreased internet connectivity and a lack of Wi-Fi and video chat/webcam in both urban and rural areas can hinder the effectiveness of telehealth to its full capability, especially among communities of color, the poor, and medically underserved. The social aspects of the provision of health care by physicians and health care workers are utilized to combat mistrust and strengthen the physician-patient therapeutic relationship. Addressing policy changes to address the digital divide as a SDOH may strengthen existing health care and public health systems to allow for patient and community-centered approaches to expressing lived narratives, including in a digital format.

Addressing Disparities in Prenatal Care via Telehealth During COVID-19: Prenatal Satisfaction Survey in East Harlem.

OBJECTIVE: In the setting of an inner city, safety net hospital, patient satisfaction with prenatal care conducted via telehealth was compared with in-person visits at the height of the novel coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: Through this cross-sectional study, patients were identified who received at least one televisit and one in-person visit during the COVID-19 pandemic. The Short Assessment of Patient Satisfaction (SAPS) survey was used to measure patient satisfaction. Surveys pertaining to in-person and televisits were conducted at the end of a telephone encounter, and overall satisfaction scores were documented. Patients were excluded if they received in-person or virtual care only and not both. The SAPS score correlated with the degree of patient satisfaction. RESULTS: A total of 140 patients were identified who received both virtual and in-person prenatal care from March 1, 2020 to May 1, 2020. One hundred and four patients (74%) agreed to be surveyed: 77 (74%) self-identified as Hispanic and 56 (54%) stated that their primary language was Spanish. The overall median satisfaction score for televisits and in-person visits was 20 (interquartile range [IQR]: 20, 25) and 24 (IQR: 22, 26) (p = 0.008, Z score = 2.651). In patients who self-identified as Hispanic or identified their primary language as Spanish, there was no statistically significant difference in their satisfaction scores. CONCLUSION: While there were lower scores in patient satisfaction for televisits in every category, there were no clinically significant differences since all medians were in the "satisfied" range. By lowering patient exposure to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), especially for those at risk for reduced access to care and higher COVID-19 cases by zip code, telehealth allowed for appropriate continuation of satisfactory prenatal care with no impact on patient perceived satisfaction of care. KEY POINTS: · Telehealth allowed for continuation of satisfactory prenatal care in Hispanic patients.. · Hispanic patients are at risk for reduced access to care.. · Telehealth was a useful tool for achieving patient-perceived satisfactory care..

In Utero Vertical Transmission of Coronavirus Disease 2019 in a Severely Ill 29-week Preterm Infant.

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) or coronavirus disease 2019 (COVID-19) is currently in worldwide pandemic state with very limited data about the mode of transmission to the growing fetus. There are a few published cases of COVID-19 infection in the infants born to COVID-19 positive mothers where most of the reported cases were either mildly symptomatic with positive COVID-19 polymerase chain reaction (PCR) or had negative COVID-19 PCR raising the question of vertical transmission. We present a case of likely intrauterine transmission of COVID-19 infection in a critically ill premature infant born to a COVID-19 infected mother and describing her clinical course thus far. The clinical presentation in the infant is consistent with COVID-19 infection described so far in literature along with positive PCR, and positive COVID-19 serology: immunoglobulin G, immunoglobulin M, and immunoglobulin A.

COVID-19 and HELLP: Overlapping Clinical Pictures in Two Gravid Patients.

Background The impact of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) on pregnancies is currently under investigation. There is a significant overlap between the clinical findings in novel coronavirus disease 2019 (COVID-19) and hemolysis, elevated liver enzymes, and low platelets syndrome (HELLP). Cases Patients presented at 22 and 29 weeks of gestation with suspected COVID-19 pneumonia. While the patient at 22 weeks of gestation subsequently had an intrauterine fetal demise, the patient at 29 weeks of gestation delivered via an emergency cesarean delivery for nonreassuring fetal status. Both patients also developed transaminitis, thrombocytopenia, and disseminated intravascular coagulation with a proof of hemolysis on peripheral smear. Conclusion Clinicians are encouraged to consider both of these diagnoses when caring for pregnant women during the COVID-19 pandemic to assure that both maternal and fetal concerns are addressed and treated appropriately.