By Sadiq Vali
Dr. Ruth Habte is a resident at UBC in the department of Obstetrics and Gynaecology. COVID-19 Women’s Initiative (CWI) reached out to her to talk about the changes in access to contraception and sexual health during the pandemic that she has seen since the start of her residency. She was excited to have this conversation with us and knew the importance of this information. She was working in the Gynae clinic at Vancouver General Hospital at the time of the interview (May 20th, 2020). She is currently on rotation doing Obstetrics and Gynaecology at St. Paul’s Hospital.
When the pandemic started how did you imagine it affecting access and attitudes towards contraception?
My biggest concern was still the cost of contraception – both separate from and intertwined with the particular measures implemented during the pandemic. Another concern was people not being able to access physicians for a variety of reasons – maybe because they are in a rural community and have trouble reaching their physician or maybe they are trapped at home with an abusive partner.
What changes have you noticed in the attitudes of the patients as well as in health care providers concerning reproductive health measures during the pandemic?
Early on during the pandemic, our preceptors were mindful of the fact that our patients would likely be at higher risk for pregnancy. For VGH Gynae, we would use every non-emergency clinical encounter to talk about contraception, unless the patient was already pregnant. We also prescribed larger quantities of contraceptives, so that patients would not need to leave their homes as often.
Are patients more interested in getting Intrauterine Devices or long-term contraceptives now?
I’ve noticed that more patients do want to have IUDs, but VGH – at least at the start of the pandemic – only had a limited capacity to see patients for IUD insertions as time and resources were needed for other urgent concerns. There are other clinics like Willow Clinic and Everywoman’s Health Center that patients can go to for IUDs as they have a lot more capacity. In some cases, these clinics can even provide free samples of Oral Contraceptive Pills (OCPs) if the patient does not have the resources or the insurance to cover the cost of it. During the pandemic, at the VGH Gynae clinic, we tended to prescribe the patch, the pill, or the ring.
What do you think could have been done during the beginning of the pandemic to ease patients’ concerns?
During the first few weeks of the physical distancing measures in the pandemic, we saw almost no patients in the Gynae Clinic or as a Gynae Service. Slowly after a couple of weeks, patients started returning. However, due to the fear of presenting for care, many were presenting far later than usual. This unfortunately meant many patients were coming in with more severe manifestations of their condition. I understand the fear the patients were – and to some extent still are – feeling. I do think it would have been really helpful if we could have put out clear messaging on the importance of still checking in with their family physician for non-emergency care needs and going to the emergency department when health emergencies occur.
Are you more concerned now if patients miss their appointment since oral contraceptive pills need to be taken on such a strict timetable?
Not really, since most of the follow ups are via phone. If a patient does miss their appointment, the Medical Office Administrator will still follow up with them to ask them the reason for missing the appointment. If they are a patient with the clinic and need a prescription refill or have a related gynaecological concern, they can always call the VGH Rapid Access Gynae Clinic and whoever is on call will provide them with the necessary care. There are also a lot of online resources available to patients such as GetCheckedOnline – an online service that offers testing for sexually transmitted and bloodborne infections.
If most of the consults and follow ups are via phone, how has that affected the patients that are potentially living with an abusive partner? Have you found a way for them to safely talk about their health?
Unfortunately, no, I haven’t found anything that works well over the phone, especially since I have had situations where their partner was on the call without me knowing. However, if it is an in-person appointment or I am seeing someone in the emergency department, now is likely a better opportunity for them to disclose, as patients are seen on their own and no visitors are allowed.
Does the VGH Gynae Clinic also perform abortions?
The VGH Gynae service’s mandate is to manage early pregnancy complications, including potentially the surgical or medical management of non-viable pregnancies. Those found to have a viable pregnancy and wish to undergo surgical or medical abortion are referred to one of the several nearby clinics whose mandate is such. The patient can self-refer to these clinics as well.
How has the pandemic affected the way you deliver care to LGBTQ2S+ patients?
I can only comment on the situation at VGH, but the barriers that have faced LGBTQ2S+ patients prior to the pandemic certainly did not go away. There is still much to advocate for on that front. Unique to the pandemic, however, is how gender-affirming surgeries have been suspended which has been detrimental.
Is there anything you want people reading this to know about, especially during the pandemic?
In general, patients with abnormal menstrual bleeding wait for a long time prior to presenting for care. If they are soaking through a maxi pad every hour for 3 hours in a row, then that is not normal. If people are passing large clots with their menses, then that is not normal. If they are having such intense menstrual cramping that they have to miss school or work, then that is not normal. Signs of anemia (dizziness, palpitations, chest pain, shortness of breath on exertion) are not normal and need to be dealt with as soon as possible. I also want them to know that there are still many options available for safely accessing contraceptives and abortions during the pandemic.