The Failing Safety Net Is Harming Reproductive Health

The COVID-19 pandemic has disrupted economies around the world and altered people's lives, with women bearing the brunt. Between February and April 2020 approximately 12 million women lost their employment--more than half of job losses in the United States. As with previous economic shocks, women of color and low-income women are hit the hardest. The blow to their economic stability can have cascading effects on women's reproductive desires and access to health care.

Our team at the University of California, San Francisco reached out to women via social media to document their experiences and the barriers they face. We found that women are facing economic struggles that have upended their ideas about pregnancy and parenting, but the same barriers that put them in this precarious position make it hard for them to get the health care they need to prevent pregnancy. At every step, they're falling, and the safety net is not catching them.

Inability to afford food, transportation, and/or housing was associated with a reduction in desire to be pregnant.

The disproportionate impact on people of color that we have seen throughout this pandemic is apparent in our study. Women who identified as Hispanic/Latina and Black/African American were more likely to experience inability to afford food, transportation, and/or housing during the pandemic than women who identified as White. Latinas have twice the odds of experiencing food insecurity. Many of the women experienced financial stress and need to work outside of home despite having higher risk of and being worried about contracting COVID-19. Food insecurity was a critical concern. One woman with dietary restrictions illustrated how difficult it was to meet her dietary needs during the pandemic. She told us she had to travel "over 50 miles round trip to charities that would work with me and allow me to pick through supplies...they specifically shopped for me."

Inability to afford food, transportation, and/or housing was associated with a reduction in desire to be pregnant. Even people who did not express that they were worried about bring a child to the world indicated that they wanted to wait until the pandemic ended to be pregnant. Many women who had less desire to be pregnant prior to the pandemic also expressed that pandemic made them sure that they never wanted to be pregnant in the future. One woman shared that: "I was ~90% sure I did not want to have children prior to the pandemic, but seeing everything going on with quarantining, inability of school/childcare, loss of jobs, plus the health risks of a pandemic have solidified any doubt in my mind that I might have wanted to have children. "Many women expressed anxiety around current pregnancies. One woman wrote, "It has been rough being in a state lockdown so close to giving birth on top of depression and anxiety. I have felt so terrified and still do about the current state of everything and it has made me feel so guilty for bringing children into the world in such a scary time."

Given how important it was to women to not become pregnant during the pandemic, it is concerning that nearly one in six women reported difficulties accessing contraceptives. The women with the hardest time getting birth control were the same ones who have seen decreased income, food insecurity and inability to access food, transportation, and housing during the pandemic. Some women reported that the problem was that they lost their job, and with it their health insurance. They also faced barriers to a doctor's appointment - whether it was difficulty in getting an appointment or feeling hesitant to go to a clinic during the pandemic.

Women gave credit to organizations and social networks for filling in the gap that a well-rounded social safety net should fill. Local food banks and community assistance played an important role in easing food insecurity. Family planning clinics provided healthcare during the pandemic. But those stopgaps are no substitute for a robust social safety net that ensures people can survive a national crisis, like this pandemic. The small amount of aid from the federal government still left many people behind. One woman shared, "Financial stress has never been a part of my marriage...Due to the CARES ACT and provisions for who was eligible for relief, we weren't eligible for any relief. Stress is at an all-time high and we've had to frequent food banks and Catholic charities to pay our rent."

People's needs for health care increase when they face a dire unemployment situation, and we need a healthcare system that can step up to that challenge. However, under the current health system, barriers to healthcare were heightened when women needed the care the most. These women's stories shine a spotlight on the need for comprehensive coverage of healthcare that is not tied to employment. The social safety nets (or the lack thereof) that have failed these women, like food transfer and cash transfer, must expand.

We owe it to these women to not forget the lessons of this pandemic. We must build a better system than the one we had before our lives were upended by COVID-19.