This is the first in a series of stories about women’s health in the pandemic.
The ongoing coronavirus health crisis is changing the face of the nation’s health care system, from what types of care we prioritize to how we get that care and how quickly. Many are seeing that during the pandemic, some forms of care cannot wait. 
One such necessity is reproductive health care, which ranges from contraception counseling to abortion services to family planning. 
Nationally, an uptick in demand for birth control prescriptions, a rise in sexually transmitted infection (STI) rates and an increase in reports of intimate partner violence suggest that reproductive health care is more essential than ever. 
And while efforts at the national level to constrain access to these services during the pandemic — some states have recently classified abortion as a “non-essential” medical service and a recent Supreme Court decision limits birth control coverage in some health plans — health care providers in Vermont are working to ensure that women can receive a full range of reproductive health care services in the state.
“Reproductive health care is essential health care,” said Lucy Leriche, vice president of Vermont Public Affairs for Planned Parenthood of Northern New England (PPNNE), which administers 12 Vermont health centers, including one in Middlebury. “These services are necessary and time-sensitive, and they cannot be deferred.”
Planned Parenthood, like many health care providers, has shifted many of its operations online in order to reduce the chance of coronavirus spread and to continue providing services that individuals may be apprehensive about seeking in person. 
“We’ve been laser-focused on patient and employee safety,” said Leriche, “and on making sure that in everything we do, we’re mitigating risk to the greatest extent possible. Once the pandemic hit, we transferred every service that we could to telehealth.”
This remote form of health care has allowed Planned Parenthood to maintain the vast majority of its services during the pandemic, in particular the distribution of different forms of contraception. While the organization provided limited telehealth services as well as the option to receive birth control in the mail prior to the pandemic, in April Planned Parenthood launched a national expansion of its telehealth program and ensured health care services online or by phone in all 50 states. 
In Vermont, individuals may access online consultations for birth control and may receive different forms of contraception including condoms, NuvaRing, and hormonal birth control pills. The demand for mailed hormonal birth control has been especially noteworthy. From April to June, PPNNE mailed an average of 721 pill packs per month to patients in Vermont. 
This ability to receive hormonal birth control through the mail has been particularly beneficial during social distancing as many individuals are wary of leaving their homes and have deferred some medical care, evidenced by the revenue losses by hospitals and healthcare professionals during the pandemic. 
However, issues of access remain. In fact, according to a recent Guttmacher Institute study, about a third of women have reported that they have experienced delays or cancellations of contraceptive or other reproductive health care due to the pandemic, and these rates were disproportionately higher among Black and Hispanic women, queer women, and lower-income women. 
Ultimately, Planned Parenthood has been able to maintain almost all of its contraceptive services, and the reception of this telehealth expansion has been positive, officials said. 
“I think that consumers have had great experiences with our telehealth, and I think we’ll continue this even after the pandemic ends,” Leriche said. Referencing the larger shift toward telehealth throughout the health care system, she added, “It’s looking like telehealth is here to stay.”
The only contraceptive services Planned Parenthood had to defer during the early stages of the pandemic were certain procedures to provide long-acting reversible contraception such as intrauterine devices (IUDs). It was feared that coronavirus could spread during the procedure. PPNNE has since resumed performing these procedures in Vermont.

THREATS TO BIRTH CONTROL 
This push to maintain access to contraception during the pandemic comes at a particularly precarious time for birth control access on a national scale. Earlier this month, the U.S. Supreme Court voted to uphold a Trump administration regulation that employers may claim a religious or moral reason for refusing birth control coverage to employees. 
The State of Vermont has implemented some safeguards against this decision, which Leriche described as an “outrageous attack on women.” 
In 2016, the Vermont Legislature passed a bill that codified into law provisions of the Affordable Care Act that guarantee no cost-sharing and no out-of-pocket costs for contraception, meaning that all commercial health care plans must provide birth control coverage. However, this protection does not apply to self-insured plans, which are regulated by the federal as opposed to the state government.
In addition to Trump administration efforts to constrict birth control access, there have also been attempts in several states to limit abortion access. In the early stages of the pandemic, 11 states took actions to categorize abortion as medically “non-essential,” and therefore effectively ban it under public health emergency declarations. Several of these bans have since been lifted by new state executive orders, settlements outside of court, or direct action by a governor. In Alabama, Ohio and Tennessee, the bans were overturned in federal court.
Despite these anti-abortion pandemic response efforts, Leriche clarified that there have not been movements to declare abortion non-essential in Vermont. And while support for reproductive health care like abortions is not universal in Vermont, Leriche said defense of such health care is widespread here.
“We are very fortunate in Vermont that our elected officials — from our Republican governor to our Democratically controlled Legislature — everyone is pretty much unanimously in support of reproductive health care and the services that Planned Parenthood provides,” she said.

ABORTION IN VERMONT
Planned Parenthood centers in Vermont have continued to provide abortion services throughout the pandemic. For medical abortions, Planned Parenthood provides information on the bulk of the resources they need for the service remotely. Individuals then make an appointment to pick up the medication, which consists of two pills, from a health center, and would be guided through the process at home via telehealth. 
Surgical abortions, as essential and time-sensitive procedures, have been provided in-person in Vermont health centers throughout the pandemic. Leriche said that she has not seen any downtick in people accessing in-person surgical abortions or anything to suggest that individuals are deferring this service.
“When people need abortion care, they need it now,” said Leriche. “We have prioritized that kind of care for our patients because we know it is urgent and essential.”

OTHER REPRODUCTIVE SERVICES
In addition to contraception and abortion care, Planned Parenthood offers a wide array of other reproductive health services through telehealth. As of two weeks ago, PPNNE began providing remote testing for several sexually transmitted infections such as gonorrhea, chlamydia and trichomoniasis. 
PPNNE also has a Peer Education Program, which trains high school students to provide sex and sexuality education to their fellow students. The program, which worked with five high schools in Vermont during the 2019-2020 school year, has been successful in engaging students. 
“I think kids aren’t always interested in hearing about sex-ed from adults,” said Leriche, “so hearing from a peer is something that has proven to be pretty effective.”
The program has become virtual in response to the pandemic, which has been especially important as the closing of high schools this spring meant that many students are experiencing a gap in their sex education programs. 
Planned Parenthood also offers behavioral health services. This past year, PPNNE piloted a program to station social workers known as Patient Support Counselors in its health centers in Burlington, Williston, Middlebury and Rutland. These counselors provide screenings for depression, substance use disorder, and intimate partner violence, which, according to some domestic violence centers across the country, appears to be on the rise as individuals are spending more time at home — sometimes with abusive partners. 
PPNNE counselors also offer treatment and referrals for a number of these concerns, as well as for economic concerns such as housing instability, food insecurity and transportation barriers, and the health centers operate under a trauma-informed care approach. These counselors are now able to access a wider range of patients via telehealth, and PPNNE is working to implement this program across all 12 Vermont centers by the end of 2020. 
These efforts are particularly significant as financial and mental health concerns increase under the stress of the pandemic. Since March 15, PPNNE has seen a 64% increase in patients who qualify for free care, and a 21% increase in patients who do not have health insurance, such as individuals who lost their jobs.
Leriche emphasized that PPNNE will continue to provide these services in Vermont despite national movements to constrain reproductive health care access, even as access becomes increasingly critical. She also highlighted the long-standing nature of not only the infringements on reproductive rights at the national level, but also the support of those rights by the health care community and many elected officials in Vermont.
In 2019, Planned Parenthood became ineligible for Title X federal family planning funding after President Trump implemented a gag rule that prevented all Title X recipients from using the word “abortion” when advising their patients about their reproductive options. In response, the Vermont Legislature funded Planned Parenthood in the amount it lost from opting out of this federal program. Also that year, Gov. Phil Scott signed a bill into law protecting women’s access to legal abortion even if that right were to be lost on the federal level through a rollback of the landmark Supreme Court decision in Roe v. Wade. 
“With the current presidential administration, there has been a steady onslaught of attacks against women’s bodies, reproductive rights, the LGBTQ+ community, the BIPOC community,” Leriche said. 
“(But) no matter what the federal government does to attack us and our services, we are committed to providing necessary care to all of our patients.”