Telehealth as a potential tool for outreach among women in Puerto Rico

BACKGROUND: Access to the full spectrum of healthcare should be available to all individuals. After the revocation of the constitutional right to abortion, women have fewer alternatives to unplanned pregnancy. Telehealth provides an additional option for such pregnancies through its remote provision of services. This could benefit women of all social strata. However, data regarding telehealth among underserved populations are limited. OBJECTIVE: This study aimed to evaluate the use of contraception, awareness of abortion services, and receptiveness to telehealth among women in Puerto Rico, a Spanish-speaking minority population. STUDY DESIGN: This was a cross-sectional study of women living in Puerto Rico aged between 21 and 65 years. Data were collected with a self-administered survey via SurveyMonkey from March to December of 2021. Recruitment was done through social media and at the gynecology clinics of the University of Puerto Rico, Medical Sciences Campus and San Juan City Hospital. Analysis was done with Stata, version 14.2. Chi-square and Cochran–Armitage tests were used to evaluate the unadjusted relationship between variables. A P value ≤.05 was considered statistically significant. RESULTS: A total of 286 women were recruited. Of these, 73.3% (189/258) were sexually active, 89.1% (229/257) were heterosexual, and 62.7% (163/260) were not using contraception. In addition, 63.3% (157/248) knew about emergency contraception, yet 42.4% (103/243) were unaware of any sources of access to it; 76.6% (197/257) were unaware of nearby abortion services. A higher education level was associated with knowing about emergency contraception (P<.05) and awareness of sources of access to it (P<.05). However, no significant association was found between a higher education level and awareness of nearby abortion services (P=.799). Regarding telehealth, 65.2% (176/270) were willing to use the service for future gynecologic visits, yet only 18.9% (51/269) were offered telehealth services. No association was found between previous telehealth experiences and willingness to use telehealth for future gynecologic visits (P=.325). CONCLUSION: The lack of contraceptive use and unawareness of nearby abortion services place women at increased risk of unplanned pregnancy and unsafe practices. The gap between knowledge about and access to emergency contraception also calls for action. Telehealth may be of benefit given that most women showed interest in using it, and could be used for educating and providing women in Puerto Rico with contraception and medical abortions, further increasing their access to reproductive healthcare. Clarifying misconceptions and instructing women about safe practices is essential to our role as physicians. Ensuring women's access to adequate services is also vital for upholding their rights to healthcare.