The corona virus disease 2019 (COVID-19) pandemic impacted all spheres of the lives of women. This article focuses on the impact on the health, careers, and family lives of women in the United States. There is a lasting impact from COVID-19 on the lives and health of women. Preventative care and chronic care were disrupted. Long covid seems to impact premenopausal women at much higher rates than men. Time spent between work and home changed for many during the pandemic. Women shifted to more time spent on home duties. The long-term outcome of career advancement and economic success is unknown.
Key points
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Preventative and chronic disease care decreased during the pandemic.
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By 2023, women regained 100% of jobs lost from the pandemic. Some job categories remain below prepandemic levels, other job categories have surpassed prepandemic levels.
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Women bore more caregiving responsibilities than men during the pandemic.
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Intimate partner violence and depression increased for women during the pandemic, highlighting the importance of screening.
| ACOG | American College of Obstetricians and Gynecologists |
| CDC | Centers for Disease Control and Prevention |
| COVID-19 | corona virus disease 2019 |
| FDA | US Food and Drug Administration |
| IPV | intimate partner violence |
| OR | odds ratio |
| PTSD | post-traumatic stress disorder |
| SNRI | serotonin and noroepinephrine reuptake inhibitor |
| SSRI | selective serotonin reuptake inhibitor |
| WHO | World Health Organization |
Introduction
The novel coronavirus disease 2019 (COVID-19) pandemic had profound repercussions on the health and wellbeing of women. This impact was across all spheres of women’s lives, from increased experiences of intimate partner violence (IPV), to pausing careers in favor of caregiving for children and elders who lost access to schools and senior centers, to losing jobs. The isolation of parenting and living in quarantine, along with diminished access to routine health care and the direct health consequences of covid infections, resulted in negative impacts on physical and mental health.
Preventative and chronic disease management
The pandemic impacted women’s physical health in many ways. Studies have demonstrated that the physical activity of women decreased during the pandemic, , and diabetes care also decreased. There were significant increases in amputations after April 2020 compared with prepandemic rates, likely because of the lack of routine care during the pandemic. In addition, primary care clinicians need to be aware that preventative care was decreased during the pandemic, and this could have a significant effect on the diagnosis and prevention of coronary vascular disease, diabetes, hyperlipidemia, and other diseases.
In 2020, an estimated 9.4 million fewer screening tests were performed in the United States compared with what would have been expected. Screening mammograms decreased among all racial/ethnic and age groups during the pandemic., and this was especially pronounced for older women and Asian women. , Asian women also had the lowest rate of rebound of mammograms, and the rate of mammography for women overall had not returned to baseline by May 2021. To improve screening and decrease this deficit, primary care clinicians can get involved with the local community groups, create support networks, and question why their patients are not returning to routine screening ( Figs. 1 and 2 ).
The Return-to-Screening Study used quality improvement methodology across 786 cancer screening programs with the goal of accelerating the return to baseline cancer screening and making up for the deficit in screening during the height of the pandemic. The methods used to increase screening rates fell into 3 main categories: increasing patient demand, increasing delivery of screening, and increasing community access. Seventy-nine percent of these programs reached prepandemic screening volumes plus 10% or more growth in their cancer screening.
Primary care access during the pandemic affected some subgroups of women more than others. Women who identified as lesbian or bisexual, women with cancer, and women with incomes less than $75,000 per year had more difficulty accessing primary care.
Reproductive health
Birth rates in the United States have been slowly trending down since 2000. Even given this trend, from August 2020 to February 2021, there were about 100,000 fewer births than would have been expected in prepandemic times. There was a rebound of births from March 2021 to April 2022, with 80,000 more births than expected. However, it is difficult to continue to relate the number of births to the COVID-19 pandemic as one gets further away from the pandemic.
Reproductive health care in particular was affected from the direct impact of COVID infections, leading to pregnancy loss and complications, increased rates of preeclampsia, preterm births, increased rates of cesarean sections, increased maternal mortality, as well as less access to anesthesia during birth, and birthing in isolation. , Although many women chose to delay pregnancy during the pandemic, access to contraception and abortion care was also decreased ( Tables 1 and 2 ).
| Pre-eclampsia | Total Pregnancies | Percent of Patients Affected | |
|---|---|---|---|
| With COVID-19 infection in pregnancy | 665 | 7866 | 8.5% |
| Without COVID-19 infection in pregnancy | 24,406 | 417,491 | 5.8% |
| Stillbirths | Total Births | Percent of Patients Affected | |
|---|---|---|---|
| With COVID-19 infection in pregnancy | 40 | 7590 | 0.05% |
| Without COVID-19 infection in pregnancy | 1318 | 405,532 | 0.03% |
American College of Obstetricians and Gynecologists (ACOG) and World Health Organization (WHO) strongly recommend COVID vaccination in pregnancy and lactation. The COVID vaccine is widely regarded as safe for pregnant women and their fetuses by the medical community. However, studies have demonstrated that the uptake of the vaccine among pregnant women at the peak of the pandemic was only about 30% in the United Kingdom and ranged from 3% to 58%in the United States. Acceptance of vaccination for COVID 19 during pregnancy was lower in historically under-represented communities of color because of a combination of health disparities (eg, access to health care, transportation, or housing) and justified historic distrust and fear of being experimented upon by the health care community. Vaccination rates also varied by state and rural versus urban communities, largely based on misinformation campaigns. These fears have been compounded by intentional disinformation widely spread on social media.
As for the COVID-19 booster vaccine, the Vaccine Safety Datalink in July 2023 showed 16% of pregnant people received a COVID booster vaccine. Rates of booster vaccination were lower in people of color, with only 8.3% of Black pregnant women and 9.6% of Latina pregnant women receiving the COVID booster
Clinicians caring for pregnant women should discuss vaccine safety with their preconception and pregnancy visits using a collaborative motivational interviewing approach. The Centers for Disease Control and Prevention (CDC) has a toolkit that outlines a basic approach of discussing vaccines in pregnancy, including presenting vaccination as a standard part of prenatal care, providing a strong recommendation, tailoring the vaccine benefits to the specific needs of the pregnant patient, listening and responding to patient concerns and fears, and explaining the risks of not receiving the vaccine.
Mental health
The pandemic brought mental health consequences for people across the world, including isolation in the setting of quarantine, misinformation and political divisiveness, social stigma, loss of kin and friends, and health fears increased post-traumatic stress disorder (PTSD), depression and anxiety. These impacts were more severe for women. Women also experienced higher levels of intimate partner violence during the pandemic.
The experiences surrounding reproductive health, pregnancy, and childbirth during the pandemic had effects on women’s mental health also. For example, in Canada, moderate to severe anxiety was experienced by 72% of pregnant and postpartum women during the pandemic, versus 29% before the pandemic. Other studies showed a similar increase in anxiety and depression. Social support and exercise were protective factors. Access to mental health care including physician visits, therapy, and addiction services was limited during the pandemic. Although the increase in depression, anxiety, and PTSD remained elevated in late 2020, there are few data about the sustained impacts of the pandemic on mental health.
Suggestions for treatment of pandemic-related PTSD are similar to those for PTSD from any source of trauma, and include therapeutic modalities such as cognitive behavioral therapy, eye movement desensitization and reprocessing, and medication such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and noroepinephrine reuptake inhibitors (SNRIs). Paroxetine and sertraline are the only US Food and Drug Administration (FDA)-approved medications for PTSD. Universal screening for intimate partner violence, depression, and substance abuse should be part of standard primary care visits. Patients who screen positive should be asked about their pandemic experiences. In order to improve the availability and flexibility of mental health care after the pandemic, access to telehealth should be maintained and continue to evolve ( Fig. 3 ).
