Birth in Color Telehealth Listening Project Report Cover Photo. Source: Birth in Color
Like many states, Virginia has vast deserts when it comes to OBGYN and reproductive health care, causing disparities in access to care for many. To gain a comprehensive understanding about the effectiveness in using telehealth in reproductive and maternal health care, reproductive justice organization Birth in Color collected qualitative research from community members, doulas, and partner organizations through surveys and listening sessions.
The project was funded by the Reproductive Health Initiative for Telehealth Equity & Solutions (RHITES) and supported by the Virginia Telehealth Network. We recently connected with Birth in Color’s Director of Policy, Galina Varchena, who shared insights from this initiative along with key takeaways from the report.
Takeaways from Birth in Color’s “Telehealth Listening Session Project”
Research found that telehealth has the potential to greatly improve access to reproductive health care in underserved regions, but enhancements in delivery methods and public education are critical for maximizing its utilization. While doula care is primarily a hands-on service, research participants agreed remote provision of services was sometimes necessary.
Patient opinions and concerns.
For patients who live in rural areas of Virginia, they found telehealth to be a convenient option for accessing specialized care or scheduling an appointment faster than in-person care with specialists. And those who utilized telehealth preferred it for follow-up appointments and check-ups. While patients had positive experiences overall, some expressed technological constraints and said telehealth sessions felt impersonal or rushed compared to their in-person experiences.
“Privacy concerns were another common concern from the patient’s side, especially for those in rural areas with limited access to broadband,” Varchena said.
Patients of color also expressed a strong preference for working with providers who match their gender and cultural background, and telehealth has the potential to serve as a solution, allowing those patients to connect with a provider who is a cultural fit and is in another part of the state.
Need for patient education and communication.
Patients that participated in conversations shared that they did not know reproductive health care through telehealth was an option through their provider. For telehealth to be a viable solution for patients, practices must advertise that virtual services are an option for patients and provide education for how to conduct a successful telehealth appointment.
“Some patients shared that they missed a virtual appointment because the provider didn’t send adequate communications for how to access the appointment, and those patients were still charged for the missed appointment, leaving them with a bad telehealth experience,” Varchena said.
Telehealth.HHS.gov provides free telehealth tools and resources for patient education and onboarding.
Need for payment clarity from insurance companies and Medicaid.
Given the strong bond and trust built between doulas and their patients, doulas frequently serve as the initial point of contact for expectant or new mothers dealing with questions or concerns. But community health care worker participants expressed significant confusion about what is covered by Medicaid and found themselves addressing inquiries and engaging in extended conversations with patients without receiving appropriate compensation.
“Doulas typically don’t get paid for virtual visits with the exception of circumstantial situations, for instance if a client is on bed rest or has COVID, and there are no private insurance mandates in Virginia,” Kenda Sutton-El, Executive Director, Birth in Color said. “When it comes to billing back insurance companies there are differences between phone calls vs. video vs. in person appointments. But for the provider, their time spent on the phone with a patient vs. time spent in person for an appointment often results in the same time and level of care delivered.”
Both doulas and interviewees who utilized doula care expressed a strong desire for increased flexibility in Medicaid reimbursements to enhance access to telehealth doula appointments.
Need for more research.
The diverse patient experiences and findings from this research highlight the need for further investigation into delivery methods and access challenges for individuals with various backgrounds. While telehealth is proven to increase access to care, many groups are left out due to language barriers, lack of technology, and other barriers.
“We only scratched the surface,” Varchena said. “We heard from Latinx communities that language barriers hinder access to virtual care and from individuals who are unhoused there are challenges in accessing technology for virtual appointments. We need to better understand the unique needs of people in unique circumstances.”
Need for policy change.
To enhance equitable access to telehealth services in the commonwealth, this research report serves as a potential starting point for future legislative efforts in the General Assembly, both in 2025 and beyond.
“This research project allowed us to speak with community health care workers to bring a different perspective into the conversation and hear anecdotal experiences from the patient side,” Varchena said. “It’s helping to give a voice to our communities and our partners, lifting those voices, and putting them in front of our state’s administrative and legislative policymakers.”
To read the full report, visit https://birthincolor.org/telehealth.
Birth in Color is a Black women-led reproductive justice organization dedicated to maternal and reproductive health, policy, and removing biases and barriers for people of color. For more information, visit https://birthincolor.org.