Trading in harms: COVID-19 and sexual and reproductive health disparities during the first surge in New York state.

In March 2020, New York City was the national epicenter of the novel coronavirus in the United States. This article draws on rapid qualitative research from July to October of 2020 with sexual and reproductive healthcare (SRH) providers who served low-income people from racial and ethnic minority groups in New York State to examine their perceptions of the effects of COVID-related adaptations to care on healthcare access and quality. We found that care delivery protocols during the early months of the pandemic compromised healthcare interactions and clinical experiences by limiting support persons, separating newborns from parents, and restricting care time in hospitals. Additionally, closures of in-person SRH services and prohibitions on prenatal support persons increased obstacles to access and utilization of care. Our intersectional analysis underscores how COVID protocols interacted with other axes of inequality to compound disparities in SRH access and quality of care. Early COVID policies prioritized controlling the risk of viral exposure over the risk of harm from the policies themselves, reflecting zero-sum approaches that we describe as "trading in harms." Our research thus raises crucial questions about how institutions and governing bodies conceive of, and organize, emergency preparedness. We argue that emergency preparedness must center concerns around racial, class, and gender equity, among others, to foreground the risks and benefits of emergency responses for different groups.