Women do not stop needing access to abortions in a pandemic. They should not need to place themselves and others at risk of COVID-19 to access one. But that is exactly what is happening — due in part to new bans, but mostly as a result of years of dwindling access across the country.
The current state of affairs
Dr. Sarah McNeil travels from her home state to Texas to perform abortions because there aren’t enough providers locally. This month, another out-of-state colleague stayed an extra week to cover her shift. Dr. McNeil was knee-deep in the response to the pandemic at her home institution. The news broke on the day she would’ve otherwise left for Texas. The governor clarified his intent to make abortion “non-essential.” The abortion clinics would now close their doors until further notice. Women now had no option but to travel out of state.
As we have seen over the last few years, women face increasing barriers to get an abortion. As someone who trained at a Catholic institution, I have seen it first hand. Birth control is only prescribed for “heavy bleeding” (preventing pregnancy is not a valid reason). Miscarriages are only managed expectantly (pills or a procedure to speed up the process are not offered). An unplanned pregnancy? The options are prenatal care or go somewhere else. Luckily, there is access elsewhere in D.C., albeit at a hefty cost. Women in other parts of the U.S. aren’t so lucky. 11 million women live an hour or more away from the nearest abortion clinic.
Hardly apolitical
Those fighting for access to abortion and reproductive rights have to contend throughout their career with attempts to undermine their efforts. Dr. McNeil worked two weeks straight setting up COVID-19 testing tents. On her last day, she received a 2” x 2” manila envelope in her work mailbox. Without thinking, she opened it to find a small glass bottle with something white inside. In a panic, she immediately thought it was anthrax. It turned out to be nothing but a piece of white paper. Still, that’s how her life was as an abortion provider. She’d been receiving anonymous anti-choice mail for years. It was putting her on edge.
No surprise, then, that anti-choice politicians across the country have been using the COVID-19 pandemic as a ploy to erode abortion rights. Citing abortion as a “non-essential service,” Texas, along with Oklahoma, Ohio, and Alabama and others have all attempted to ban abortion. This, in flat contradiction to the fact that hospitals and clinics have been allowed to loosen regulations in response to the COVID-19 crisis to improve access to care.
A public health nightmare
It’s not just abortion providers putting themselves on the line by traveling to hot spots. With increasing evidence of asymptomatic spread, every patient who must travel outside their home to seek an abortion could increase the spread of COVID-19.
Further, over 70,000 women across the US get abortions each month. If they live in a restrictive state, they may need to stop for food or gas and stay overnight to comply with waiting periods. This puts them and the public at greater risk.
Add to that evidence that people of color are being infected at higher rates secondary to the effects of structural and environmental racism. Women of color will also be most affected by limited access to abortion. This, yet another reflection of the inequity in our healthcare system.
Transitioning to telehealth
There is a well-researched solution: medication-based abortions facilitated via telehealth. In 2017, medication abortion accounted for approximately 40% of abortions in the US. From high-quality studies, we know they can be safely and effectively provided over the phone/video. As of 2020, 33 states allow for remote prescribing for a medication abortion. A physician (or nurse practitioner or physician’s assistant) counsels the patient and prescribes the pills, just as they would in the office. But there’s a catch. Federal regulations on Mifepristone, one of the two medications used in a medication abortion, mandate that patients take the pills under the supervision of a certified provider in a healthcare facility.
We can decrease COVID-19 transmission by removing these excessive and unnecessary restrictions on mifepristone. This would allow women to talk with a clinician over the phone and go to the pharmacy to pick up their medication, or better yet, receive it by mail. Medicine is adapting to meet the needs of the country. There is no reason to silo abortion. Doing so increases the spread of COVID-19 and risks women’s lives[pdf].
Moving forward
The pandemic is bringing the brokenness of our healthcare system and vast societal inequity to light. There are two stories that could come from this time. The first: we simply endure the trauma this virus is wreaking across the country. We say it was out of our control. The second: we learn from this. We may not have many choices, but we all have a voice, a vote, and a very long time at home to reflect on what we think is just.
Author’s note
I refer to women in this piece but non-binary and trans communities also need access to abortion and often face even steeper barriers.
Libby Wetterer