Essential reporting details barriers to -- and the need for -- abortion access during the coronavirus crisis
Update (4/29/20): This piece has been updated with additional examples.
As abortion opponents exploit the coronavirus crisis to call for restrictions or bans on abortion, some media outlets are highlighting the situation's impact on abortion access.
Up until now, amid rising numbers of COVID-19 cases in the U.S., right-wing media and anti-abortion advocates have mostly contained their abortion-related outrage to online and televised outbursts. For example, opponents were enraged about supposed abortion funding in Congress’ coronavirus spending bill (an untrue allegation), and they issued seemingly toothless calls to close abortion clinics as states temporarily shut down “nonessential” services.
Now, however, federal and state efforts are resulting in potential restrictions on abortion access and near bans on abortion. As writer and Yellowhammer Fund Communications Director Robin Marty wrote for Time magazine, “In just two weeks the novel coronavirus managed exactly what anti-abortion activists struggled for nearly five decades to accomplish: it is the biggest threat to legal abortion in America ever imagined.” Marty further explained, “Despite having a safe and effective means of ending an early pregnancy without any need to physically see a medical professional” via telemedicine, “abortion opponents are instead using this moment to close as many abortion clinics as possible throughout the U.S.”
State officials and abortion opponents claim that abortion clinics need to close because such services are “nonessential” during this time and medical equipment used during abortions is vitally needed for health care workers treating COVID-19 cases. However, as abortion provider Dr. Daniel Grossman explained on Twitter, first-trimester abortions require only a small amount of personal protective equipment. In addition, Salon’s Amanda Marcotte clarified:
This excuse is farcical on its face, of course. Most abortions are performed not in hospitals, but outpatient clinics. A patient who goes to Planned Parenthood is not taking up space in a hospital because she is not going to the hospital. In order to get around this problem, the misogynists who control the Republican Party are trying to argue that abortion clinics use up needed medical supplies that should go to hospitals instead. This too is a bad-faith argument, especially since Donald Trump is refusing to invoke his presidential powers to compel companies to manufacture those supplies.
Arguments by state officials to close clinics rely on the assumption that abortions are “nonessential” health care when the opposite is true. BuzzFeed News’ Ema O’Connor talked to Dr. Meera Shah, chief medical officer for Planned Parenthood Hudson Peconic, located “in the New York City suburbs of Long Island, Westchester, and Rockland, one of the hardest-hit regions in the country”:
Despite the lockdown and social distancing occurring in her region, Shah said, she’s noticed more people making and keeping appointments than usual. Of the 19 patients who were scheduled for an abortion yesterday, 18 showed up, she said. In her experience, many end up canceling or not showing up to their appointments.
“It seems like patients are doing everything they can to get to their appointments at this time,” Shah said. “Some patients have expressed to me … that they were scared that they may not have health insurance in the future, that they may not be able to get their appointments, that childcare is becoming more of an issue now with all of the schools closed.”
Slate’s Christina Cauterucci pointed out what an alternative world, where people are not able to access abortion care when they want it, would look like under the threat of the coronavirus:
Though abortion care is extremely safe, it gets riskier, more expensive, and more difficult—or impossible—to access as a pregnancy progresses.
Let’s be clear about what patients will endure if states begin to enforce their state-of-emergency bans on surgical abortions. Women who cannot obtain surgical abortions won’t be freeing up space in an over-capacity, under-supplied health care system … . The further along a pregnancy gets, the more likely a pregnant person is to develop life-threatening complications that require urgent medical care. Forced to carry unwanted pregnancies to term, women will also need prenatal care, which will compel them to risk exposure to COVID-19—and risk exposing others—to make several visits to doctor’s offices staffed by overworked practitioners. If they miscarry or develop certain pregnancy complications, they may have to take up valuable surgical supplies and hospital space during what will long be a dangerous time to inhabit a hospital bed. When they go into labor, in some hospitals, they’ll have to endure childbirth alone, without a partner, doula, or family member by their side. Their infants’ first days of life may be spent in a virus-rich environment without proper supplies, staffing, or standards of care.
For many people right now, the financial and emotional strain of an unplanned pregnancy, much less an unplanned child, is too much to bear. The ability to obtain an abortion is an essential component of any sustainable strategy for weathering a crisis like this one. It’s an option we can’t afford to lose.
In addition, before this coronavirus crisis even hit, abortion opponents succeeded in passing state-level restrictions forcing some clinics to close, resulting in some states having only one clinic and forcing the small pool of providers to travel from state to state to provide care. These restrictions will result in further complications and delays in care, as HuffPost’s Melissa Jeltsen wrote:
According to a Guttmacher Institute analysis released earlier this month, the outbreak may result in “a shortage of clinicians who can provide sexual and reproductive health services,” as well as increased wait times for patients in need. In places with a limited number of providers, this will put “an extreme strain” on the capacity to serve patients.
“If a provider gets sick, that’s one fewer person to provide care,” said the Very Rev. Katherine Hancock Ragsdale, president of the National Abortion Federation. “One or two people unable to show up can make the difference between a clinic being able to function or not.”
Colorado Public Radio’s Claire Cleveland wrote that Colorado, which has not restricted abortion access during the pandemic, has instead faced increased visits to abortion clinics from out-of-state residents, particularly after Texas temporarily banned the procedure:
Since then, Colorado has been picking up the slack. Providers have seen an increase in patients from states like Texas.
“Obviously we didn't expect that this pandemic was going to come and amplify anti-abortion efforts,” said Dr. Angela Marchin, an abortion provider who works at multiple clinics. “But it has become an unconscionable effort to decrease access to abortion in certain states.”
One woman who spoke to CPR News who wished to remain anonymous had an appointment scheduled in Waco for two days after the order went into effect. It was canceled.
After her appointment was canceled, she called clinics in Austin, but they had the same restrictions under the executive order. She started to look at neighboring states — New Mexico, Oklahoma, Nevada, Louisiana. But those clinics either had long wait times or restrictions of their own.
She decided to make an appointment in Colorado.
Marchin said that typically, clinics can schedule multiple patients at any given time because there are multiple examining rooms and providers who can consult with patients. But that’s changed with the pandemic. They’ve had to schedule fewer patients a day, despite what Marchin called an increase in need from out of state.
For those abortions that take place before 10 weeks and can be completed via medication, telemedicine provides a ready solution during the coronavirus pandemic. However, as Dr. Grossman told Mother Jones’ Becca Andrews, it’s often not allowed:
Grossman called telemedicine “the perfect solution” for women looking to terminate early pregnancies. “Unfortunately, it’s burdened by the restrictions in 18 states that completely ban telemedicine abortion care and then it’s also restricted due to the risk evaluation and mitigation strategy for mifepristone, which limits the possibility of doing direct to patient telemedicine,” Grossman said, referencing the Food and Drug Administration’s classification of mifepristone, the first of two medications taken to induce abortion, as a high-risk drug, despite its extraordinarily high safety profile.
Time magazine’s Anna Purna Kambhampaty highlighted how telemedicine services had been utilized during the pandemic in a state that doesn’t restrict access to abortion services:
In late March, Leah Coplon, the program director at Maine Family Planning, watched as a young mother parked her car in front of the building. Carrying her baby, the mother was greeted by staff in the foyer and handed a brown paper bag that looked like a lunch sack. Then she loaded the bag and the baby into her car and drove away. Now she could end her pregnancy.
Maine Family Planning’s program allows patients to receive the two medications necessary to complete an early abortion, without an in-person examination. For the young mother Coplon saw using the service in late March, the issue of finding someone to watch her baby, now that daycares and schools are closed due to the virus, was a huge barrier to getting the medical care she needed. Instead, she was able to go through an initial screening over the phone to determine if she was eligible for a medication abortion, followed by a telehealth visit with staff to review her available options, go through the informed consent process and receive instructions for care. After a telehealth visit with the clinician, she could simply pick up her pre-packaged medication, instructions, and a home pregnancy test at one of 18 branches of the clinic around the state. One week later, she’d have a follow-up telehealth appointment to ensure everything went smoothly, and three weeks after that, she’d take the home pregnancy test to make sure the abortion was effective. The clinic has a 24/7 number where patients can reach out with any concerns.
SELF.com’s Nina Bahadur interviewed Dr. Meera Shah about the telemedicine situation in New York (emphasis original):
When New York State went into lockdown in response to COVID-19, how did you modify the care you offer to follow guidelines while still serving patients?
We switched to a telehealth model within a few days.
It’s made a huge impact. We’ve been able to see health care workers working on the front lines. I saw someone the other day who is taking care of COVID-19 patients in the ICU. We’ve seen emergency responders sitting in their ambulances who had a moment to spare and were able to get onto their telehealth appointment for 10 minutes and get what they needed. We’ve been really busy.
You said Planned Parenthood Hudson Peconic is still offering some other services, including procedural abortion, in the health centers. What steps are you taking to keep staff and patients safe?
Patients needing a procedural abortion have to come with somebody if they are receiving sedation, but we are not allowing their companion to come into the health center to wait for them. They have to wait outside or in their car to minimize foot traffic in the centers. We have spread out appointment times to allow for social distancing, allowing no more than a handful of people in the waiting room at any given moment. We also do some of the counseling during telehealth before the actual procedure to minimize the amount of time the patient has to be in the health center.
We are also following the guideline that all New Yorkers must wear some sort of face covering over their nose and mouth. We ask that patients wear something when they come to the health centers. We will help them get a face covering if they don’t have one on their own, but anecdotally, I’m seeing that 99% of patients already have one.
And, of course, we ask screening questions asking about COVID-19 symptoms, any recent contact with anyone who has tested positive, or any recent travel.
While the federal government pushes the adoption of telemedicine for other medical services that can be accessed remotely, the Food and Drug Administration told Vice News that the same flexibility “will not apply to medication abortion care.”
Also, at the federal level, a bevy of anti-abortion groups sent a letter to the Department of Health and Human Services demanding that it issue guidance that abortion clinics nationwide should close during this time. Rewire.News’ Dennis Carter explained:
The letter claimed that abortion providers will divert much-needed personal protective equipment from the COVID-19 response, and that potential complications from abortion care will increase demand on emergency rooms—a suggestion that falsely depicts abortion as risky. (Experts agree that the complication rate for legal abortion care is very low.)
The letter included a list of suggestions for how the Trump administration could use the COVID-19 outbreak to cut off access to abortion care, including making sure “telemedicine abortion is not expanded during the crisis” and ensuring “emergency response funds are not diverted” to clinics that provide abortion care.
At the state level, some officials are moving to restrict or ban abortion while others are trying to classify it as an “essential” health care service that will remain open while other services shut down. Rewire.News maintains an updated list of what access currently looks like in the states.
Here are some of the national and local outlets that have highlighted specific impacts of the coronavirus outbreak on proposed abortion restrictions at the state level:
The Advocate’s Mark Ballard explained that Louisiana abortions clinics -- already facing possible closure or restrictions pending a decision from the Supreme Court in the June Medical Services v. Russo case -- have now sued the state for its attempts to restrict abortion access during the coronavirus pandemic. In addition, Ballard highlighted how the state had targeted the clinics in the name of compliance:
Saying Louisiana politicians are trying to exploit the coronavirus pandemic to further their goals, a national reproductive rights group Tuesday asked federal court in Baton Rouge to immediately block the state’s efforts to close the state’s three abortion clinics.
Two assistant attorney generals burst in on the Hope Clinic – they visited clinics in Baton Rouge and New Orleans as well – demanding a review of the protocols put in place and equipment being used to check compliance with the directive limiting medical procedures during crisis, said Kathleen Pittman, Hope’s administrator. They also demanded to review the personal records of individuals who have received abortions since the beginning of the pandemic.
The visits came as something of shock, Pittman said. Usually, it’s health department personnel who perform inspections, not the state’s chief law enforcement agency.
Pittman said she needed to involve lawyers to keep the Attorney General’s Office from taking the charts of patients back to Baton Rouge.
Kimberly Kelly, a sociologist studying abortion politics in Mississippi, wrote an opinion piece for the Jackson Free Press about what would happen in the state if abortion is stopped during the pandemic:
Here’s what will happen in Mississippi if the state’s lone clinic, the Jackson Women’s Health Organization (JWHO), is forced to temporarily stop performing surgical abortions. Some women will be able to access medication abortions, which do not require surgery.
While a large majority of abortions occur in the first trimester of pregnancy, many women will now have to delay the procedure into the second trimester, increasing procedure costs and risks. In some cases, the delay will force Mississippi women to travel out of state, as JWHO performs abortions only up to 16 weeks.
Still other women will attempt to self-abort without medical expertise or assistance. Some women will not be able to access abortion at all, forcing them to continue pregnancies and give birth in increasingly uncertain conditions, as unemployment rises, incomes decrease, and housing, transportation, food, and health care become more difficult to access. Black women will be harder hit by all of these forces than their white counterparts, yet again.
It will take years for many Mississippians to recover from the economic effects of COVID-19. Being forced to bear a child in these circumstances dramatically increases the odds some women will never fully recover and potentially furthers entrenched economic inequality between women and men. It denies women full personhood, as their needs and priorities are deemed expendable to rally conservative political bases.
Rewire.News’ Tiffany Diane Tso interviewed Kelsea McLain, who volunteers as a clinic escort in North Carolina, about the behavior of anti-abortion protesters during the pandemic (emphasis original):
McLain’s clinic escort group made the difficult decision to stop volunteering on-site, in order to do its part in fighting the spread of the virus. Rewire.News spoke with McLain to gain insight into the situation in Raleigh, North Carolina, and how clinic escorts are adjusting.
During this time, what have you encountered from the anti-abortion protesters that you usually come across at the clinic?
While there are fewer protesters, they continue to have a presence. One of the big motivating factors in our decision to pull back and ultimately stop volunteering was the behavior of protesters: They were openly talking about defying stay-at-home orders if they were going to be issued, coughing in the direction of older volunteers, and making jokes about being “sick with the virus.” And in general they were demonstrating a total sense of disregard for established social distancing guidelines.
We hoped pulling back would send a general message to the protester community that everyone should take this seriously, but protesters have continued to show up. One group, Love Life, has even faced arrest and charges for violating stay-at-home orders in other cities. They showed up this past weekend and appeared to be almost salivating at the idea of facing arrest. Our local police department tends to be very hands-off with the problems protesters create and their often intentional violations of laws.
On March 22, CBS News’ Kate Smith wrote about how clinics in Ohio will continue to provide abortions even though the state’s attorney general ordered them to stop performing this allegedly “nonessential” service. On April 23, a federal judge ruled that abortion clinics in Ohio could temporarily resume abortion procedures.
Clinics that provide abortion services in Ohio will continue to provide the procedure, despite an order from the state's Attorney General's office ordering them to stop. In Ohio — a state that has been on the forefront of abortion restrictions and regulations — a debate has emerged over whether the procedure is "essential" and allowed to continue during a government clampdown on medical services because of the COVID-19 outbreak.
On Wednesday, the Ohio Department of Health ordered all "non-essential and elective surgeries" be temporarily suspended to preserve protective gear for health care workers. Though the directive made no mention of abortion services, by Friday, the state's Attorney General's office had sent letters to two of Ohio's six clinics that provide surgical abortions, ordering them to "immediately stop performing non-essential and elective surgical abortions."
Despite Ohio’s given reason for attempting to close clinics in the state, Vox’s Riley Beggin explained that “critics of the order … note that anti-abortion advocates in Ohio and other states have been working to roll back access for years”:
Late last year, lawmakers in Ohio introduced a bill that would make it a felony for people to have or perform abortions under a new crime called “abortion murder.” The bill would have also recommended doctors try to reimplant ectopic pregnancies in patients’ uteruses, which medical experts say isn’t possible.
That bill hasn’t progressed since it was introduced in November, but it’s not the first time Ohio has spearheaded anti-abortion legislation.
Ohio was the first state to introduce a “heartbeat” bill banning abortion after around six weeks of pregnancy (before many women know they’re pregnant) back in 2011. In recent years, similar policies have become law in Iowa, Georgia and elsewhere — though such laws have been halted by courts.
The Dallas Observer’s Stephen Young explained Texas' initial ban on abortion in the state (as updated below, Texas removed coronavirus-related restrictions on abortion access in late April):
Gov. Greg Abbott didn't say anything about it last week, when he announced his ban on elective medical procedures, but Texas Attorney General Ken Paxton made it clear Monday afternoon — abortion is banned in Texas until, at the earliest, April 3. Before the novel coronavirus pandemic, anyone seeking an abortion in Texas faced a lengthy ordeal. Now, they face utter uncertainty.
The full force of the law, in this case, is a $1,000 fine and up to 180 days in jail.
Paxton's office says the ban is essential to preserve Texas' stock of personal protective equipment. Texas anti-abortion groups are praising Abbott's order for different reasons.
Abortion providers in the state, however, sued Texas on March 25 to stop the order from closing clinics. Texas Tribune’s Raga Justin wrote:
In a press conference Wednesday, national and state abortion rights groups said they are seeking a temporary restraining order, with hopes of a more permanent injunction to follow. They are representing various abortion providers in the state, including Austin Women’s Health Center and Southwestern Women’s Surgery Center.
Sealy Massingill, the chief medical officer of Planned Parenthood of Greater Texas, took politicians to task for “playing politics” at a critical time. Planned Parenthood of Greater Texas still plans to keep clinics open, though he said the organization is bracing for further developments.
“I find it extremely distressing … that we are trying to respond to a purely political fight that [Gov. Greg Abbott] started. Patients who need abortions are on a time-sensitive deadline,” Massingill said.
Providers have already had to turn away patients, Massingill added, and delays of even a few weeks could render some abortions impossible if the patients' pregnancies extend past legal deadlines.
New York magazine’s Bridget Read reported on how people in Texas were reacting to the possibility that the state could prohibit most abortions there:
Women in Texas, where maternal mortality rates are among the highest in the country, are already scrambling to reschedule appointments or leave the state. The New Mexico branch of the Southwestern Women’s Surgery Center said on Tuesday that its phones were ringing off the hook, with Texas patients over 600 miles away trying to reschedule their appointments there. Amy Hagstrom Miller, president and CEO of Whole Women’s Health, said that they had to cancel 150 appointments. Patients were sobbing, begging the clinics not to close. The Clinic Access Support Network, which helps provide rides, hotels, gas money, and other logistical needs for patients in Houston, was working frantically to “rethink how we operate — in a day,” said board member Sahra Harvin. She had to spend Tuesday calling patients who had appointments scheduled, informing them of the news herself. “It’s been rough,” she said.
“I’ve had a few [patients] reach out to me who are just like, ‘What the fuck am I going to do? I can’t wait a month because at that point I’m going to have to be a parent, since the cutoff is 20 weeks,’” Makayla Montoya, an abortion access and sex workers’ rights organizer in touch with working class women in San Antonio, told the Cut. “People are scared.”
Even if abortion access continues in the state, Texas still heavily relies on outside providers due to anti-abortion restrictions, as Texas Observer’s Sophie Novack explained:
Since she became the medical director of her Dallas-Fort Worth abortion clinic in 2013, Robin Wallace has been trying to recruit more physicians to meet the growing demand. That year, the Texas Legislature passed the sweeping House Bill 2, which shuttered dozens of clinics across the state. State restrictions also make it difficult to find providers who live in Texas. So the clinic has long relied on traveling doctors, piecing together the schedules of one Texas-based physician and seven who fly in from around the country to provide abortions for 150 or so patients each week. That patchwork has dissolved in recent weeks as coronavirus spreads, sending doctors into quarantine and limiting travel.
Right now, just one of the clinic’s remote doctors is able to travel. One of the providers is stuck in California under a shelter-in-place order. Another is quarantined at home after a coworker tested positive for the virus, and yet another is quarantined after a patient tested positive. Wallace, a family physician who left Texas last year and travels back to the clinic for one week each month, says she can’t leave her family while her kids are out of school. For the next three weeks, patient visits that would normally be covered by an additional four doctors will fall to two: the local provider, who at over 60 years old is high-risk for COVID-19, and Wallace’s co-medical director, who flew in last weekend to “hunker down” in the area until early April.
“It’s an incredible burden on the two of them,” Wallace says. “And should either of them need to go into quarantine, or become symptomatic, then we’re really facing having to close the doors.”
Other restrictions already in place in Texas further complicates access, as Paige Alexandria wrote for Rewire.News:
The impacts of the COVID-19 pandemic are compounded by the Texas legislature’s aggressive anti-abortion efforts.
Due to targeted regulations of abortion providers, or TRAP laws, people in Texas must wait 24 hours after receiving an ultrasound and state-mandated counseling before they can get an abortion, increasing their visits to the clinic—and their chances of contracting or spreading the virus.
There aren’t nearly enough abortion clinics in the state to serve every community, let alone during a pandemic—a result of HB 2, which shut down over half of Texas’ abortion providers and increased the costs and distance traveled to receive abortion care. Texas has the most cities over 100 miles from a clinic that performs abortions. And with the highest number of uninsured residents, needing an abortion in Texas often means deciding whether or not to pay rent or utilities, sleeping in cars, selling personal belongings, or borrowing money.
Anti-choice legislation has also eliminated the possibility of potential alleviating factors. In Texas, both public and private health coverage are prohibited from being used toward most abortions in the state, and telemedicine abortion is banned.
Texas Monthly’s Arielle Avila provided insight into the frustrations patients have experienced in the state while abortion access was restricted and then allowed again:
More than one hundred patients at Whole Woman’s Health facilities in Texas were turned away on March 31 for appointments that some had scheduled the day before. The morning of the 31st, the U.S. Fifth Circuit Court of Appeals had ruled that an executive order banning abortion during the coronavirus outbreak could remain in place, reversing a federal judge’s block of it, meaning that many who hours before thought they could go through with their appointments now could not. According to Amy Hagstrom Miller, CEO and president of the organization, patients were begging, often in desperation, to see the clinicians. But with the order back in place, there was nothing doctors could do except provide funds for some patients to fly to get their abortions out of state, increasing their risk of being exposed to the coronavirus or unwittingly exposing others.
Kamyon Conner, executive director of Texas Equal Access Fund, an organization that provides funding to low-income women in the northern region of Texas who are seeking abortions, said she had heard from Texans in situations where both adults in a household had lost their incomes. “They are angry at the people who enacted these restrictions on abortion at this time,” Conner said, “and are pretty upset that it’s happening at a time when they’re already going through so much other stuff.”
Amanda Williams, executive director of the Lilith Fund, a non-profit that assists Central Texas women, said that nearly half their clients were forced to travel out of state for care while the ban was in effect, trekking an average of 700-plus miles to access a clinic. A Houston woman recently traveled as far as 3,000 miles even though she lived only three miles away from her local provider. Those who can afford to travel out of state are stuck in hotels for three to four days and many clients are traveling by plane, placing them at greater risk of COVID-19 exposure.
But, as 60 percent of callers report losing their jobs due to the pandemic, there are many who weren’t able to venture past Texas: Williams shared the story of Alex, a Lilith Fund client whose insurance doesn't cover the procedure and who couldn’t afford to travel for care with her child. Alex was forced to wait for the ban to end, extending her pregnancy into the second trimester, when abortion is more expensive. Another caller, Nikki, told the Lilith Fund she is unemployed with no savings and didn't want to risk getting her children sick by driving to another state for an abortion.
While abortion services have resumed in Texas (for now), abortion fund leaders say the painful month-long battle can’t erase the damage and suffering inflicted on hundreds of women during the pandemic and the smaller pool of resources that will be available for people in the future. And they suspect another state restriction is just lurking around the corner.
In other states, anti-abortion advocates and media outlets are directly petitioning state officials to ban abortion or urging their followers to essentially act as informants if they know of clinics performing abortions where the procedure has not been affirmed as “essential.” Additionally, Ms. Magazine’s Micaela Brinsley wrote that “in North Carolina, Wisconsin and Kentucky, anti-choice protesters have continued to show up at clinics that provide abortion services, refusing to comply with the pressure for people to practice social distancing and shelter-in-place.” Protesters in front of clinics in North Carolina were arrested for violating the state’s stay-at-home orders and have now sued for what they claim is an infringement of their First Amendment rights. Clinics have also had to deal with increased security costs due to fears over protesters’ continued presence in front of clinics without escorts to act as a buffer between them and the patients. Patients also must face the risk of encountering deceptive anti-abortion clinics that continue to operate despite not offering any essential medical services.
With their previous push for restrictions on abortion at the state and federal level, abortion opponents have created a pressure cooker for people needing abortion access as the coronavirus spreads across the country. As seen in places like Ohio and Texas, limitations already in place will further endanger the lives of people who seek abortions in a fraught time when health care is most needed.