States That Use COVID-19 To Ban Abortion Are Increasing Risks, Hardships And Trauma Nationwide

An activist holds a NARAL placard that reads “Keep Clinics Open” in Dayton, Ohio on May 19, 2019 … [+] during a nationwide day of protest organized after multiple US states passed so-called ‘heartbeat’ bills. (Photo by Megan Jelinger/SOPA Images/LightRocket via Getty Images)

LightRocket via Getty Images

For the past few weeks, lawmakers in a growing number of US states have taken it upon themselves to restrict abortion during the COVID-19 pandemic by deeming that care “nonessential,” despite medical experts’ explicit warnings not to.

As US states have rushed to define and maintain their own responses to the global viral disease outbreak, numerous state lawmakers have chosen the extra step of declaring virtually all abortion care or procedures “nonessential,” rather than letting doctors decide (along with patients) what’s essential and safe right now.

In doing so, patient experts and advocates say, lawmakers not only cause added burdens for delayed patients, their families, and other state residents in a moment of economic upheaval; they also increase the chances of spreading the virus across states and overloading healthcare systems in coming days.

States with lawmakers pursuing such dangerous aims include Texas, Ohio, Iowa, Alabama, Oklahoma, Indiana, North Carolina, Kansas, and Kentucky. In Texas, Alabama, Iowa, Ohio, and Oklahoma, state lawmakers have already issued orders to limit abortion access in April. So far, courts in Iowa, Alabama, Oklahoma, and Ohio have sided with patients and abortion providers, placing temporary blocks on states’ restricting and/or fining them during the COVID-19 crisis.

In Texas, however, a court most recently reinstated the order by Governor Greg Abbott, with “an exception if delaying the procedure would place the pregnancy beyond the state’s 22-week abortion cutoff,” the New York Post reported. As a result, during this pandemic, “Texas is once again the epicenter of the legal fight around abortion,” NPR wrote Friday.

Among other things, Texas is therefore also forcing patients to consider out-of-state travel to obtain the services they need, with all of the added financial costs, physical and emotional stressors, and risks of contracting or spreading viral infection that such a step would entail.

Before most states had even begun ‘shelter in place’ protocols, US medical experts and physician organizations repeatedly spoke out against restricting abortion, having anticipated this kind of move from some states. Earlier this month, the American Medical Association also filed a brief in the Texas case in support of abortion providers, “as did 18 states,” NPR reported.

In response to the Texas Circuit Court’s ruling, which said “all public constitutional rights may be reasonably restricted to combat a public health emergency,” medical teams and patient advocates have now asked the Supreme Court to take emergency action to “restore essential, time-sensitive medication abortion services while the case proceeds.”

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The Center for Reproductive Rights (CRR), which has been litigating opposition to the bans in multiple states, commented in a statement, “For almost three weeks, providers [in Texas] have had to cancel appointments for hundreds of patients while Gov. Abbott continues to exploit a pandemic in order to score political points.” They also said the Texas ruling “is one of many that has created legal whiplash, causing confusing and uncertainty for hundreds of patients in need of essential, time-sensitive abortion care.”

Because of the legal back-and-forth there, Texas’ abortion providers, represented in court by Planned Parenthood Federation of America, the Lawyering Project, and CRR, were “in the midst of calling patients back to health centers when the 5th Circuit’s ruling came down,” and will now have to turn patients away “unless they will pass the gestational limit for abortions in Texas before April 22, [after the] order is set to expire,” CRR wrote.

As researchers at the Guttmacher Institute highlighted in March, the COVID-19 crisis poses multiple threats to US residents’ sexual and reproductive health, including but not limited to a reduction in access to HIV/AIDS medication, fertility treatment, pre-natal exams, contraception, abortion care, and simple prophylactics like condoms.

Researchers also noted, “Moreover, if pregnant women and infants are found to be at heightened risk from COVID-19 — or if [much] of the public fears that may be the case — that may prompt some people to avoid having children and could lead to increased demand for contraceptive and abortion services … the case in many countries hit hard by the Zika virus in 2015 and 2016.” The WHO and other health authorities have also emphasized similar points.

At the same time, laws in many states prevent patients who’re seeking contraceptives or particularly abortions to access such care from a variety of prescribers, or via telemedicine — a problem that seems even more stark as US medical professionals continue working flat-out to care for patients while protecting their own health.

Elisabeth Smith, Chief Counsel for State Policy and Advocacy at CRR, said in a phone interview this month that as a native of Texas — which “has long demonstrated an intense hostility toward abortion rights,” Smith said — she finds the state’s attempts to politically “exploit” a national medical crisis “absolutely disgusting.”

Smith also said it’s important for people to be aware that other states, such as Alabama, Iowa, and Ohio, have already instituted what she calls “medically unnecessary abortion restrictions that actually exacerbate unnecessary contact between providers and patients.” According to the Guttmacher Institute, for example, 33 states currently require clinicians who perform medication abortion procedures — that is, who prescribe the medication for a wanted abortion, and counsel patients on its use — to be a physicians, ruling out nurse practitioners and licensed prescribers.

In addition, 18 states require such prescribers to be physically present during the procedure, thus prohibiting the use of telemedicine or simple phone calls to facilitate medication abortion (which happens at home, or ’remotely,’ anyway).

An abortion rights activist holds placards outside of the US Supreme Court before the Court struck … [+] down a Texas law placing restrictions on abortion clinics on June 27, 2016 in Washington, DC. (Photo credit should read MANDEL NGAN/AFP via Getty Images)

AFP via Getty Images

According to Smith and other reproductive rights advocates, the language being used in states’ “nonessential” abortion orders — in multiple cases, setting an exception only ‘if the mother’s life is in danger’ — is not only “devastating” to patients, but critically “amounts to a pre-viability ban, which the Supreme Court has repeatedly [called] unconstitutional since 1973.”

In addition, she said, “We have no idea how long a pandemic response will last.” In general, Smith said, “Delays [for abortion] always cause harm, and this is a delay of unknown duration.”

Sonja Spoo, Director of Reproductive Rights Campaigns at the progressive research and cultural organization UltraViolet, said that as multiple state lawmakers move to restrict abortion while they can, her group is making note of which US companies have continued to fund such lawmakers, and trying to raise awareness of the plethora of issues that women in particular face during the COVID-19 crisis.

In recent weeks, Spoo said, “We’ve been focusing on the particular issue of abortion access in the greater narrative of women being on the front lines of this pandemic, and being particularly impacted because they’re not centered in policy.” For example, she said, women account for the majority of healthcare workers, grocery and drug store cashiers, and other essential-worker groups providing services and risking their own health right now (as in pre-COVID-19 times). “Yet people don’t have an image of women as front-line workers.”

Spoo also pointed out that, as long-term and recent data have indicated, people of color (and especially women, non-binary, and low-income ones) are facing not only higher rates of infection and illness, but also worse-than-usual hurdles to getting medical and financial support in their states.

“We can’t do a ‘one size fits all’ policy,” she said. “COVID-19 doesn’t discriminate, but healthcare does. And for abortion, there are already competing intersectional access barriers out there.”

Millions of potential patients working in service jobs, agriculture, and the ‘gig industry’ don’t have paid leave or other protections that would allow them to take time off not only if they’re sick, but if they must suddenly leave the state to obtain a safe, wanted abortion, for example. Even if patients can afford it, traveling between states may be very difficult but also dangerous right now, Spoo said. “But they shouldn’t have to travel out of state.”

Spoo said that US companies as well as governments must be prepared to make meaningful changes in their policies during this crisis, and in the weeks and months that follow, to give workers that basic level of safety and security — and that her group, like others, will be keeping track of which companies say they’re supporters of women, but simultaneously donate to lawmakers responsible for “anti-science, anti-women” policies.

“These long-term structural changes are necessary for society to prosper and flourish,” she added.

Jen Stark, Senior Director of Corporate Strategy for the Tara Health Foundation, also commented by email that given current conditions in the US, “Going back to the status quo isn’t enough.”

“When it comes to the constellation of issues facing women showing up to work as their full selves — from sick leave to parental leave, pay equity, forced arbitration, and access to reproductive health — the COVID-19 crisis exacerbates all the existing fault lines.”

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Indeed, the pandemic and related developments seem to be exacerbating any number of ongoing struggles in general or specific terms for most US residents, including those of us lucky enough to be safe at home with the care we need.

For example, most people I’ve spoken to have had trouble sleeping at night over the past month. Two of my four roommates have been passing the days in our cozy, gently crumbling Brooklyn apartment with dark circles under their eyes, their usual insomnia and worries over an uncertain future pushed to the brink. My two nephews, aged six and nine, have begun sleeping in the same bed for that reason.

In my case, generalized worry about the pandemic as well as specific concerns about family, friends, and groups of exploited or at-risk workers have kept me on edge, and catalyzed my usual persistent depressive disorder. But news on the abortion front in particular has, to my surprise, caused feelings and symptoms I can only assume are a form of trauma. For weeks, I’ve been trying to write about states lawmakers’ decision to call abortion “unessential,” and simply haven’t been able. As I stare at my screen, or catch up on the latest states to attempt these bans, my chest soon tightens, I get slightly nauseous, and my words drift away.

For whatever reasons, that abdominal clenching and nausea transports me to another a moment of crisis just over a year ago: I was across the country visiting my mom, who’d just been hospitalized again for symptoms and injuries related to seizure disorder, when I realized that I’d become pregnant due to contraceptive failure.

I’ve worked with kids (whom I adore) for much of my life, and planned to one day foster and adopt them, rather than having my own, since I was 16 years old — when and if financial stability presented itself, of course (which I imagined could happen by age 35 or 40; at age 33, this seems miles away). So I knew I wanted to end my pregnancy, and to stop the total exhaustion, daily vomiting, and other physical signs which had tipped me off, but were nevertheless unexpected.

Rather than wait four days and pay several hundred dollars for a medication abortion in that part of Northern California, I decided to wait a week and get one back in Brooklyn, where my Medicaid plan would cover it, though my mom had kindly offered to pay. A few years before my eldest sister was born, she and my dad had one just days before they took the California bar exam (a medical process sounding far more unpleasant than either today’s medicinal abortions or the very quick, minimally attended surgical one I finally chose, which required an extra day to schedule, but was best for me).

That week in California, as I tried to care for my mom while I was physically and emotionally off-kilter, I couldn’t help but wonder about the uncertain future: whether I’d have to accept major life changes and move back West if my mom’s care needs increased; whether and how I’d still be able to work enough to support us; even whether, if the laws in my state or others were different, I would ever have enough money to support a child if forced to carry a pregnancy to term.

One day, as I drove her home from a hospital visit with those thoughts in mind, I spotted a group of five or six white-haired women holding signs in front of a building we’d driven past for years, and which I only now knew — from calling around, and finding few options — provided abortions.

I felt strongly then, as I do today, that those protesters were likely among the relatively few US voters who are truly, deeply, morally compelled to oppose abortion on behalf of the sanctity of human life — just as I am compelled to defend it for similar reasons. I truly believe, too, that we have much in common in that way, and can benefit our whole society by discussing these issues with open hearts and ears. So I pointed the women out to my mom, and silently wished them well.

But I also wished that neither they nor any of their loved ones would ever have to be in the position that I was then, in early 2019 — waiting to see if life as I knew it could go on, but depending on politics.

And now, as I imagine the uncertainty and fear physically gripping hundreds or thousands patients waiting each day for one small but fundamental reassurance, I know the time for me to stay quiet has passed.

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