During the COVID-19 Crisis, Abortion Access Must be Considered “Essential”

In an effort to protect patients and staff from exposure to COVID-19, and to conserve critical equipment and supplies, the U.S. Surgeon General and American College of Surgeons have recommended restrictions or eliminations on “elective” surgeries.

But abortion rights advocates fear this declaration may adversely impact abortion access.

A group of eight family and reproductive health groups—including the  American College of Obstetricians and Gynecologists (ACOG) and the American Society of Reproductive Medicine (ASRM)—released a joint statement March 16 on the subject of elective surgeries, which reads:

“Obstetric and gynecologic procedures for which a delay will negatively affect patient health and safety should not be delayed.  This includes gynecologic procedures and procedures related to pregnancy for which delay would harm patient health.  Obstetrician-gynecologists and other health care practitioners should be aware of the unintended impact that policies responding to COVID-19 may have, including limiting access to time-sensitive obstetric and gynecological procedures.”

One word is crucially missing from the “essential” gynecological surgeries outlined above: abortion.

Activists like those from the National Abortion Federation (NAF) are calling on local and state government leaders to ensure that outpatient abortion clinics remain open, as well as urging hospitals to continue to provide abortion care. 

In a March 17 statement, NAF spelled out the urgent need for continued safe access to abortion, not in spite of, but rather especially in light of the pandemic:

“As we navigate COVID-19, it is critical that leaders treat outpatient abortion providers as essential businesses, and that hospital systems ensure the continuation of abortion care as an essential service,” wrote NAF in a statement.

NAF explained in more detail:

“Abortion care is a time-sensitive service that cannot be significantly deferred without profound consequences for women and their families.

“Abortion is provided for almost one in five pregnancies in the United States, as part of the continuum of pregnancy care. It is an essential health service. An individual and family decide to end a pregnancy for a complex constellation of reasons that include the impact of pregnancy and birth on their health, ability to work, and strained economic circumstances. These are conditions that do not go away—and are likely heightened—in pandemic conditions. Denying or deferring abortion care places an immediate burden on patients, their families, and the health system, and can have profound and lasting consequences.

“Patients presenting for time-sensitive care, including abortion care, need timely access to treatment, even during this pandemic.”

Leaving the Decision Up to Individual States

State leaders like Gov. John Bel Edwards in Louisiana and Gov. Greg Abbott Texas have used the pandemic to suspend abortions outright—and Nebraska may be the next state to pass a similar decree.

Gov. Tate Reeves of Mississippi became the latest politician to attempt to prohibit abortion procedures during this pandemic. He said during a news conference Tuesday that he would take action if the state’s single clinic was providing elective abortions after the state health department required that non-essential surgery be postponed.

“It’s insidious for anti-choice lawmakers to politicize this time of crisis to restrict abortion and necessary reproductive services,” wrote #VOTEPROCHOICE co-founder and CEO Heidi Sieck in an email Wednesday. “Mississippi only has one remaining clinic—it is already difficult enough to access critical care in this state. Barring access further is just unconscionable, and forcing people to remain pregnant during a global pandemic is horrific.”

Abortion access in Ohio is at risk, but not suspended: Over the weekend, Ohio Attorney General Dave Yost issued an order to three clinics in Cincinnati, Dayton and Cleveland to stop “nonessential” abortions.

In response, Planned Parenthood of Greater Ohio and Planned Parenthood Southwest Ohio Region sent a joint statement promising to “reduce the use of equipment in short supply” but still ensure access to abortions.

“Planned Parenthood can still continue providing essential procedures, including surgical abortion,” the organization wrote, while “doing our part to conserve needed resources and to protect the health and safety of our patients and staff.”

In the end, reproductive rights organizations, like Planned Parenthood, and state legislators, like Ohio Reps. Juanita Brent and Janine Boyd, were able negotiate a compromise with the Ohio’s attorney generation to allow abortions to continue.

In other states, elected officials have explicitly declared abortion an essential, protected service during these extenuating circumstances.

When Washington Gov. Jay Inslee on Thursday ordered a halt to elective surgeries and dental services, his proclamation made it clear that the “full suite of family planning services and procedures” was an exception.

Additionally, after Massachusetts Gov. Charlie Baker on Sunday ordered hospitals and surgical centers to cancel all elective medical procedures on Sunday, he clarified on Tuesday that abortion is considered an essential medical service—but left the “ultimate decision” up to “the caring physician.”

Dr. Dominika Seidman—a professor at the University of California, San Francisco—would like to see more elected officials follow Govs. Inslee’s and Baker’s leads.

“It’s important to explicitly name abortion a non-elective procedure because there is so much in the media about ‘elective abortions,’” Seidman said. “There is no such thing as an elective abortion. Elective procedures can be postponed. The repercussions of postponing or not having an abortion are profound, especially during a pandemic when a pregnancy could become high risk if someone is infected with Covid.”

Provided that clinics are allowed to stay open, providers are worried about additional challenges brought on by the pandemic that could make obtaining abortion that much more difficult—such as limitations or cancellations of public transportation systems; looming layoffs and the lack of paid sick leave, leaving many women without sufficient financial resources; and the lack of reliable child care, for those with children.

Moreover, TRAP laws in various states may also cause additional disruptions to abortion access.

D.C.-based local news outlet Route Fifty reports:

“Patients in places like the San Francisco Bay Area, which is currently under a ‘shelter in place’ mandate, might still have an easier time accessing reproductive health services than people in other parts of the country. California is a state with relatively few restrictions on abortions.

“In other states, particularly those in the South and the Midwest, patients may have to appear for two appointments with a waiting period in between—a difficult task if they have to travel a long distance to an abortion clinic at a time when many hotels might be closed.

“In some states, abortions have to be performed in a hospital after a certain number of weeks—something that will become increasingly difficult to schedule as hospitals become overwhelmed with Covid-19 cases.”

Abortion Clinics Take Precautions as They Declare “We 100% Plan to Stay Open”

Abortion providers say that unlike elective surgeries, access to safe reproductive care can’t be delayed. They say abortions are time-sensitive for health reasons—as some women have medical conditions that can make each additional day of a pregnancy life-threatening—and some states prohibit abortions beginning as early as 20 weeks into a pregnancy.

“Abortion is not something you can put off for a few months,” said Brigid Leahy, senior director of public policy for Planned Parenthood Illinois. “We do not want to delay that care because the longer you delay, the more it increases risk and cost. It’s important that patients don’t postpone necessary healthcare.”

Clinics have reported taking additional precautions to limit contagion, such as: opting for telephone screenings when possible; increasing the frequency of cleaning and disinfecting; and pre-screening for coronavirus symptoms. The National Abortion Federation has released additional guidelines for abortion providers, like encouraging patients to fill out screening forms at home, spreading out patient scheduling, and limiting the amount of people allowed in waiting rooms.

Clinics Experiencing Increased Protesters and Anti-Abortion Extremism

In spite of calls to shelter-in-place and practice social distancing, clinics across the U.S. are still reporting the presence of anti-abortion protesters.

In some places, protesters are able to stand directly outside the clinic door and walk up to patients—blatantly ignoring public health guidance advising people should remain six feet apart and putting those seeking an abortion at risk. (K Garner)

On Saturday, March 14, one Charlotte-based abortion clinic reported more than 150 protesters outside their clinic—even though North Carolina Gov. Roy Cooper had already advised people to cancel meetings of more than 100 people and stay home for work.

And this week, a clinic in New Jersey had at least 15 protesters targeting their staff, although the Gov. Phil Murphy had already ordered restaurants, gyms and other large gathering locations to close.

Numerous other clinics have reported similar extremism and demonstrations, according to March 20 communication from NAF. In some places, these protesters are able to stand directly outside the clinic door and walk up to patients—blatantly ignoring public health guidance advising people to remain six feet apart, and putting those seeking an abortion (as well as anyone else entering the building) even more at risk.

Protection for abortion-seekers during these times is compounded due to the fact that several escort programs have been suspended due to health concerns.

Clinic escorts serve to shield clients from potential dangers at the clinic—but are in short supply in the midst of a pandemic. (Robin Marty / Creative Commons)

“So-called pro-lifers are placing the lives of patients, themselves and the general public at risk by continuing to carry out protests targeting abortion clinics,” said duVergne Gaines, director of the Feminist Majority Foundation’s National Clinic Access Project. “Clinics are reporting that protesters are pushing up against patients, their companions and volunteers, threatening their safety and in flagrant disregard of CDC and public health recommendations to stay at home and avoid gatherings of more than ten people.”

On top of the health risk and the stress inherent in seeking an abortion, especially during these trying times, the last thing abortion-seekers need is additional stress caused by the presence of aggressive protesters.

Jen Villavicencio, an ob-gen in Michigan and a fellow with the Physicians for Reproductive Health told VICE, “In the time of a pandemic, anxiety and fear are at an all-time high for both health care providers and patients, and protestors are only adding to that, all while putting themselves at risk of contracting a potentially dangerous infection.”

The coronavirus pandemic and the response by federal, state and local authorities is fast-moving.

During this time, Ms. is keeping a focus on aspects of the crisis—especially as it impacts women and their families—often not reported by mainstream media.

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Roxanne Szal (or Roxy) is the managing digital editor at Ms. and a producer on the Ms. podcast On the Issues With Michele Goodwin. She is also a mentor editor for The OpEd Project. Before becoming a journalist, she was a Texas public school English teacher. She is based in Austin, Texas. Find her on Twitter @roxyszal.