• Abortion Access is Essential – Even During a Pandemic

    ​Tracey A. Wilkinson, MD, MPH and Erika R. Cheng, PhD, MPA are Assistant Professors of Pediatrics at the Indiana University School of Medicine.

    We are in the midst of a global pandemic. Schools have closed, businesses shuttered, important gatherings cancelled. In order to preserve supplies of basic medical supplies – like masks and gloves – which are in high demand due to the current COVID-19 outbreak – even “non-essential” medical care has been halted.

    Some have used this opportunity to attack abortion rights.

    In a moment of chaos and so-called togetherness, governors in seven states (Texas, Ohio, Mississippi, Iowa, Oklahoma, Alabama and Indiana) have decided to take steps to further restrict women’s access to abortion. Just last week, the governor of Texas joined in deeming abortion as non-essential medical care that should be halted immediately. In Texas, women and providers who violate this restriction are subject to 180 days in jail or a fine of $1,000. Texas’ Attorney General, Ken Paxton, threatened “the full force of the law” for anyone who violates the Governor’s order.

    Because some medical supplies are in such great demand, it makes sense to stop using them for medical procedures that are not urgent or time-sensitive. The problem is that abortion does not fit that description in any way.

    Abortions are extremely time-sensitive. Restrictions around access to abortion in many states increase exponentially with every week of pregnancy, meaning that for most women, whether they can access abortion depends on how far along in their pregnant they are. We have no idea how long this pandemic will last. Waiting until this pandemic is over to ease these newest restrictions will likely make abortion completely inaccessible for women living in some states.

    Further, pregnancy is not a risk-free life event. It’s a medical condition that has associated risks, that, for some women, can be fatal.  In these situations, abortions save lives.  While these orders do have exceptions for “the life or health of the mother” it is not clear how that will be interpreted. Preventing abortion clinics from staying open will limit women’s ability to obtain an abortion even in these circumstances, as 95% of abortions are performed in outpatient clinics, not in hospital settings.

    For the record, in these states, liquor stores have been deemed essential businesses and will remain open.

    Women trying to access abortion already face significant hurdles. Many are forced to travel long distances to access abortion. An analysis last year showed that 11 million women traveled over an hour to get to an abortion clinic. More are subjected to waiting periods – sometimes up to 72 hours – between their initial appointment and the abortion procedure itself.  Insurance plans rarely cover abortion, meaning women have to find the money to pay for it quickly, which can be a challenge as unemployment claims are on the rise.  Furthermore, as many health systems are transitioning to tele-health models to provide care through this pandemic, there are 18 states that restrict providing medication abortions with this model.

    The coronavirus pandemic complicates this picture for women all over the country. Given how quickly things are changing, excessive waiting periods could eliminate access for women who unable to return within the set-time for either personal reasons, like caring for children or family members, or external reasons, like stricter shelter-in-place orders.

    It’s not as if current travel restrictions and shelter-in-place orders make it easier for women to access abortion. So why efforts to restrict it further? These new restrictions are a political attack on women’s health, disguised in the name of public safety.

    Not all states have acted in this manner. In stark contrast to these six states, New Jersey and Washington, where the first known cases of COVID-19 were detected, explicitly clarified that reproductive healthcare, including abortion, would be considered essential healthcare and not be restricted at this time. Illinois clarified that individuals can leave their residence to obtain healthcare, including reproductive healthcare. The American College of Obstetrics and Gynecology also issued a statement deeming abortion “a time-sensitive service for which the delay of several weeks, or in some cases days, may increase risks or potentially make it completely inaccessible.”

    Just last year, several states, including Ohio, Iowa, and Mississippi passed legislation that would ban abortion as early as 6 weeks. While these laws are currently being challenged in the courts, they are not yet in effect, but the state’s overall approach to comprehensive reproductive healthcare access for its citizens is clear. And, in the chaos of a global pandemic, these governors have chosen to cast an even broader and dangerous prohibition of all abortions which will have ripple effects on women everywhere.

    These recent developments have already resulted in a legal battle and emergency court hearings and decisions that will divert attention away from what is actually important right now – preventing the COVID-19 pandemic from worsening.

    It’s bad enough when policymakers limit medical care for political reasons.  Using a global pandemic to further an agenda to remove essential healthcare from women is much, much worse.

     
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