No one leads the same life they did two weeks ago. Under this pandemic, millions have lost work, retreated from public spaces, and canceled all outings deemed non-essential in order to flatten the curve of COVID-19. Time will tell the long-term effects of these restrictions intended to impede the virus’s spread, but already there have been adverse impacts on other aspects of life and health for some. People seeking abortion care—services that were already limited by unprecedented restrictions since well before the outbreak—are now faced with even more limitations to accessing this essential health care.
As COVD-19 spreads, state governments are issuing Executive Orders in order to consolidate resources and ensure that hospitals are prepared for an influx of patients. While some bar in-clinic abortion care outright, many others neglect to specify whether it is considered an essential service or not, despite its protection under federal law and the history of discrimination that has always driven the need for expanded access. While anti-choice politicians leverage this global health crisis to regulate pregnant people’s bodies and restrict access to health care under the guise of taking emergency safety measures, data shows that childbirth itself is categorically riskier than abortion. Moreover, abortion allows for the planning and spacing of pregnancies, meaning parents are more able to emotionally, physically, and financially prepare for the family they want to support.
Now, under the condition of pandemic, the health of pregnant people and infants is more at-risk than ever before. Countless individuals have lost their income and ability to travel. Hospitals and medical centers continue to overflow with more patients than they are equipped to treat. This drastically heightens the need to make “no-touch” medication abortion (abortion induced by pills) available to all patients in need through telemedicine, or remote care.
There is no justifiable reason for healthy people seeking abortion care to travel, make multiple visits, and fulfill waiting periods when all they need is medication that, under most other circumstances, could have been called into a pharmacy or delivered to their home. The FDA introduced a requirement called the Risk Evaluation and Mitigation Strategy (REMS) in 2007 to place restrictions on only the most dangerous drugs with known or suspected serious complications or contraindications, but these rules remain in place on mifepristone, one of the medications used (along with misoprostol) to end an early pregnancy—despite the proven risk of complication falling at a mere 0.5%.
These regulations have always inhibited access to reproductive health care, but the need for their removal has never been more pressing. REMS mandates that mifepristone must be stocked and distributed to patients directly by their provider in a health care setting, effectively requiring healthy and asymptomatic people to enter a clinical space alongside patients and clinicians who may have been exposed to COVID-19. This defies social distancing and quarantine logic, and unnecessarily endangers the elderly, immunocompromised, and countless others in a way that telemedicine could easily prevent. In the case of those experiencing miscarriage, these restrictions mean prolonging and overcomplicating a traumatic experience that could have been managed in the safety of their own home.
Even in many states where abortion has not been deemed non-essential, patients seeking abortion care must make multiple appointments in order to fulfill legal requirements for waiting periods, forcing them to repeatedly expose themselves and others to increased risk of infection from both the health care facilities and, particularly for low-income communities, public transportation. While these waiting periods always adversely affect low-income folks—who make up about 75% of abortion patients—new measures to curb the spread of the virus have further underlined the difference socioeconomic status has on access. School and daycare closures have eliminated the option of affordable and reliable childcare for many, creating an economic and practical inability to access care for a group who is far less likely to have paid leave from work. What’s more, the ability to make in-person visits may be nearly impossible for those who rely on public transit, due to state and citywide closures or mandates for social distancing.
Access to care is limited further by the safety concerns facing the clinicians who provide abortion care themselves. Often, these clinicians travel across state lines to restrictive or rural areas to offer abortion care where it may be scarce or highly protested. Many of these medical professionals are now restricted by their local workplaces from travel in order to prevent the spread of the virus between health care centers. This means those providers still working in low-access areas must take on more patients than ever, and many patients areas are no longer able to receive face-to-face reproductive health care whatsoever. The need to lift REMS restrictions on telemedicine for abortion is even more vital for both parties.
Nevertheless, people have been safely self-managing their abortions (SMA) even before this pandemic. Now it is likely to become even more commonplace, due to the increased restrictions on clinical care. While the term SMA may bring to mind the iconic second-wave feminist image of a wire hanger, most are now managed with abortion pills—mifepristone and misoprostol—acquired outside the parameters of a legal clinical setting. (This Sam’s Medication Abortion comic book offers a great step-by-step view of one person’s experience with a medication abortion, without specifying how they obtained the pills.) In general, these medications are sold through third party websites that provide instructions for use that may be poorly translated or written at an exclusively high literacy level, which can be confusing and discomforting for those who choose to—or feel forced to—access abortion in this way.
The COVID-19 pandemic is forcing us to adapt in every aspect of our daily lives, and the enormity of that transformation can be overwhelming. It is critical that we embrace these changes through the most responsible actions we can take, both individually and as a community. Making abortion care more accessible is essential in protecting the health and safety of patients, medical professionals, and the expanse of society working so tirelessly to take care of one another in a time of great uncertainty. A future where reproductive health access is equal and comprehensive regardless of one’s gender, race, socioeconomic status, or location is possible, but it starts with defending that access and ensuring the utmost safety for patients, health care providers, and everyone else experiencing the life-changing effects of this pandemic.
Find out where you or your loved ones can receive abortion care in your area, if needed, and seek out free support from the trained clinicians at the Miscarriage and Abortion Hotline if you are self-managing. To do your part in defending access, donate to abortion funds and organizations like the Reproductive Health Access Project, which provides support and training in comprehensive reproductive health care to primary care clinicians on the frontlines of the pandemic.
Lily Trotta works for the Reproductive Health Access Project (RHAP), a national nonprofit that trains, supports, and mobilizes primary care providers to integrate abortion, contraception, and miscarriage care into their primary care practice settings, so that everyone can have access to this essential care. As RHAP’s Organizing Associate, Trotta works on the Reproductive Health Access Network, a community of over 4,000 primary care clinicians across 48 states, Washington D.C., Puerto Rico, and Canada, who come together virtually and in-person to engage in advocacy, clinical training, and peer support.
Lead Image by: Saul Loeb via Getty Images