Abortion Providers Fight to Keep Working During the Coronavirus Pandemic

As the country faces the COVID-19 pandemic, abortion providers in the United States are fighting to continue providing care. 

The emergency measures being taken in response to the novel coronavirus present a new set of challenges for abortion providers, and lawmakers are taking advantage of the crisis to further restrict abortion access. Within the last few weeks, Ohio, Texas, Oklahoma, Mississippi, and other states moved to make surgical abortion a nonessential surgery and stop services during the pandemic. 

After Ohio’s Department of Health ordered the postponement of all nonessential surgical and elective procedures, state Attorney General Dave Yost sent letters dated March 20 to Planned Parenthood and other abortion providers with orders to “immediately stop performing non-essential and elective surgical abortions.”

Texas Governor Greg Abbott quickly followed suit, issuing a statewide order on March 22 to stop hospitals from performing surgeries, unless the patient faces an immediate risk for “serious adverse medical consequences or death,” until April 21. A spokesperson for Abbott confirmed that abortions were subject to the order. 

Abortion providers are fighting back, and federal judges blocking efforts to ban the procedure during the pandemic. In Texas, a group of providers filed a lawsuit against Abbott on March 25 challenging the statewide ban. On Monday, federal judges issued temporary blocks to Texas and Alabama’s efforts to ban abortions during the pandemic. 

Yet a federal appeals court ruled that Texas can temporarily enforce a ban on abortions as part of the coronavirus emergency response. In a 2-1 opinion, the Fifth Circuit Court of Appeals ruled that the order from the lower court be stayed until an appeal from Texas is considered, The Hill reported.

In Ohio, a judge ruled that “a new Ohio order is unconstitutional if it prevents abortions from being carried out” and clinics are to determine if an abortion can be delayed to preserve resources on a case-by-case basis. If the abortion is deemed necessary, then it’s declared legally essential. 

“They’re playing politics with people’s lives,” said Staci Fox, President and CEO of Planned Parenthood Southeast. A legal abortion with a medical professional is still safer than childbirth and can save the life of someone experiencing a medical emergency during pregnancy.  

The American College of Obstetricians and Gynecologists agreed in a March 18 statement: “Abortion is an essential component of comprehensive healthcare. It is also a time-sensitive service for which a delay of several weeks, or in some cases days, may increase the risks or potentially make it completely inaccessible.”

Planned Parenthood organizations in Ohio issued similar responses to the state attorney general, reiterating their compliance with the Department of Health’s order regarding personal protective equipment and that they “can still continue providing essential procedures, including surgical abortion.”

As Congress was trying to pass the Families First Coronavirus Response Act, allocating emergency funding for relief efforts, some lawmakers expressed concerns that the bill’s original draft did not include Hyde Amendment language, which restricts federal funding for abortions, except in extreme and rare circumstances. This ensures that reimbursement would only go toward laboratory claims for COVID-19-related services and could not apply toward abortion services. The bill became law on March 18 with an amendment that allows funding only for COVID-19-related reimbursements.

In addition, a $2 trillion stimulus package, which allocates cash assistance to individuals and couples, small businesses, corporations, and state and local governments for emergency relief passed on March 27. The bill included Hyde Amendment language, giving the Small Business Administration “broad discretion to exclude Planned Parenthood affiliates and other non-profits serving people with low incomes and deny them benefits under the new small business loan program,” according to Rewire.News.

The pandemic adds great financial strain on Americans who were already living precariously. In this uncertain time, providing abortion access is critical, says Melissa Grant of Carafem, a family planning and abortion provider with locations in Atlanta, Nashville, Washington, D.C., and Chicago.

“I think it’s wise to remember that at times when people are stressed, it’s normal to sometimes reach out for the comfort of human touch and sometimes that results in unprotected sex.” Isolation and difficulty in obtaining birth control and condoms could result in more cases of unanticipated pregnancies. Grant says there has been a surge in calls at Carefem locations from patients concerned about whether they will have access to abortions should they need it. 

Abortion providers like Planned Parenthood and Feminist Women’s Health Center are used to operating under hostile legislative environments and duress. “We’ve been through plenty of crises before, we have a little bit of muscle memory around crisis,” said Fox. For the past 25 years, she said, Planned Parenthood staff members at clinic locations have faced intimidation and violence, including fake anthrax threats, and kept working during natural disasters, providing free contraception and reproductive health care services for people displaced by Hurricane Katrina.

At the start of the COVID-19 outbreak, abortion providers like Kwajelyn Jackson, executive director of the Feminist Women’s Health Center in Atlanta, focused on keeping staff members safe from infection. The health center limited elective wellness services, staggered staff schedules and patient appointments to limit the number of people at their site, and removed some chairs from the waiting areas to maintain six feet of distance between people, Jackson said, in addition to abiding by guidance from the World Health Organization and Centers for Disease Control and Prevention on maintaining proper handwashing. She was concerned about how they would continue to operate with limited resources. “When you are a small nonprofit working at the thinnest of margins, you’re always functioning at over-capacity. We don’t have a lot of back-ups or on-call staff.”

Jackson is also concerned that Governor Brian Kemp may use COVID-19 emergency measures to restrict or ban abortions. “We know that the current administration in Georgia is not friendly to abortion and could be persuaded by anti-abortion extremists, too,” she said. Kemp’s office did not respond to a request for comment.

Dozens of national conservative groups sent a letter to Health and Human Services Secretary Alex Azar on March 24, calling for officials to divert emergency response funds from abortion providers, urging providers to “cease operations,” and to make sure “telemedicine abortion is not expanded during the crisis.” 

In the worst-case scenario—that abortion providers cannot provide care—Jackson hopes hospitals will prioritize abortion care, a risky bet in the face of a global pandemic. But she worries that hospitals will be too overwhelmed. While the exact numbers of potential cases is still unknowable, a New England Journal of Medicine article published March 23 estimated that 5 percent of the U.S. population could become infected within three months. The authors say that U.S. hospitals simply do not have the capacity to meet the demand of this pandemic. 

For now, abortion providers are counting on telemedicine, a promising avenue of expanding access to medication abortion. Before the pandemic, medication abortion through telemedicine was considered a promising option for women living in geographic areas where targeted regulation of abortion providers reduced access to reproductive health services. The need for social distancing is now catapulting this technology to the forefront. 

The process of getting a medication abortion via telemedicine is similar to the in-person model. In person, the process typically involves a patient traveling to an abortion clinic to get screened and evaluated by a provider who then gives the abortion pills at the clinic. For patients who opt for telemedicine, the steps that are typically done on site are done online. Some models involve a patient visiting a health center for a consultation and screening with an on-site provider, then later connecting with a clinician through video conferencing, in which the clinician reviews the patient’s medical records, answers questions, then remotely authorizes mifepristone and misoprostol, the FDA-approved medications that induce a miscarriage. Other models, which are more conducive to social-distancing, have the abortion provider conduct all steps—evaluation, screening, and prescribing—over videoconference, and the abortion pills are sent by mail. 

“I think a new interest has been generated in how we can provide an abortion or other kinds of reproductive healthcare with the least amount of physical touch necessary,” said Grant. 

Research shows that the success rates and safety of medication abortion via telemedicine are similar to in-person care and that medication abortion via telemedicine is acceptable to patients. As of March 1, 33 states require clinicians who perform medication abortion procedures to be a physician, and 18 states require the clinician providing medication abortion to be physically present during the procedures, essentially prohibiting the use of telemedicine medication for abortion remotely, according to the Guttmacher Institute.