Why abortion access during COVID-19 is being unfairly limited

In early March, the American College of Surgeons (ACS) released its official recommendations for how medical facilities should manage “elective surgeries” as the growing number of COVID-19 cases made available hospital beds increasingly scarce. The ACS rightfully encouraged in-patient facilities to reschedule operations without a clear and present urgency (like plastic surgery procedures or tonsillectomies), but this new directive also emboldened anti-abortion politicians to include reproductive health-care procedures in their definitions of “elective surgeries” and therefore cut off patients’ rights to choose how, if, and when they will make a family.

Last week, Planned Parenthood and the American Civil Liberties Unions (ACLU) filed lawsuits against public officials in four states—Iowa, Ohio, Oklahoma, and Alabama—who attempted to suspend abortions throughout the state during the COVID-19 pandemic, deeming them “non-essential procedures.” “No one stops needing sexual and reproductive health care in a public health crisis. People still have sex. They still need birth control, STI testing and treatment, and access to safe and legal abortion. And in fact, in a time of crisis, they may need it more,” Planned Parenthood Acting President and CEO Alexis McGill Johnson said in a recent media briefing.

Indeed, people in need of an abortion would hardly consider the procedure “elective,” despite what anti-abortion officials may try to write into law. “Abortion care is unique because of the urgency our clients express around being seen [by a doctor],” says Melissa Grant, chief operations officers at carafem, a campaign dedicated to lifting abortion coverage bans like the Hyde Amendment and providing abortion care and family planning to people in Illinois, Georgia, Tennessee, and the District of Columbia.

Part of that has to do with the strict timeline required for an abortion. Medication abortion can only be taken within the first nine weeks of pregnancy (and often has to be prescribed in person). Otherwise, a person must make an in-clinic appointment in a time frame supported by their states’ laws; most states prohibit abortion after the 20-24 week mark. Meanwhile, it’s unclear when the coronavirus will be contained—in all likelihood, Americans will have to endure several more weeks of social distancing and other containment measures. Someone who needs an abortion, particularly someone whose life is endangered by a pregnancy due to cancer or other pre-existing medical conditions, cannot afford to wait that long.

Judges have acted to block abortion restrictions in Texas, Ohio, and Alabama, (although Texas’s law was upheld Tuesday on appeal, and may to go the Supreme Court) but people seeking care during this time still face obstacles to their reproductive rights that will likely only worsen as the pandemic goes on.

The obstacles keeping people from abortion access during COVID-19

Abortion access in America has long been under attack on both a national and state level. In 2019, dozens of states, including Georgia, Alabama, and Missouri, passed draconian restrictions on abortion access in the hopes of overturning the constitutional right to an abortion up to fetal viability established by Roe V. Wade.

“Seeing as abortion care is already stigmatized and difficult to receive, particularly in the Midwest and the South, COVID-19 creates even more urgency amongst clients who might be afraid or needing to travel to find care,” says Grant. If clinics are forced to close in Texas due to the upheld ban, 94 percent of counties will be 100 miles or more away from the nearest abortion provider—which would force people to break the state’s shelter-in-place order to obtain the care they need.

The extreme actions of places like Texas have granted them plenty of air time in the news cycle, but Reynolds notes that a number of states are hanging out in a gray area: State officials haven’t come out in support of abortion clinics staying open, but they haven’t made moves to close them, either. “The state of Illinois right away proclaimed that abortion was an essential service, and needed to be provided. Other states have been less clear on that,” she says. Officials in Washington D.C., for instance, have made no statement about whether or not abortion clinics should remain open, which adds to the confusion as people seek the health care they need.

“Seeing as abortion care is already stigmatized and difficult to receive…COVID-19 creates even more urgency amongst clients who might be afraid or needing to travel to find care.” —Melissa Grant, chief operations officers at carafem

As of right now—and despite the efforts of many conservative politicians—providers like Planned Parenthood have every intention of staying open. But if previous attempts at abortion bans are any indication, the temporary bans might become effectively permanent ones for smaller clinics that struggle to stay profitable. (For example, the Supreme Court overturned Texas’s abortion ban in 2016’s Whole Woman’s Health v. Hellerstedt, yet as of November 2019, only 22 of the state’s 40 clinics had reopened.) Abortions are just a small part of the business for women’s health-care clinics, which also provide other essential services like contraceptive care, mammograms, pap smears, and STI testing. So when they’re closed, all patients lose out. “That amount of time not being able to provide care absolutely could be financially devastating and result in more clinic closures across the state,” Robin Wallace, MD, co-medical director at Southwestern Women’s Surgery Center in Dallas, told TIME in a recent interview.

There also remains the problem of how people will pay for abortions during an unprecedented economic crisis. According to Kelsey Ryland, director of federal strategies at All* Above All, an abortion-rights activism group, the largest burden will fall once again on low-income people who rely on Medicaid for their health insurance. Why? A whopping 21 percent of the 317 million people in America are covered by Medicaid or the Children’s Health Insurance Program (CHIP), and thus would be subject to the Hyde Amendment. Under Hyde, federal Medicaid funds cannot be used to pay for abortions, so a Medicaid patient would have to pay for the procedure out of pocket, which can cost between $350 to $950. That’s a major financial decision—even in a non-pandemic environment—but even more so now that more and more people are losing their jobs.

“I think [the COVID-19 pandemic] is just really amplifying how challenging it is for people to get access to the care they need, and I hope that if nothing else, it makes folks realize that now is the time to be making our voices heard,” says Ryland.

The best resources for people seeking abortion care during COVID-19

Those seeking abortion care during a time when social distancing is the norm may feel that they’re going it alone, but Andrea Miller, president of the National Institute for Reproductive Health, says that simply isn’t the case. “I can tell you from the conversations that we’re having with our partners across the country that they are active on social media, that they are making sure information is getting out there, and that they’re going to be communicating and building community through this time,” she says. “If people are looking for resources, I really encourage them to look for those organizations in their city and in their state, that are making [reproductive rights] their priority.”

Not sure where to find those? Here are a few to get you started.

For funding, transportation, or Telemedicine:

• The National Network of Abortion Funds (NNAF): With the mission to alleviate the financial and logistical burdens of getting an abortion, the NNAF curates a list of funds from different states across America. You can reach out to one if you’re in need of a procedure, or donate to the fund in your state.
• Telabortion: As part of a study taking place in 13 states, Telabortion connects those seeking abortions with a teleprovider who can prescribe a medical abortion. (Carafem provides such services in Illinois and Georgia.)
• Planned Parenthood: The abortion provider search bar, which you can find on Planned Parenthood’s homepage, is a pretty invaluable tool for those seeking care.
• The National Abortion Federation (NAF): The NAF’s “find a provider” tool is also a great resource for finding clinics and providers.

For updates on your state’s COVID-19 abortion response:

• NAF Hotline Fund: “We provide callers with unbiased, factual information about abortion in English, Spanish, and French. We receive thousands of calls a week from women, their partners, families and friends,” the NAF website says. That hasn’t changed during COVID-19.
• Planned Parenthood’s Twitter feed: Planned Parenthood keeps a pretty updated feed of news regarding abortion access and restrictions.

For information on insurance coverage:

• The Guttmacher Institute: A very thorough, state-by-state breakdown of insurance coverage of abortion can be found on this site. Here, you can find the 16 states that have policies designed to redirect Medicaid funds to provide abortions to people in need.
• *All Above All: *All Above All’s abortion coverage map provides yet another resource for learning how each state deals with insurance providing healthcare coverage for abortion procedures.

How you can advocate for the right to choose during this time

We’re living in unprecedented times, but Ryland says that how you should be supporting reproductive rights right now doesn’t differ all that much from how you should be defending them normally. “One thing that you can do to bring relief to folks is donate to your local abortion fund. You know, those dollars really go directly to people seeking abortion care,” Ryland says. Just Google your city plus “abortion funds” and give some of your well-earned dollars to someone whose insurance or bank account might not allow them to pay for the procedure on their own.

Calling your local politicians to either thank them for supporting abortion rights or ask them to do so also never hurts. “Don’t discount how important your voice is with your elected official,” says Ryland. A call or letter might seem small now, but remember: The mission here is to create a nation day by day in which reproductive rights are understood—not up for debate. “Everybody should be able to decide when and how to expand their families. There is never a time for politicians to be interfering in these decisions for us,” says Ryland. “COVID-19 is really exposing the cracks we have in our system.”

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