Providing abortions during a pandemic

When I interview abortion providers, researchers, and legal experts, I often ask them what they expect to be the next big attack on abortion access. Their answers usually have to do with legislative trends. For years, either a 20-week abortion ban or a ban on D&E (a procedure used in the majority of second-trimester abortions) was positioned to be the next big abortion-related Supreme Court case. Anti-abortion lawmakers chose these measures carefully, intentionally pushing the bounds of Supreme Court precedent and handing conservative justices a path to dismantle Roe v. Wade.

Then Justice Anthony Kennedy retired, tipping the balance on the Court. In 2019, with its two new Trump appointees, the Supreme Court took on June v. Russo, a dispute over an anti-abortion law identical (literally, identical) to one it had struck down in 2016. This, advocates feared, would be the big blow to Roe v. Wade, allowing conservative states to effectively outlaw abortion. Of course, we already have “two Americas” as Whole Woman’s Health CEO Amy Hagstrom Miller once described it—some states where you can get an abortion, and some states where restrictions are so many that abortion is effectively out of reach for most. But a dismantling of Roe v. Wade would codify this into law.

The Court heard oral arguments in June v. Russo in early March, which feels like a lifetime ago. A decision was expected in June. But then there was a global pandemic, and suddenly anti-abortion governors didn’t need permission from the Supreme Court. Executive power in the face of disaster gave them an unprecedented opportunity to unilaterally shut down abortion access.

On Friday, I reported for GEN that abortions were halted in the state of Texas after the governor banned all “non-essential” medical procedures. Doctors would have leeway to determine which procedures were and weren’t essential—except for abortion providers. There were to be no abortions in the state. The Center for Reproductive Rights had just mounted a legal challenge, asking for a temporary restraining order to allow abortions to continue. In the following days, similar legal fights began in Alabama, Ohio, Iowa, and Oklahoma.

In an indication of just how quickly the news cycle is moving right now, things look quite different today, and may be different still by the time you read this. In good news, legal challenges have succeeded in Texas, Alabama, and Ohio, allowing abortions to move forward temporarily. Texas has filed for immediate appellate review, however, which means the fight there is far from over. Abortion access is also under threat in Kentucky, Louisiana, and Mississippi.

The justification for these bans, in part, is that they are meant to preserve PPE. This Twitter thread from Dr. Daniel Grossman explains why this is baseless. The tl;dr is that in-clinic abortions require hardly any PPE, and that if lawmakers were serious about preserving PPE they would be making medication abortion (which requires no PPE and can be done at home) more accessible.

In my GEN article, you’ll hear more from researcher Ushma Upadhyay and abortion provider Dr. Jamila Perritt about the importance of medication abortion, the potential for its provision via telemedicine, and the unnecessary regulations that stand in the way of accessibility. I first wrote about telemedicine abortion for WIRED back in 2018. From a regulatory perspective, unfortunately, not much has changed since then. What has changed is that abortion pills are increasingly accessible online, an avenue that people will no doubt pursue if they are unable to access abortion due to Covid-19. However, Upadhyay pointed out that these pills usually come from an Indian pharmaceutical company, and travel disruptions could cut off that supply.

On top of all this, abortion providers are under tremendous pressure to keep themselves and their patients well. There’s such a shortage of abortion providers that most have no one to fill in for them if they get sick, and they’re at higher risk for getting sick because they are medical providers.

Protesters also continue to show up at clinics in defiance of stay home orders.

Plus, providers told me that existing restrictions in some states are putting patients at risk by requiring multiple clinic visits for one procedure. These laws were designed to make abortions harder to get. Now they’re forcing people to risk their safety to access medical care that is inherently time-sensitive, and yes, essential. I hope you’ll read more about it at GEN.

Stay well.