Abortion & COVID-19

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As the COVID-19 pandemic begins to peak in the United States, “flattening the curve” has become the new watchword of our society. We are looking for any way to limit physical contact between individuals, and closing down all but the “essential” services. Doctor’s offices and other healthcare facilities are cancelling some types of visits, rescheduling others, and scrambling to learn to use telemedicine for as many as possible.

The Surgeon General recommended that ‘elective’ surgeries be cancelled and postponed at least for several weeks, and many hospitals are doing this indefinitely. This step is important in preserving hospital resources (particularly hospital beds), and in reducing foot traffic in and out of the hospital to reduce the spread of the disease. But abortion is not “elective” (more discussion below!).

Abortion is essential healthcare, and is continuing amidst the chaos with the full support of the medical community, public health officials, and (most) politicians. Still, some are willing to use this pandemic as another excuse to close abortion clinics.

From the National Abortion Federation:

Abortion care is a time-sensitive service that cannot be significantly deferred without profound consequences for women and their families. Abortion is provided for almost one in five pregnancies in the United States, as part of the continuum of pregnancy care. It is an essential health service. An individual and family decide to end a pregnancy for a complex constellation of reasons that include the impact of pregnancy and birth on their health, ability to work, and strained economic circumstances. These are conditions that do not go away—and are likely heightened—in pandemic conditions. Denying or deferring abortion care places an immediate burden on patients, their families, and the health system, and can have profound and lasting consequences. Patients presenting for time-sensitive care, including abortion care, need timely access to treatment, even during this pandemic.

National Abortion Federation’s Statement on Abortion Provision during COVID-19 Pandemic

What ‘elective’ abortion really means
Why we should stop using the term “elective abortion”
Katie Watson, JD | AMA Journal of Ethics, 2018

This article is a short, well-argued piece explaining all the different connotations of the word ‘elective’ when it comes to abortion, and why, at best, it is not accurate, and at worst, is insulting, stigmatizing, and harmful. For a brief overview, though:

First, hospital surgeries are scheduled according to a three tier system: elective, urgent, or emergent. ‘Emergent’ means that it’s a true emergency, and the patient needs surgery within the next hour (think about a gunshot wound). ‘Urgent’ usually means that the surgery must be performed in the next 24 hours or else the patient is at risk of suffering serious harm (think appendicitis or a broken bone). A surgery is scheduled as ‘elective‘ if it is to be scheduled at the convenience of the patient and surgeon. Abortion is in a special category called “time-sensitive”–it need not be performed today or tomorrow, but even modest delays can cause risk of harm. Another example of time-sensitive surgery is oncologic procedures: if the surgery to remove your tumor or your chemotherapy were delayed even a few weeks or a month, that might seriously jeopardize your health. Abortion is time-sensitive, too: with each increasing week of gestation, the risk of mortality rises 38%. (That absolute risk is very low, but that doesn’t mean we can ignore the increased risk from delaying. This is not even to mention the risk that delay might make the abortion inaccessible entirely, which causes other harms–see the link in the next paragraph!)

Second, abortions are often categorized as ‘elective’ to distinguish them from more necessary procedures that are ‘therapeutic’ or ‘medically indicated.’ The consequences for a woman who is denied an abortion are real, and have been studied. But let Katie Watson tell you why ethically they are just as necessary as other kinds of care.

Ohio and Texas are using COVID as a reason to shut down abortion clinics

Ohio clinics ordered to halt abortions deemed ‘nonessential’ amid coronavirus response
3/21/2020 | washingtonpost.com

Texas and Ohio Include Abortion as Medical Procedures That Must Be Delayed
3/23/2020 | NYTimes.com

Abortion providers sue Texas governor over ban on procedure during coronavirus crisis
3/25/2020 | thehill.com

Ohio’s Attorney General, David Yost, says that they received complaints about several abortion clinics (from Ohio Right to Life; see the NYTimes article above) because they are providing abortion care that is ‘nonessential.’ It is unclear at this point whether they will comply with the order, which takes effect Wednesday 3/25/2020. And Texas has, by executive order of their Attorney General Ken Paxton, banned abortion except if the woman’s life is in danger. While most Texas clinics have stopped providing abortions since this order went into effect, abortion providers in Texas filed a lawsuit on Wednesday, March 25, against Gov. Greg Abbott challenging this abortion ban.

(Side note: it is impossible for a doctor to determine at what point exactly the Attorney General–in his learned medical opinion–considers a woman’s life to be in danger. How close to death does she need to be? Days? Hours? Minutes?)

If you are interested in more articles on Texas and Ohio’s bans during COVID-19 check these out:

For a comprehensive list of state abortion restrictions during COVID-19:
State Officials Try to End Legal Abortion During COVID-19 Crisis
3/23/20 | Rewire News

The medical community is not mincing words: Abortion is essential healthcare and should continue
Joint Statement on Elective Surgeries
3/16/2020

This is a joint statement from all the major ObGyn professional societies, saying essentially that abortion access is necessary, essential, and should not be considered elective surgery. The list of groups that have signed on include:
American Congress of Obstetricians and Gynecologists (ACOG)
American Association of Gynecologic Laparoscopists (AAGL)
American Society for Reproductive Medicine (ASRM)
American Urogynecologic Society (AUS)
Society of Family Planning (SFP)
Society of Gynecologic Surgeons (SGS)
Society for Maternal-Fetal Medicine (SMFM)
Society of Gynecologic Oncology (SGO)

What providers have to say:
Abortion clinics are staying open during the coronavirus outbreak. Here’s why.
3/20/2020 | Buzzfeed News

This article interviews providers, and considers the issue a bit more comprehensively.

‘I Feel Very Powerless’: How Abortion Providers Are Dealing With COVID-19
3/23/2020 | Rewire News

This article focuses on some of the unique challenges that abortion providers are facing during the COVID-19 pandemic.

All together now: abortion is ESSENTIAL!

During the COVID-19 Crisis, Abortion Access Must be Considered “Essential”
3/25/2020 | msmagazine.com

Abortion Care Is Essential Health Care
3/23/2020 | Slate

Make Abortion More Available During the Pandemic — Not Less
3/26/2020 | New York Times

UPDATE (April):
Wondering what’s been going on for the last month? Here are some updates on how COVID-19 has been continuing to impact abortion care:

What has it been like for patients to access abortion care?

The Brutal Reality of Getting an Abortion During a Pandemic
4/3/2020 | Glamour

In this article, one woman shares the challenges she faced in accessing abortion care during the COVID-19 pandemic.

When the Abortion Clinic Is Open, But You Have No Way to Get There
4/6/2020 | Rewire

During the COVID-19 pandemic, travel has been discouraged due to the risk of disease transmission. However, as abortion restrictions increase, so does the distance needed to be travelled for people to access abortion care. This articles discusses some of these challenges.

The Struggle for Abortion Access During the Coronavirus Pandemic
4/21/2020 | Marie Claire

In Texas, COVID-19 has been used as a reason to further restrict access to abortion care. This piece highlights the challenges these bans create by telling the story of one Texan seeking abortion care.

As always, we need to keep in mind that abortion bans as well as healthcare disparities disproportionately impact marginalized communities and this pandemic is no exception:

Your Job Is Deemed Essential, But Your Abortion Is Not: Black Low-Wage Women In Texas Are Being Robbed Of Their Humanity
4/20/2020 | Essence

Wondering how protestors outside clinics have responded to social distancing guidelines?
Anti-Abortion Protesters not Exempt from Duty to Practice Social Distancing
4/10/2020 | Medium

What do providers have to say about it?

What It’s Like to Provide Abortion Care During a Global Pandemic
4/7/2020 | Vogue

Correcting the Record on Abortion During COVID-19: A Q&A With Dr. Erin King
4/21/2020 | Rewire

Which states have enacted bans and what’s the status of those bans?

And in case anyone was still confused as to why abortion care is essential, the New England Journal of Medicine chimed in by publishing this excellent piece:
Abortion during the Covid-19 Pandemic — Ensuring Access to an Essential Health Service (NEJM)

UPDATE (June):
As the pandemic has continued to spread globally, what is the current state of abortion care in the U.S.?

How has COVID-19 impacted patient experiences? Here are a few more first hand accounts of accessing abortion care during the last 3 months

(Disclaimer: These stories do not represent the challenges of all of those who have tried to access care during this time. It is of value and importance to recognize that marginalized communities, including people of color and queer folks face additional challenges and barriers to accessing care that might not be represented in these stories.)

I had an abortion during the pandemic. Reproductive health care is crucial. 
5/4/2020 | The Philadelphia Inquirer

I Had An Abortion In California During The COVID-19 Pandemic
4/24/2020 | Newsweek

At the start of the pandemic we saw many states enact restrictions on abortion care and access. What’s the status of those restrictions now?

Abortion Access During COVID-19, State by State
4/14/2020 (updated regularly) | Rewire News

The fight over Texas’ abortion ban during the COVID-19 pandemic is over, but what did it all mean?
4/28/2020 | The Dallas Morning News

Timeline: Our Fight Against Opportunistic Abortion Bans During the COVID-19 Pandemic
Planned Parenthood Action Fund

What has the anti-choice strategy been during the COVID-19 pandemic?

How the Anti-Abortion Movement Repackaged Its Strategy for a Pandemic
4/27/2020 | Rewire News


Abortion Clinic Protests Are Still Happening in the Pandemic: ‘They Accost Patients Face to Face’
5/26/2020 | Vice

What does public opinion have to say about abortion restrictions during COVID-19?

Americans Don’t Want Politicians Using COVID-19 to Attack Abortion
5/21/2020 | Ms. Magazine

What changes in abortion care might (or should) come out of the COVID-19 pandemic?

FDA Should Lift Abortion Pill Restrictions, Says Former Agency Head
4/27/2020 | Vice

How have Trump’s anti-abortion policies impacted the pandemic?

Trump’s Anti-Abortion Policies Are Hurting Coronavirus Vaccine Research
5/12/2020 | Vice

UPDATE (August):

While the COVID-19 pandemic is unfortunately far from over in the United States, many of the COVID-19 motivated abortion restrictions have been defeated, overturned, or rendered obsolete by states reopening. While the use of COVID-19 as an excuse to restrict access to reproductive care was a clear violation of people’s right to access care and autonomy to make healthcare decisions, it did teach us a few things about what a post-Roe world might look like. Below are some pieces that reflect on the lessons we have learned in the last 6 months during the era of abortion during COVID-19. 

Protestors did not stop harassing patients going to clinics and at times showed up in greater numbers. Wondering how a lack of social distancing fits in a “pro-life” ideology? Us too…

The Fight to Protect Abortion Access Amid the Pandemic
June 15, 2020 | The Intercept

This article describes the series of events that has occurred in the realm of abortion restrictions since the COVID-19 pandemic hit the United States in March. It discusses how new restrictions in addition to increasing numbers of protestors at clinics who are not using appropriate precautions, such as masks, has galvanized people across the nation to speak out against further restricting abortion access. 


Abortion Clinic Protests Are Still Happening in the Pandemic: ‘They Accost Patients Face to Face’
May 26, 2020 | Vice

This piece discusses the challenges faced by an abortion clinic in Michigan due to increased protestor presence during the pandemic. These increased numbers have created patient safety issues not only in regards to increased risk of disease transmission, but also due to the aggressive actions of protestors and changing police practices during “shelter in place” orders.

How the state became the perpetrator of reproductive coercion:
Advocates Fear Another Devastating Impact of COVID-19: More Forced Pregnancies and Reproductive Control
June 10, 2020 | Rewire

This article asserts that abortion restrictions, which have become more stringent during the COVID-19 pandemic, are a form of reproductive coercion by the state. Additionally, this piece examines the added barriers to accessing abortion care for Black, Brown, and Indigenous people as well as those in abusive relationships.

Abortion during COVID-19 is showing us what a post-Roe world looks like and confirmed that, unfortunately, many people are already living that world

The Coronavirus Pandemic  Gave Us a Look at a Post- Rose v. Wade World
June 12, 2020 | Teen Vogue

In this Op Ed, Jennifer Dalven, director of the ACLU Reproductive Freedom Project, discusses how COVID has shown us what a post-Roe world might look like. While many of the restrictions we saw in the early days of the pandemic are no longer in place, she urges people to act now before we see more intensive abortion restrictions resurface.

So… what are some takeaways from this new era of abortion restrictions? 

The Covid Crisis Reveals the Need to Abolish Abortion Restrictions | July 15, 2020 | The Nation

The state of abortion care during this pandemic has highlighted the importance of keeping abortion care accessible and ensuring that people are not criminalized for accessing basic reproductive care. In order to maintain adequate access to abortion care, abortion restrictions must be abolished.