Bioethics Forum Essay
Using the Pandemic as an Excuse to Limit Abortion
Several states, including Ohio, Alabama, Arkansas, Texas, Iowa, and Oklahoma, declared abortion a nonessential service at some point during the pandemic, meaning that it was effectively banned until the crisis passed. Supporters of the policies maintain that abortion is an elective procedure whose medical resources are better off used in the fight against the pandemic. But abortion opponents have been taking advantage of the current circumstances to limit abortion access.
Most abortions don’t require protective gear and other resources that are needed to treat Covid. The abortion restrictions do pose risks. They force women to travel out of state for abortions, compromising social distancing measures and contributing to the spread of the virus–and exhausting other states’ health care workers. Some women may have resorted to dangerous at-home abortions. A doctor who provides abortion services at a Planned Parenthood in Houston told NPR that some patients were inquiring about home abortion remedies after abortions were banned during the pandemic.
Compounding the issue is that women are more likely to seek abortions during the pandemic: lack of access to birth control and an uptick in rape and sexual assault are collateral damage of lockdown measures. “When stresses like this occur, crime tends to rise and sexual and domestic violence survivors are often abused,” explains Lauren Carroll, executive director of the Sexual Assault Resource Center. According to a report of two dozen states, there was a 10%-30% increase in domestic violence cases in March and April, when coronavirus cases were surging. Historical data also suggests an increase in sexual assault during the Ebola health crisis. During 2016 Ebola quarantines in Africa, the United Nations reported an 65% increase in teenage pregnancy.
While only Arkansas continues to limit abortion services because of Covid, temporary abortion restrictions could have permanent effects by financially crippling abortion clinics, making it hard for them to reopen. In Texas, the number of abortion clinics dwindled after the state imposed a restrictive 2013 law, and even after the law was overturned by the Supreme Court only 22 out of more than 40 abortion clinics remained. The clinics’ bottom lines were hit too hard to recover. “Just because you have a legal win doesn’t mean you can restore the infrastructure and rebuild immediately–or maybe ever,” said Amy Miller, CEO of Whole Women’s Health.
All-too-familiar inequities in abortion access are increased during the coronavirus crisis. A growing number of women seeking abortion in the U.S. are poor, without insurance coverage for abortion, and unable to afford travel to abortion clinics. Women of color, who are disproportionately lower income, face racial bias and are at highest risk for maternal mortality and complications at birth.
The battle over abortion access in the U.S. is longstanding, and it is unlikely to end anytime soon. But in the meantime, two policy changes could help improve access to this legal health service.
Lift the mifepristone restriction. Thirty-nine percent of abortions in the U.S. are medication abortions, and yet access to mifepristone, one of the of the drugs needed, is restricted by a federal requirement for it to be dispensed by designated suppliers, preventing women from getting the drug by mail or from nearby pharmacies. This restriction should be lifted.
Permit telemedicine for medication abortions. Telemedicine could improve access to medication abortion for women in regions where abortion is not available. During the pandemic, the Trump administration has allowed Medicare to temporarily finance telehealth visits. However, telemedicine for medication abortion is legal in only 23 states. Five states explicitly ban it; 13 states have, in effect, banned it by requiring an in-person visit with a prescribing clinician; and 14 other states have effectively ban it by requiring an ultrasound before an abortion. But there is strong evidence on the side of “tele-abortions”: video-conferences for prescription of medicinal abortion pills is safe and effective, according to the Guttmacher Institute, which found that patients and providers report positive experiences.
Sarah Li is a senior at Memorial High School in Houston who plans a career in public health. She has worked for the Houston Health Department in areas concerning the health of women and children.