In recent weeks, some states have issued directives to halt abortion care in response to the spread of COVID-19. Using the argument that abortion care is “non-essential”, anti-abortion governors in Texas, Ohio, Alabama, Louisiana, Oklahoma, and Iowa have used the COVID-19 pandemic to political ends, restricting access to abortion for pregnant people in need of this care. And additional bans and restrictions may be on their way: in other states, anti-abortion groups have started to organize and encourage similar measures. Less known is that the recent federal bill in response to the pandemic, the CARES Act, includes anti-abortion provisions as well.
Make no mistake—conservative attacks on abortion are nothing new. The COVID-19 pandemic has simply presented an additional opportunity to undermine reproductive rights and keep pregnant people from accessing abortion care. In this commentary, we provide an overview of anti-abortion actions in six states, and within the recently passed CARES Act. We also present information on how abortion is essential, time-sensitive care, and root this context in the reproductive justice (RJ) framework.
Antiabortion Directives in the States and the CARES Act
On March 22, Governor Greg Abbott issued an executive order directing health care providers to cancel nonessential surgical procedures in response to the spread of COVID-19. The order called on health care providers to postpone all procedures that were not medically necessary, which was then interpreted by Texas’s attorney general to include abortion care. A number of reproductive health providers, including Planned Parenthood Center for Choice in Houston, Planned Parenthood Greater Texas, Whole Women’s Health, and others, joined together to file a complaint against Governor Abbott and other Texas state officials. A federal district court judge initially granted the providers a temporary restraining order, allowing abortion care to continue. The Fifth Circuit Court of Appeals then put that decision on hold. For now, this Texas abortion ban is in effect.
The Ohio Department of Health issued its directive on nonessential health procedures on March 17. The order defined nonessential surgery as that which could be delayed without undue risk to the health of a patient. Abortion was included as such a surgical procedure under the directive. However, a federal judge in the state struck down the directive on March 30, stating in his opinion that the order “likely places an ‘undue burden’ on a woman’s right to choose…” He went on to state that the enforcement of the directive would “inflict irreparable harm.” The Ohio Senate also passed a telemedicine abortion ban on March 4.
The state issued an order on March 27 that would effectively impose limits on abortion care during the COVOD-19 response effort in the state of Alabama. The plaintiffs of the complaint to the order argued that the state attorney general’s broadly worded interpretation includes procedural abortions, as well as medication abortion. Medication abortion is a safe method of care where a pregnant person takes two different medicines in order to end a pregnancy. It is also the method most widely used by the majority of pregnant people in Alabama. As in Ohio, Alabama’s abortion directive was also struck down by a federal judge earlier this week.
Abortion clinics in Louisiana were also initially shut down based on orders from the state’s health department in response to the spread of COVID-19. Using language similar to orders in other states, all health care providers were directed to delay all medical and surgical procedures except for emergency conditions. As of March 30, two of Louisiana’s three remaining abortion clinics had resumed health care services.
Oklahoma Governor Kevin Stitt’s executive order on medical prioritization during the pandemic was specific in prohibiting abortion care through April 7. The order, which suspends all “elective surgeries and minor medical procedures,” states that the purpose for suspending these health services is to preserve medical supplies and personal protective equipment (PPE). An exception was included in the ban to allow abortion care to protect the health of the pregnant person.
Iowa has also been sued by leading women’s health and legal organizations over its ban on abortion in the COVID-19 response. Governor Kim Reynolds issued the ban by way of an emergency proclamation on March 26. Like the orders mentioned above, the proclamation bans “nonessential surgeries,” which it takes to include surgical abortion procedures.
The CARES Act
Anti-abortion federal policymakers have also used the national respnse to COVID-19 for political ends. The bipartisan Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, includes an unecessary extension of the dangerous Hyde Amendment abortion restriction. The bill also includes language that would effectively cut Planned Parenthood affiliates, as well as other organizations providing abortion care, out of funding opportunities through small business loans, denying important support for frontline health care providers serving some of the most vulnerable communities during the COVID-19 pandemic.
All of these bans ignore the fact that abortion care is in fact medically necessary, time-sensitive, and essential. In what follows, we will explain why and how.
Abortion Is Essential
The expansive and widespread nature of the COVID-19 pandemic has impacted care throughout the health care system. Delivery of abortion care has been no exception. In 2017, approximately 862,000 abortions were performed, and it is estimated that 70,000 people seek abortion care in the United States each month. Abortion is one of the safest and most commonly performed procedures in the United States. Thus, the pandemic, by squeezing the system’s resources and personnel, has already negatively impacted access to this medical service for tens of thousands of people.
The attempts we have been seeing to restrict access to abortion services during the COVID-19 pandemic seek to amplify that negative impact for purely political ends.
The attempts we have been seeing to restrict access to abortion services during the COVID-19 pandemic seek to amplify that negative impact for purely political ends. They are attempting to capitalize on the state of emergency by using the need to respond to the pandemic as an excuse for banning abortion care. This excuse pivots on an erroneous interpretation of the guidance issued by the Centers for Disease Control (CDC) on how to prioritize health care during the pandemic, which orders the limiting of “nonessential health care services.” Seeing an opportunity, abortion opponents have chosen to define abortion services as nonessential and/or elective, and thereby find cover under the CDC’s guidance for a goal that essentially has nothing to do with medicine.
These efforts are in direct contradiction to statements and guidance by the American College of Obstetricians and Gynecologists (ACOG). To dispel these misconceptions and manipulations, ACOG, along with seven other medical societies, issued a statement clearly identifying abortion an essential health care service that requires timely access to care. The statement notes that an inability to obtain an abortion can have longstanding and profound impacts on a person’s life, health, and well-being.
It is true that, in some cases, determining and defining which services qualify as essential may vary to some degree across communities and populations; but no expert has deemed abortion care to be conditional in this way. “Essential” means that a service is vital to the health and welfare of the population, and therefore it is imperative that the service is maintained at all costs, even during a disaster. “Essential” services are necessary and time-dependent, and their absence risks impacting the ongoing health or life of the individual. Abortion care meets all of these criteria without exception.
Timely Access Is Critical
The ability to access abortion care in a timely manner is critical to the health and safety of individuals seeking care. Delays in access to the service increases the risk that an individual may experience a medical complication and, in all cases, negatively impacts their social, emotional, and psychological well-being overall.
Furthermore, delays in timely access to abortion care are especially dangerous, because they decrease the likelihood that an individual seeking an abortion will be able to obtain that care at all. This is the case for a number of reasons.
Abortions later in pregnancy typically cost more than procedures performed at earlier gestational ages. On average, in 2011, the cost of surgical abortion was approximately $495 in the first trimester, as compared with $1,350 at twenty weeks of pregnancy. Therefore delays in obtaining care are likely to create dire obstacles in obtaining any care at all for those with limited financial resources.
Many providers of abortion care are only trained to provide abortions during the first trimester, and many clinics only offer this care within the first trimester as well. As a result, the number of clinics that can provide abortions begins to decline as the gestational age increases.
Additional Logistical Barriers
People attempting to access abortion care are making decisions about the need for the service based on their current life circumstances. Many have at least one child or are already parenting, are traveling from long distances to access abortion services, and/or are navigating any number of systemic barriers to accessing care, such as lost wages from time off work and the need for accomodations, that may result in significant delays.
Furthermore, although surgical abortion is one of the safest medical procedures performed, delays in access to abortion care increases the likelihood of complications. Overall, the earlier an abortion is performed, the safer it is. Estimated complication rates for a medication abortion is approximately 1.3 percent for a first trimester surgical abortion and 1.5 percent for abortions in the second trimester or later.
Evidence shows that when pregnant people don’t have access to abortion care and, instead, are forced to carry a pregnancy to term, their long-term physical, emotional, and mental health suffers. In addition, their families and communities are impacted as well. Women denied an abortion have an increased likelihood of being unemployed and having a household income almost four times the federal poverty level. They report an increased likelihood that they don’t have enough money to pay for necessities like food, housing and transportation, and are more likely to remain in contact with a violent partner, putting themselves and their children at increased risk for harm.
A Matter of Reproductive Justice
Abortion access has become increasingly restricted in recent years, primarily through state level efforts to eliminate care. Measures have included restrictions such as gestational age bans, waiting periods, and requirements that abortion providers have admitting privileges at local hospitals. Restrictions on abortion care like these and those recently imposed under the guise of mitigating the COIVD-19 pandemic impact anyone seeking abortion services; but these burdens disproportionately fall on historically marginalized communities. Communities of color, individuals living in or near poverty levels, young people, and others who experience disparate access to care in general are more likely to need access to abortion. Therefore, restrictions that make it more difficult to access this care worsen existing inequities.
Approaching the need to access abortion care during the COVID-19 pandemic through a Reproductive Justice (RJ) lens acknowledges the importance of including the context in which abortion decision making occurs, emphasizes the need to account for intersecting oppressions that individuals seeking care encounter, and prioritizes the disproportionate impact of restricted access to abortion on specific communities. The RJ movement, created by twelve Black women in 1994, uses a broader framework to describe ways that social, political and economic inequalities impact reproductive rights, one that does not solely focus on the “right to choose.” The creators of this framework, instead, combined the reproductive rights, social justice, and human rights frameworks with a focus on grassroots mobilization and public policy change as a means to advocate for care.
Justice Can’t Wait
While there is no question that the current COVID-19 pandemic has impacted the ability of pregnant people to access abortion care, the reality is that access to abortion has been disparate and unequitable in the United States for a very long time. COVID-19 is simply an exacerbation of already poor conditions. These conditions are worsened by the rising trend of stratifying abortion care into “essential” and “nonessential” services, the initiation of additional barriers that create delay in timely access to care, and the interference of politicians with anti-abortion agendas in medical care. The politicization of access to safe and legal abortion care has created a false hierarchy of need and importance, one that, moreover, runs along existing fault lines of racial, ethnic, and income inequity, mimicking what access to abortion care looked like pre-Roe v. Wade. Before that court case, it wasn’t simply that safe abortion services didn’t exist, or even that all abortions were illegal: instead, those with resources, social capital, and wealth were able to obtain abortions, and those without, did not.
The politicization of access to safe and legal abortion care has created a false hierarchy of need and importance, one that, moreover, runs along existing fault lines of racial, ethnic, and income inequity, mimicking what access to abortion care looked like pre-Roe v. Wade.
Advocating meaningful access to reproductive health care, supporting agency and autonomy, and centering equity requires strategies that impact both the individual and institutional levels. This includes proactive efforts to expand access to abortion services while aggressively pushing back on efforts to restrict health care. We mustn’t be fooled: it isn’t COVID-19 now, abortions later. Immediate access to services for both are equally crucial.