In just two weeks the novel coronavirus managed exactly what anti-abortion activists struggled for nearly five decades to accomplish: it is the biggest threat to legal abortion in America ever imagined. The entire globe is facing completely uncharted territory in public health, and many are working to address the pandemic by implementing telemedicine and other online tools to care for everyday health needs while COVID-19 patients inundate hospitals. This could help people in need of abortions, too — if legalized, doctors could remotely prescribe medication to be taken at home that would terminate pregnancies up to 10 weeks. Yet despite having a safe and effective means of ending an early pregnancy without any need to physically see a medical professional, abortion opponents are instead using this moment to close as many abortion clinics as possible throughout the U.S. — an action that will lead to another health system crisis even if COVID-19 is contained.
Last week, the state of Ohio ordered all abortion clinics to shutter, declaring them non-essential medical providers and claiming that by continuing to operate they are using medical resources and personal protection equipment (PPE) that needs to be prioritized for hospitals dealing with COVID-19 patients. Texas has now followed suit. They will not be the last states to make this argument, either, as abortion opponents across the nation demand that clinics that provide abortion services close during this pandemic.
But medically ending an unwanted pregnancy is an essential health service — one that the American College of Obstetricians and Gynecologists (ACOG), the American Society for Reproductive Medicine and a number of mainstream medical groups declared must be kept accessible even during this COVID-19 outbreak. According to data from the Center for Disease Control, pregnant people in the United States are now 50% more likely to die in childbirth or soon after than they were just 30 years ago, with those deaths more often occurring in states with the most restrictions on abortion access. Abortion, especially early abortion like that performed remotely by medication, remains far safer than childbirth and often saves the life of a person experiencing a medical emergency during a pregnancy. And those who are unable to access abortion when they want one don’t just put themselves at greater health risks, but suffer emotional and economic consequences as well.
From the moment Justice Brett Kavanaugh was sworn in as the newest Supreme Court justice and solidified a conservative majority on the bench, reproductive rights activists have been waiting for the seemingly inevitable moment that Roe v. Wade would be overturned. The reproductive rights movement spent years preparing for the likelihood that at some point many states would no longer allow legal abortion. We knew that someday helping pregnant people get an abortion could mean they would need a plane ticket and a hotel room to stay in overnight. What we couldn’t fathom was a future where there are no airplanes or hotel rooms to be had – and where leaving home at all was forbidden.
In the end, it didn’t take the Supreme Court to end Roe. All it took was one public health crisis to show exactly what we already knew: as long as abortion as a legal right is centered on the clinic or medical person providing it – not the person seeking to end the pregnancy – it is a “right” that could easily be ripped away just by ending the ability to provide that care. In red states, that could be through closures like Ohio’s. But every state is just as vulnerable, regardless of whether a state board of health has an anti-abortion agenda or not. An exposed staff member or an inability to obtain enough hand sanitizer or other medical equipment could shutter a provider indefinitely. Pending airline furloughs and schedule decreases are making it far more difficult for the approximately 100 doctors who travel the country to provide abortions in more restricted states to find flights into rural areas to keep those clinics open.
We have walked straight into a post-Roe America and its far worse than we ever expected. And it happened at a time of economic collapse and mandated social isolation, two added factors that make it increasingly likely that we will see an upswing in unintended pregnancies very soon. (Unintended pregnancies historically increase during recessions due to lack of availability of affordable contraception.) Without legal, accessible abortion services there are only two outcomes possible: illegal methods that could put a pregnant person into legal or physical risk, or a continued pregnancy and childbirth during a period where our medical systems are already overwhelmed, where people are being encouraged to avoid hospitals and even regular doctor’s care unless it is an emergency.
Anti-abortion activists’ efforts to close clinics during the outbreak won’t just exacerbate the COVID-19 impact, but could bring about a second health crisis, too. Without accessible abortion for those who are pregnant and do not want to be, there will be a rise in pregnancy complications and poor maternal and fetal health outcomes in the following months and years as patients avoid prenatal and postnatal care. There will be an uptick in incomplete abortions and other miscarriage complications as people turn to less effective ways to try to terminate a pregnancy, despite the fact that a safe, easy, and non-invasive form of medication abortion exists and could be easily distributed if not for the far-right social conservatives embedded in every level of the Trump Administration.
England made an early move to approve telemed abortion at home in order to decrease possibility of viral spread and save lives, but appeared to rescind the allowance within 24 hours. The U.S. would do well to take the lead in this moment. Medication abortion’s effectiveness has been clinically proven, and there is no reason not to distribute it nationwide to those in need immediately — with no in-person clinic visit required. The FDA could quickly end the Risk Evaluation and Mitigation Strategy (REMS) policy that blocks pharmacies from stocking mifepristone (the key component of a medication abortion) in their stores. Or clinics can begin mailing mifepristone and misoprostol (the two medications needed to complete a medication abortion) directly to patients who show a pregnancy test or in some other way verify their need.
We didn’t act fast enough to stop COVID-19 from spreading, and we could see tens of thousands die because of that inaction. But we can stop this second health crisis from occurring just as long as we act now. Every person deserves the right to decide when and if they want to give birth. We cannot allow a pandemic strip that right away.