Who would have thought COVID-19 would give anti-abortion forces the quick victory they could not win in the courts, in the legislative process, or through the deployment of screaming protesters outside clinics? Claiming abortion is a nonessential service that can be postponed so that the clinics’ medical resources can be used to fight the coronavirus, officials in Texas, Ohio, and Louisiana have moved to severely restrict or cut off abortion services completely; the governor of Mississippi announced his intention this week to do the same. Opponents of women’s reproductive rights hope to achieve, with the stroke of a pen, their dream of making states abortion-free.
For patients at these clinics, the situation is terrifying. “We have patients crying on the phone and staff crying with them,” Kathaleen Pittman, the director of Hope Medical Center in Shreveport, Louisiana, told me. “This is hard. So hard.” The clinic is open but has postponed all of its appointments. “We’re looking at all our options,” Pittman said.
You have to hand it to the anti-abortion movement for taking full advantage of the social and medical crisis into which the coronavirus has plunged the nation. Chaos, as the scheming Littlefinger says in Game of Thrones, is a ladder.
If you ever thought opposition to abortion had anything to do with concern for women’s health, disabuse yourself of that notion right now. The World Health Organization calls abortion “essential” to women’s rights and health. Closer to home, the American College of Obstetricians and Gynecologists and the American Board of Obstetrics and Gynecology, along with six other mainstream medical associations, issued a joint statement opposing the postponement or cancellation of abortion provision. It declared:
Abortion is an essential component of comprehensive health care. It is also a time-sensitive service for which a delay of several weeks, or in some cases days, may increase the risks or potentially make it completely inaccessible. The consequences of being unable to obtain an abortion profoundly impact a person’s life, health, and well-being.
They’re right. Abortion is crucial to women’s ability to have decent lives: to have children when they are ready and able to take care of them, to get an education, to avoid bad marriages and escape abusive partners, to work and support themselves, and to fulfill the many demands society makes on women, such as caring for the children they already have. (Fifty-nine percent of women who have abortions, according to the Guttmacher Institute, are already mothers.) Moreover, abortions can’t be postponed indefinitely. The longer a patient has to wait, the more likely she is to need a more complex—and more expensive—procedure. And the more likely she is to come up against the legal time limit, which, thanks to abortion opponents, is already more restrictive in many states than is stipulated in Roe v. Wade (roughly the 26th week of pregnancy).
One shouldn’t assume clinics that are shut down now will reopen when COVID-19 subsides. A clinic is not a hamburger stand. It’s a heavily regulated medical site, with highly trained staffers. Many independent clinics are already under financial pressure, thanks partly to intentionally burdensome regulations and low insurance and Medicaid reimbursement rates. “For independent clinics, reopening is a nightmare,” Pittman told me. “If they can’t afford to pay their staff while they’re closed, those people have to go elsewhere.”
Of the more than 40 abortion clinics open in Texas in 2013 before the state legislature passed tough new restrictions, at least 18 never came back after the U.S. Supreme Court struck down those regulations in 2016. As that statistic suggests, attacks on abortion rights and access coming from every side means that even when the anti-abortion activists lose, they often kinda sorta win.
In much of the country, abortion has been barely accessible for many years; travel services such as Fund Texas Choice and the New York City–based Brigid Alliance help bring patients to distant clinics. Even in normal times, it’s an expensive process involving transportation, hotel stays, child care, and, often, lost paychecks. Now imagine doing all of that when airlines and buses are on restricted schedules and many hotels and restaurants are closed or insufficiently sanitized. Do you go halfway across the country in nitrile gloves and a face mask, subsisting on bologna sandwiches that you made at home? And what about the small networks of local volunteers who offer practical help—making arrangements, driving patients, hosting them in their homes, and so on? Social distancing gets in the way of such kindnesses. “We need to ensure the safety of the volunteers we’ve been relying on,” Odile Schalit, the executive director of the Brigid Alliance, told me. “We can’t ask them to risk their safety or their families’ safety.’
There are ways to ease the predicament of pregnant women seeking abortion in places where there are no clinics nearby. Notwithstanding the deliberate campaign to focus attention on late-term abortions, most terminations take place early in pregnancy. For those women, abortion pills—the combination of misoprostol and mifepristone—are a safe and preferred method. As the author and activist Robin Marty recently noted in Time, doctors could prescribe the pills and monitor patient safety via telemedicine. A 2019 study showed that telemedicine was as safe and effective as a regular medication abortion.
Unfortunately, the states that are shutting down clinics now are no friendlier to ending pregnancies via telemedicine than in clinics. The process is banned in Texas and Louisiana, and earlier this month the Ohio state Senate voted to ban it there. By the Guttmacher Institute’s count, telemedical abortion has been banned in 17 states, including some, such as West Virginia and the Dakotas, that have only a single clinic.
What will happen to women who can’t travel? Some will have babies, and some of those babies will have fatal fetal anomalies, the sort of tragic conditions that even some people opposed to abortion would make an exception for. Some women will have severe health problems. Abortion has become so politicized that Americans can forget that it’s sometime necessary to preserve women’s physical health and lives. A few women may even die—pregnancy and childbirth have risks, and those risks have been increasing in recent years. Some, however, will turn to the internet or informal networks to obtain abortion pills on their own, either the two-pill regime or just misoprostol, which is a common ulcer drug available over the counter in Mexico. Plenty of evidence indicates that women are already doing this, and have been for some time, in Poland and other countries where abortion is illegal.
It’s now a truism to say that the coronavirus will change our society in many ways long after the crisis has passed. As far as abortion is concerned, the pessimist in me says that abortion-free states will be the new normal, as travel becomes an expensive, time-consuming option ever farther out of reach for ordinary women. The optimist in me notes that terrible times often lead to innovation. Maybe the new normal will be telemedical abortion and self-managed abortion. If anti-abortion governors and legislators can make a ladder of chaos, maybe abortion-rights supporters can do the same.