'I see a danger in returning to a pre-Roe world:' Abortion advocates view coronavirus-era restrictions as a dark sign of what could come
Kayla Epstein BUSINESS INSIDER May 15, 2020
During the coronavirus pandemic, states unfriendly to abortion used the pandemic to further restrict access by arguing it was a non-essential service that needed to be delayed to preserve medical equipment.
Texas succeeded in banning procedures for a month, forcing women to travel hundreds of miles for care in other states.
Arkansas now requires women to obtain a negative COVID-19 test to get a surgical abortion.
Even though most restrictions have been lifted, women, abortion providers, and advocates remain on the defensive and fear that care could again be restricted during the pandemic.
The National Abortion Federation's Katherine Ragsdale told Insider she saw "a danger of ending up in sort of a pre-Roe world where access depends on where you live and what kind of resources you have."
In non-pandemic times, obtaining an abortion already presented serious legal and logistical challenges for millions of women. For patients who live in certain states, getting care means enduring state-imposed waiting periods, submitting to unnecessary ultrasounds, or rushing to receive care before an arbitrary legal deadline. For patients who already have children, care must be arranged. Those without a car need a ride, especially if the nearest clinic is hours away. Some need flights to more accommodating states. And many, many need funds.
But women seeking abortions since the coronavirus outbreak began faced a new challenge — states' attempts to temporarily limit or ban abortion outright by deeming them "non-essential" procedures, under the pretext of preserving medical supplies for COVID-19 treatment. These restrictions collided with the travel and social distancing restrictions put in place to limit the spread of the virus, leading to an even more precarious situation for abortion care than the one already in place.
To reach one of the abortion clinics in Planned Parenthood's Rocky Mountain network, one woman had to drive 16 hours from Texas to Colorado to obtain care, Dr. Kristina Tocce, Vice President and Medical Director at Planned Parenthood of the Rocky Mountains, told Insider.
Tocce said that since February, the network, which has 24 clinics in Colorado, New Mexico, Wyoming, and Southern Nevada, has seen a tenfold increase in women seeking abortions. Some of those women traveled hundreds of miles after neighboring Texas imposed a month-long ban on the procedures, citing the need to reserve medical equipment.
Another patient, unable to find care for a disabled family member, embarked on an "incredibly long road trip" with a relative to reach care in Colorado, Tocce said. She drove for two days.
Many more have sought care in New Mexico. Other women have taken the now-extraordinary measure of boarding planes to Denver.
"The pandemic, and some of the bans to essential care that politicians are trying to enforce, just exacerbates unjust laws that have already been passed," said Odile Schalit, executive director of the Brigid Alliance, which helps women travel for abortion care.
In states unfriendly to abortion, providers have had to scramble to arrange care, and organizations that help with logistics and funding have pivoted to a war footing. But at the national level, abortion advocates worry that red states' bold actions during the pandemic are just a preview of the obstacles to come.
"I see a danger in returning to a pre-Roe world," Reverend Katherine Ragsdale, president and CEO of the National Abortion Federation, said, in reference to the 1973 Supreme Court decision Roe V. Wade that legalized abortion nationwide and is perennially under legal siege.
States already unfriendly to abortion capitalized on the coronavirus pandemic to restrict care
An exam room at the Planned Parenthood South Austin Health Center is shown on June 27, 2016. REUTERS/Ilana Panich-Linsman/File Photo
During the outbreak, states like Texas, Ohio, Alabama, Iowa attempted to impose some sort of restriction on abortion during the coronavirus outbreak by deeming them non-essential procedures. In Texas, this ban extended to medication abortions as well as surgical ones, the Los Angeles Times reported.
Many of the initial restrictions have expired or eased, and some were struck down after legal challenges, but the episode has left women and abortion rights proponents on the defensive.
Arkansas is currently the only state that actively has abortion restrictions in place due to the coronavirus. A federal appeals court held up an initial ban on surgical abortions, but restrictions elective surgeries began to ease late last month. However, on April 27, the state's health department issued a rule that required a woman to receive a negative coronavirus test result 48 hours before an elective surgery. Arguing that this created a new hurdle to access at a time when the tests remain scarce, the American Civil Liberties Union challenged the case on behalf of Arkansas' last remaining clinic but a federal judge rejected the motion on May 7, the Associated Press reported.
The states issuing or attempting these orders said that they were necessary to preserve PPE, which in some locations has been in desperately short supply as states scramble to deal with their COVID-19 outbreaks.
Around the country, Americans have had to forgo medical care. These so-called "non-essential" services could range in severity from dental visits to cancer treatments because of the need to preserve vital PPE.
Abortion, however, is "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 American College of Obstetricians and Gynecologists and American Board of Obstetrics & Gynecology said in a joint statement in response to the attempted bans. "The consequences of being unable to obtain an abortion profoundly impact a person's life, health, and well-being."
And these new orders and legal battles threw the prospects for care for millions of women into flux.
The most well-known, and arguably impactful ban, was enacted in Texas this past March. On March 22, Republican Gov. Greg Abbott issued order GA-09, which halted all "all surgeries and procedures that are not immediately medically necessary." The order didn't specifically mention abortion, but Texas Attorney General Ken Paxton clarified that these procedures were covered by the order.
The order launched a month-long battle that only ended when it expired on April 21, but not before it threw the state, and the southwest, into chaos. A total of 55,440 abortions were performed in Texas in 2017, according to the Guttmacher Institute, constituting more than 6% of all abortions performed nationwide that year. Abortion advocates went to court to halt the order, which resulted in some delays, but Texas ultimately prevailed, leading to 30-days of on-again, off-again abortion access in a state that already been limiting access for years.
A new order, effective April 22, allows procedures that don't deplete necessary personal protective equipment (PPE) required to combat COVID-19. Abortion is permitted once again, but providers — and women seeking abortions — are still on edge after last month's experience.
"There were several days where we started seeing patients, and a decision was made by a court or something happened where we had to stop," Dr. Bhavik Kumar of Planned Parenthood Gulf Coast in Houston told Insider.
Kumar and his colleagues had to tell "hundreds" of women to go home, or spend hours on the phone re-scheduling appointments with no guarantee that they could provide care on the new date, either.
"They would ask questions like, 'where would we go?' 'What do I do now? I came here to get care.' 'What are my options?' 'Can I come back tomorrow?'" Kumar said.. They only had two options: Tell women to wait, even knowing that the state had a 20-week abortion ban and the longer a pregnancy continued, the more expensive abortions became; or travel out of state, which could require long — and costly — drives, expensive hotel stays, and the risk potential exposure to the coronavirus.
"I've never had to do anything like that before in my career," Kumar said.
The experience not only placed stress on women seeking care, but the uncertainty took a "huge emotional toll" on the clinic staff, too, Kumar said.
"We are used to taking care of people. We make them feel better, we can answer their questions," he said.. "When that's robbed of us...that leaves us feeling helpless."
Some communities were impacted more severely than others, deepening social fault lines that already played a role in abortion access.
"It's definitely the people who struggle the most normally, and it just becomes all the more desperate now," Bridget Schilling of the Clinical Access Support Network (CASN), a Houston based-organization that provides funding, logistical and transportation support for women seeking abortions and often refers women to Kumar's clinic.
Even without abortion bans, the unprecedented logistical challenges posed by the COVID-19 outbreak have complicated abortion access.
The Nuestra Clinica del Valle in San Juan, Texas, September 22, 2015. REUTERS/Delcia Lopez
Planned Parenthood Gulf Coast in Houston had to implement social distancing protocols, meaning fewer patients could be in the clinic at one time.
"Our capacity is very different than it would be outside the pandemic, and on top of that we have a lot more people who need care because there are a number of folks who have been waiting," Kumar said.
CASN had to temporarily suspend its volunteer driver program, which provided transportation to and from clinics, after Houston implemented its stay-at-home order. Because of safety concerns for volunteers, Schilling said, the service simply could not continue. Women who needed an abortion had to drive to neighboring states, making their travel arrangements more complicated and costly.
The Louisiana-based New Orleans Abortion Fund (NOAF), which has a similar mission to CASN, was receiving more calls, said Elizabeth Gelvin, NOAF's client services program coordinator.
NOAF has had to go to extra lengths to coordinate care for women from Louisiana, which only has three abortion clinics and already has numerous restrictions including a 20-week abortion ban.
In addition to providing funding for everything from Greyhound bus tickets, airfare, and childcare stipends, they went into overdrive helping to book hotels, and "really figuring out the nitty gritty of where someone needs to go and how best to get them there, and how most safely to get them there."
Women from the state often sought care in Texas, Gelvin said, but while the ban was in place that was not an option. Meanwhile, Arkansas, to the north, has also restricted the procedure.
"This new lack of access isn't going to go away quickly"
Organizations at the national level have watched states' attempts to limit abortion during the coronavirus outbreak with apprehension.
Pandemic aside, conservatives and anti-choice lawmakers have already instituted a slew of laws aimed at making it more difficult to get an abortion. Seventeen states already ban abortions after 20 weeks of pregnancy, though Supreme Court precedent keeps abortion legalized in all 50 states. Many states have tried to impose six-week bans or eliminate the procedure altogether, though these efforts invariably wind up blocked in court. Meanwhile, states like Tennessee pass flagrantly unconstitutional abortion restrictions with the hope of overturning Roe v. Wade through a legal challenge that escalates to the Supreme Court, which now has a 5-4 conservative tilt.
But during the pandemic states like Texas and Arkansas had managed to do the constitutionally impossible: temporarily halt abortions in the state, by using the coronavirus crisis as justification.
While abortion is currently available in all 50 states, organizations like the National Abortion Federation are preparing for a drawn-out fight as the pandemic continues. It could take more than a year to develop a vaccine for the coronavirus if one can be made at all. And during that time, abortion access could remain in flux.
"Those of us in touch with reality are talking about the understanding that we're not gonna suddenly be back to normal in May or June, probably for at least a year," said NAF's Katherine Ragsdale. "[There's] a danger of ending up in sort of a pre-Roe world where access depends on where you live and what kind of resources you have."
"This new lack of access," Ragsdale said, "isn't going to go away quickly."
