Margaret Okobi, BS1
1 Harvard Medical School, Boston, MA 02115, USA
With the current pandemic, providing healthcare leads to an inevitable tradeoff between serving patients and potentially exposing them to coronavirus infection. Seemingly in response to this concern, there has been immense, state-level pressure within the US, to limit abortion services indefinitely. As of April 30th, 2020, at least 11 states have issued orders limiting or banning abortions [5]. Interestingly, 100% of these states have Republican-controlled state legislatures, and several of them had been pushing increasingly restrictive abortion legislation prior to this pandemic [6,8]. The political undertones of these efforts are clear.
Outside of the political sphere, many organizations have released guidance as to which healthcare services and workers are considered essential during these times [1-4]. The American College of Obstetrics and Gynecology (ACOG) and the World Health Organization (WHO) recognize reproductive services as essential during this pandemic, with the latter explicitly recommending continued “access to contraception and safe abortion” [3,7].
Amid this polarizing debate, we cannot forget the people affected by these new policies. What happens to the women who cannot access safe abortions near their homes? Some will travel hundreds of miles to different abortion clinics. Prior to COVID-19, this was already a common occurrence. In 2018, Dr. Diane Horvath told the story of a 16-year old girl, who drove all night, from Michigan to Maryland, to receive a safe abortion [11]. If they cannot reach an abortion provider, some women will attempt dangerous abortions on their own, harkening back to the “coat hanger abortion” era before Roe v. Wade (1973) [12, 14]. Lastly, women who are unable to access some form of abortion may carry unwanted pregnancies to term and face long-term consequences, starting even before delivery. Unwanted pregnancies are associated with increased interpersonal violence and maternal mental health conditions. Women become less likely to finish college or enter the workforce. Their children are more likely to have social, cognitive, and emotional deficits [13,14]. By limiting access to safe abortions, we are forcing women into unsafe practices and unwanted pregnancies, which have life-changing, multi-generational consequences.
With all that is at stake, abortion providers and other healthcare professionals can take this opportunity to be advocates, individually and organizationally (9). Providers can obviously contribute to this cause by continuing to perform surgical abortions, but also by challenging their affiliated organizations to take a firm stance on the issue. In terms of combatting governmental orders, ACOG has gathered numerous resources for providers and/or constituents to track legislation, contact legislators, or advocate as state legislators themselves [10]. Providers have powerful insight and authority on this topic, which can make public discussions less partisan and more evidence based [9]. Already, abortion providers and reproductive advocates have successfully resisted abortion-banning orders in six states [5].
Ultimately, as governed by federal law and health organization guidance, we have an imperative to help women access reproductive services, and avoid the emotional, psychological, medical, financial, and social burdens associated with unwanted pregnancies. During this pandemic, we should ensure that women have continued (or even better) access to abortions. Now is not the time for a referendum on the morality of abortion, and it is unconscionable to use COVID-19 as an excuse to block access. Now, more than ever, with a global pandemic threatening our health and livelihoods, women deserve to have control over their health and their futures.
REFERENCES
Department of Homeland Security, Cybersecurity and Infrastructure Security Agency. (2020). Guidance on the Essential Critical Infrastructure Workforce. https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce
Center for Medicaid and Medicare Services. (2020). Non-Emergent, Elective Medical Services and, Treatment Recommendations. https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf
Ford, Liz. “Declare abortion a public health issue during pandemic, WHO urged.” The Guardian. April 10, 2020. https://www.theguardian.com/global-development/2020/apr/10/declare-abortion-a-public-health-issue-during-pandemic-who-urged
“Helping private practices navigate non-essential care during COVID-19.” American Medical Association. April 14, 2020. https://www.ama-assn.org/delivering-care/public-health/helping-private-practices-navigate-non-essential-care-during-covid-19
Sobel, Laurie et al. “State Action to Limit Abortion Access During the COVID-19 Pandemic.” Kaiser Family Foundation. April 27, 2020. https://www.kff.org/womens-health-policy/issue-brief/state-action-to-limit-abortion-access-during-the-covid-19-pandemic/
“State Partisan Composition.” National Conference of State Legislatures. March 31, 2020. https://www.ncsl.org/research/about-state-legislatures/partisan-composition.aspx
“Joint Statement on Abortion Access During the COVID-19 Outbreak.” The American College of Obstetricians and Gynecologists. March 18, 2020. https://www.acog.org/news/news-releases/2020/03/joint-statement-on-abortion-access-during-the-covid-19-outbreak
Panetta, Grace. “The states passing strict abortion bans have some of the highest maternal and infant mortality rates in the country.” Insider, Inc. June 1, 2019. https://www.businessinsider.com/states-passing-abortion-bans-have-highest-infant-mortality-rates-2019-5
Mark et al. “What can obstetrician/gynecologist do to support abortion access?” International Journal of Gynecology and Obstetrics. 131(1): S53-S55. https://www.sciencedirect.com/science/article/pii/S0020729215000909
“Get involved.” The American College of Obstetricians and Gynecologists. (2020) https://www.acog.org/advocacy/get-involved
Frye, John. “OB-GYN advocates for better abortion policy.” The Johns Hopkins News-Letter. April 15, 2018. https://www.jhunewsletter.com/article/2018/04/ob-gyn-advocates-for-better-abortion-policy
Fox, Maggie “Abortion in the U.S.: Five key facts.” NBC News. July 5, 2018. https://www.nbcnews.com/health/health-news/abortion-u-s-five-key-facts-n889111
Bernstein, Anna and Kelly Jones. “The Economic Effects of Abortion Access: A Review of the Evidence.” Institute for Women’s Policy Research. July 18, 2019. https://iwpr.org/publications/economic-effects-abortion-access-report/
“Abortion and Mental Health.” American Psychological Association. (2020). https://www.apa.org/pi/women/programs/abortion/