For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.  

Independent reproductive health-care clinics are still largely allowed to operate, even in cities and states with COVID-19 shelter-in-place orders, but the outbreak is straining an already precarious situation.

“What we’re seeing is the barriers that already exist for access to abortion being compounded by the current crisis in a way that it is limiting people’s resources significantly,” said Roxanne Sutocky, director of community engagement at the Women’s Centers, which operates independent clinics in four states. And people most at risk of losing health-care services, including people of color, will be the among the most vulnerable during this pandemic.

Even if clinics don’t legally or permanently close during the crisis, abortion is time-sensitive—so for some patients, any limitations on the clinic’s end could mean the difference between getting care and not.

Staff shortages likely while clinics see increased traffic

Between putting health-care providers at risk of contracting the virus and diverting them to other areas of care, the global pandemic will have a particularly notable impact on reproductive health care, according to a paper published last month by the Guttmacher Institute, a research and policy organization for advancing sexual and reproductive health.

“This may create a shortage of clinicians who can provide sexual and reproductive health services and increase wait times for patients in need,” Guttmacher policy managers Zara Ahmed and Adam Sonfield wrote. “In places that already have a limited number of providers, this will put an extreme strain on capacity to serve patients, especially for non-emergency care.”

Abortion clinics are already vulnerable to staff shortages, even outside of a crisis, and the risk of infection leaves their providers vulnerable. As with many health-care sectors—like dentistry—reproductive health-care clinics are eliminating non-essential appointments to maintain social distancing. However, as Dr. Yashica Robinson, medical director at Alabama Women’s Center for Reproductive Alternatives, told Rewire.News, abortion clinics in many states are forced to have unnecessary appointments in order to provide essential care.

“One of our biggest struggles is reconciling with having patients come in for medically unnecessary visits in order to comply with state regulations, like our 48-hour waiting period,” Robinson said, referring to the Alabama law requiring people to wait 48 hours before getting an abortion. “Some areas have actually experienced temporary disruptions in abortion services or have had to limit appointments due to physicians’ inability to travel.” Robinson said her clinic has seen increased traffic from people traveling from areas with less access to abortion care. While Alabama has just three abortion clinics as of 2019, adjacent Mississippi has just one clinic.

“One young lady drove seven hours … for an initial visit to guarantee her procedure could be done [in two days],” Robinson said. “There is an abortion provider in her area, but the patient’s appointment was going to be for a later date. She did not feel comfortable waiting.”

Anxiety and uncertainty around the COVID-19 pandemic, possible clinic closures or abortion bans, and personal health concerns are fueling an uptick in appointments. “We are dealing with the harms caused by misinformation,” Robinson said. “Patients think clinics are closed; there is increased panic due to patient’s fear of being turned away.”

Cedar River Clinics, in abortion-friendly Washington state, is moving forward quickly with a telemedicine program to help maintain staffing while decreasing the risk of spreading the virus, said clinic spokesperson Mercedes Sanchez. Clinics in Alabama do not have the same option.

“In [my OB-GYN] practice, I can complete visits using telehealth in order to decrease risk of exposure for patients,” Robinson said. “For things that I can handle remotely, I have the authority as a physician to do that in order to promote what is in the best interest of my patients. As an abortion provider, the state has taken that option away.”

A strain on resources and finances

For clinics with limited resources to begin with, COVID-19 has caused a huge strain.

“Our biggest struggle is financial,” Sanchez said. “The majority of abortions in this country are provided by independent clinics like Cedar River Clinics, and the current pandemic has had a big impact on us financially.”

“Most abortion clinics operate on tight budgets and, like most of the country, we were not financially prepared for a pandemic,” Sanchez continued. “There are not many funding resources available to independent abortion clinics. We are committed to providing care to our communities—but we need help.”

Independent abortion clinics don’t have the same access to federal stimulus loans as other businesses.

As the pandemic exposes shortages in medical equipment and supplies across the United States, clinics are bracing themselves. But they’re used to working with limited resources.

“As abortion care providers, we are constantly preparing for the next crisis,” Robinson said. “In the past, we have seen shortages or extreme price increases in essential items [like] medications, IV fluids, and more. Our goal is always to stay on top of our inventory.”

Hostile legislation

Against the advice of medical experts, anti-abortion lawmakers are trying to exploit the COVID-19 crisis as a backdoor for abortion bans. Several states are attempting to end legal abortion amid the pandemic by declaring abortion procedures “elective.”

While reproductive rights advocacy groups are fighting these decisions, the orders have already had a drastic impact on people seeking abortion care: Amy Hagstrom Miller, president of Whole Woman’s Health, told the Associated Press that the organization’s three Texas clinics had to cancel more than 150 appointments.

“Such restrictions are stressing the reproductive health-care infrastructure, especially in areas that already have problems with access to care,” Robinson said. (On March 30, a judge granted a temporary restraining order against Alabama’s ban until at least April 13—and officials in nearby Louisiana and Mississippi have attempted to shut down abortion services, too.)

Friendly states not immune

While COVID-19 has had an especially adverse impact on reproductive health in states with more anti-choice regulations, clinics in abortion-friendly states aren’t in the clear.

While the Women’s Centers’ New Jersey clinic isn’t subject to mandatory waiting periods, “there’s still those impacts of the current quarantine, and people being out of work, and health-care complications,” Sutocky said.

The clinics are also bracing for an influx of patients unable to access care in other areas. For example, the Women’s Centers has a clinic in Georgia, a state with anti-choice restrictions that aren’t quite as onerous as some of its neighbors’.

“As other surrounding states like Louisiana have less and less access, we will see an increased need for patients to travel,” Sutocky said. “So we’re navigating with abortion funds, practical support networks, and other providers throughout the state about what it would mean to increase the patients that we need to see while making sure that people are as safe as they can be.”

For better or for worse, she said, clinics are typically adept at crisis management and are used to making adjustments to provide care: “There is always the potential that a new legislative barrier can be imposed, and we’re constantly having to shift to meet people’s needs in a way that’s safe and legal.”