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

Last month, a woman took a bus from her home in Louisiana, traveling hundreds of miles to New Mexico to secure a later abortion. Three days later, her procedure complete, she was ready to return home.

Then her bus was cancelled.

With the help of volunteers from the Brigid Alliance, a national organization that provides funds and travel support to patients seeking an abortion, and which had arranged her bus travel, the woman was able to secure a flight home.

As transportation providers across the country drastically reduce or cancel their regular routes in response to the COVID-19 crisis, stories like this may become increasingly common. Amtrak and Greyhound are among the carriers that have canceled certain routes, while public transportation in cities like Madison, New Orleans, and Boston are operating on reduced schedules.

“We’ve seen the barriers that our clients face increase dramatically in size and number,” said Diana Parker, director of strategic partnerships at the Midwest Access Coalition, which provides travel support to those traveling from, to, and within the Midwest for abortion care. “Under COVID-19, public transportation is, all too often, the only remaining mechanism that makes abortion access a reality in this country,” Parker explained in an email.

As the New York Times reported last year, research from the University of California, San Francisco shows that more than 11 million women across the country are further than an hour’s drive from the nearest abortion clinic. Travel requirements are among the most onerous barriers to care for people seeking an abortion, and have the potential to exacerbate already existing hurdles. This is especially true for those who are seeking care later in pregnancy, which is only available in a handful of states. Compounding these access issues today is the risk of exposure to COVID-19 as patients travel to and from clinics, hotels, and other shared spaces to receive care.

“Our clients are dealing with untangling the newfound web of clinic pre-screens and restrictions that so often push back personal abortion care timelines while increasing associated costs,” Parker said. “Clients are also dealing with … perhaps more obvious hurdles, such as more complicated travel itineraries, round-the-clock childcare needs, sky-rocketing costs, and an increased sense of isolation.”

Her team’s days, Parker explained, are now full with last-minute pivots thanks to various anti-choice directives and injunctions that come down each day, sometimes multiple times a day. Just last week, Texas’ COVID-19 abortion ban was blocked by a judge on Monday but then reinstated by an appeals court one day later.

Restrictions imposed by COVID-19 have already led to a drop in the number of patients at some clinics nationwide. The Hope Clinic for Women in Granite City, Illinois, has seen a 10 percent decrease in the number of patients seeking an appointment over the past three weeks. “Show rates” for those who do make an appointment, however, have risen from 50 percent to 85 percent, suggesting pregnant people may be increasingly unsure of their ability to access an abortion in the future. Meanwhile, Karen Duda, coordinator of the Haven Coalition in New York City, reports that requests for help from her organization have gone down “dramatically” in the past two-and-a-half weeks, since the first stay-at-home orders were issued for the state. The organization provides lodging and clinic escort services to people traveling to the city to have an abortion.

Alison Dreith, deputy director of the Hope Clinic, told Rewire.News that she believes in the coming weeks and months, it will “most certainly” become more difficult to provide care for patients outside of her clinic’s community in the greater St. Louis metropolitan area. “We see patients from around the country,” Dreith said. “It was already really difficult to get to us.”

But other practical support providers are facing greater demand for their services amid the ever-changing landscape of the coronavirus pandemic. “Our work has grown and is growing,” said Odile Schalit, executive director of the Brigid Alliance. “The thing about COVID is that it really hits at the heart of practical support work and how critical it is to accessing abortion care … [COVID-19] just asks us to do more of it and under more stress and with greater concern for safety of all different kinds.” The group is also anticipating a rise in the need for later abortion care, as more patients experience a delay in access to services.

Though Parker reports the Midwest Access Coalition has seen its highest-ever client volume in March 2020 alone, the coronavirus has forced the group to suspend its 200-strong volunteer host-and-driver program, exponentially increasing the organization’s operating costs and the level of complexity of case work. “Right now, we’re booking clients expensive hotel stays and ride-shares, and doing our best to stay afloat,” Parker said. 

The Brigid Alliance has lost long-standing relationships with some hotels, but they are either closed or at half-capacity because of COVID-19. “We have fewer options,” Odile said.

But as the country’s transportation infrastructure continues to contract, reaching an accommodation and abortion care is increasingly complicated.

Practical support providers like Odile and Parker are pivoting to rental cars as a favored method of travel, but the shift requires different considerations than securing a ticket on a bus, train, or plane. It’s an option that depends on a litany of privileges, including having a driver’s license. “The majority of our clients either don’t own cars, aren’t old enough to easily rent a car, or don’t have the funds to pay the up-front costs that go along with car rental,” though these costs would later be reimbursed, Parker said.

These questions are not just limited to transportation to and from a city where a clinic is located, but to the clinic itself. Dreith explained that patients, who are often under sedation, don’t necessarily want to use rideshares such as Uber or Lyft, and may be uncomfortable navigating public transport in an unfamiliar place.

“It’s a really concerning time,” said Dreith, referring to the risks faced by practical support organizations and their volunteers. “Not enough conversation is happening around how we transport patients and our volunteer networks that exist around the country.”

Recently, a patient at the Hope Clinic needed a volunteer to transport them from their appointment; one was found on a second try. “That was something that came with a really conscious and heavy heart to even be able to ask someone to do that, knowing the risks that could put people in,” Dreith said

“In a moment like this, we’re all now questioning how we leave our homes. We’re all now questioning the safety of getting on a train or getting in a car or going to the doctor,” Schalit said. “It is an opportune moment right now for those of us with privilege to consider and really feel what for years have been the realities and the barriers and the fears that people trying to access abortion care have faced.”