For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.
Rewire.News: How has the COVID-19 outbreak been affecting people accessing abortion care?
Dr. Diana Wu: The effect on people accessing abortion care is considerable, especially in those states that have limited access.
Patients seeking abortion care already faced so many barriers to access before the pandemic. As patients are now staying home from work, potentially losing wages, and watching their children, or who are home from school, or unexpectedly paying for child care, we know patients will have less funds available and less flexibility in their schedules to make it to the clinic for care.
Many of these states already depend on doctors to travel and fly in to provide abortions. Some of these doctors have other jobs that are banning them from work or personal travel during the pandemic. These doctors and the clinics they travel to have to judge if it is safe and ethical to bring that doctor—even if they do not have symptoms—to a state with little abortion access. The doctor also has to judge if they are willing to risk their own health by traveling through the airport and flying in an airplane. In addition, staff at abortion clinics may also need to care for themselves, a sick relative, or children who have to stay home from school. The effect the virus has on a clinic’s ability to operate normally is substantial.
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For states that have better access, they are still operating in a limited capacity to provide abortion care since many clinics are increasing visits for those with respiratory infections.
Is it OK to go to the clinic for a scheduled abortion?
DW: Just like all other clinics, clinics that provide abortion care as a part of the full spectrum of reproductive health care are rapidly adjusting to the pandemic and its implications on social distancing in waiting rooms, using increased precautions for hygiene, and other measures to protect patients, staff, and health-care providers from becoming infected.
For those clinics that are able, they are increasing their capacity to provide abortion by telehealth or removing requirements around abortion like in-person consent, ultrasound, and lab testing before an abortion to reduce patient contact. National Abortion Federation recommends these evidence-based changes for clinics providing abortion. This is impossible for clinics in hostile states that prohibit telemedicine or mandate multiple, medically unnecessary appointments.
For example, in Texas a patient has to go to a clinic three separate times for a medication abortion. No one should have to risk their health or the health of their families by traveling on public transportation, wait in waiting rooms, or listen to a state-mandated scripts to obtain an abortion pill. Hostile states where people are punished for having an unplanned pregnancy now also put them at risk for COVID-19 given the extra travel and extra office visits. In the end, this endangers their families and communities, too, as it promotes spread of the virus.
Many hospitals are delaying all elective procedures to prioritize virus-related cases. Is abortion considered an elective procedure?
DW: All patients accessing abortion care deserve their care without delay. Given that abortions become more complex as pregnancy continues, abortion should not be considered elective and minimize any delays in care. The majority of abortion care is provided in clinic settings. However, with shifts in access both in hospitals and in clinics, both sites need to be able to provide abortion without delay.
How has coronavirus been affecting pregnant people? Are they more vulnerable?
DW: We currently know little about COVID-19 and its effects on pregnant people and infants. According to American College of Obstetricians and Gynecologists (ACOG) and Centers for Disease Control and Prevention, the current data does not indicate that pregnant people are particularly vulnerable to COVID-19. In a limited study in China of nine pregnant people with pneumonia due to COVID-19, the pregnant patients had similar symptoms to non-pregnant patients, and none experienced severe complications or consequences. None of the infants had COVID-19 infections. Some had pre-term birth, but it was thought to be due to other complications of their pregnancy, and not COVID-19. However, it is well-established that pregnant people are at more risk for severe complications and even death from other viral respiratory infections like influenza and SARS. Because of this, ACOG is recommending that pregnant patients be considered an at-risk population.
The limitations on hospital visitors by age (less than 15 to 18 years old) or number (some hospitals [are banning] visitors, others are limiting to one to two support people), has a detrimental effect on pregnant people during an already emotional and physically vulnerable time. Some clinics and hospitals may be considering or already conducting telehealth appointments to reduce the risk for pregnant patients.
Is it safe to continue a pregnancy right now?
DW: Unfortunately, the data is limited currently and continues to evolve. This is a personal decision that individuals need to make, whether that be based on their concerns for their own health, pregnancy’s health, and their goals and values.
Has defunding reproductive health care further hindered the ability to deliver health care to people during the virus outbreak?
DW: Yes. Defunding reproductive health care has already hindered the ability to deliver health care to those facing the most barriers to accessing health care prior to the virus outbreak, and it is only worse during this virus outbreak. As vulnerable people have their cash reserves depleted to pay for necessities for their families, they will de-prioritize their own health care. This includes Asian Pacific Islander, Black, and brown communities, people with low income, rural communities, LGBTQIA folks, immigrants, and young people.
Should we be stocking up on contraceptives in the face of quarantine? What are some alternative ways to obtain these supplies during a lockdown?
DW: If someone is high risk and taking contraceptives to treat a medical condition or to prevent a high-risk pregnancy, they should have at least a three-month supply available. Alternative ways are to ask your health-care provider to send prescriptions to a mail-order service. Many clinics are extending prescriptions without appointments, and pharmacies remain open even in places with “shelter in place” orders.
Is it OK to have sex during the pandemic?
DW: Social distancing is an essential component to reducing the spread of COVID-19, and it is important to minimize contact with people as much as possible. Even if you are young and without risk factors, young people can still become severely infected. In addition, you will put others you come into contact with at-risk, whether or not you are experiencing symptoms. Avoid anonymous or casual in-person sex.
At the same time, we are only going to get through this with love, kindness, and intimacy. A possible guideline is to not have in-person sex with anyone you would not want to be quarantined with for 14 days. Consider phone, video sex, and/or mutual masturbation to reduce risk.
For more questions and answers about sexual and reproductive health during the pandemic, see here.