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Texas’ COVID-19 executive order to suspend most abortions—including them among “nonessential” medical procedures—is supposedly intended to free up necessary hospital beds and personal protective equipment (PPE) for Texas hospitals. It’s a justification that abortion providers have swiftly debunked.
On Sunday, Texas Gov. Greg Abbott (R) issued an executive order calling for “all surgeries that are not medically necessary” to be postponed. Texas Attorney General Ken Paxton specified that the order included abortion clinics in the state, ordering providers to halt any abortion services “not medically necessary to preserve the life or health of the mother.” Health-care providers who fail to comply with the order could face up to $1,000 in penalties or 180 days in jail.
Abortion rights advocates said the arguments for halting legal abortion during the COVID-19 outbreak are being made in bad faith, as reproductive health clinics rarely need the kind of equipment in high demand at hospitals and complications requiring hospital trips for abortion patients are exceedingly rare.
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“[It] really just doesn’t make any sense given that … the vast majority … of the abortions in Texas are performed in outpatient clinics,” said Dr. Daniel Grossman, director of the Advancing New Standards in Reproductive Health research program at University of California, San Francisco. “It’s also very, very rare that a patient has a complication that requires treatment in a hospital, much less than 1 percent.”
According to a 2018 report, just 0.01 percent of emergency room visits made by women in the United States are related to abortion.
Abortion procedures also do not require significant amounts of personal protective equipment. “Very little personal protective equipment is used in a first-trimester aspiration abortion that’s performed in an outpatient clinic,” Grossman said. “Maybe you would use a pair of disposable nonsterile gloves for the ultrasound and then another pair of disposable nonsterile gloves when the abortion is actually performed. It’s important that the clinician use a face shield that can be reused throughout the day with multiple patients. But usually, a mask isn’t used. There’s no gown.”
Grossman pointed out that in states, including Texas, that require an ultrasound before an abortion, such restrictions force providers to use more gloves than they would need to otherwise. And that pales in comparison to the amount of personal protective equipment that would be needed throughout a person’s pregnancy, or during delivery, which requires “multiple sterile gloves, gowns, masks. [And] if the patient has a C-section, obviously that’s even more,” Grossman said.
Abortion access is already limited in Texas, where more than half of clinics have closed since the state imposed more stringent restrictions in 2013.
“Anti-abortion politicians in Texas have spent the past decade trying to ban abortion,” Aimee Arrambide, executive director of NARAL Pro-Choice Texas, told Rewire.News. “[But] I’m surprised that they would take advantage of a public health crisis in order to advance their agenda.”
Texas’s decision bans nearly all abortions, but the full extent of its reach is unclear, with experts uncertain if the new restrictions are limited to surgical abortion, or extend to medication abortion.
“Instead of trying to ban abortion for Texans … they could have been doing things like lifting the current restrictions,” Arrambide said. “I think they could have … waived mandatory waiting periods, so it doesn’t require multiple visits. I think they should allow telemedicine for medication abortion and counseling.”
Texas’s decision signals a potentially worrisome trend for pregnant people in states hostile to abortion, as anti-choice governors, state and local lawmakers, and their allies weigh the decision to postpone “nonessential” medical procedures.
“We are starting to get a lot more requests [about teleabortion services],” said Melissa Grant, COO of FemHealth USA, which operates carafem, a network of health-care centers and provides in-person and teleabortion services in Georgia, Illinois, and will soon expand to Maryland. “People [are asking], ‘What does this mean? What can we do, where can I go?’ … The level of anxiety is rising.”
Last week, the American College of Obstetrics and Gynecology issued a statement advising that abortion should not be categorized as an “elective” or “non-urgent procedure.” In Alabama, which, like Texas, has some of the most onerous abortion laws in the country, the Department of Public Health announced Wednesday that the state’s three abortion clinics would remain open and designated as “essential” businesses.
But decisions like the one carried out in Texas can position pregnant people’s bodies, lives, and welfare as the collateral damage to the COVID-19 crisis. That is especially true of low-income, Black, Latinx, and Native women. “Putting [abortion] this much further out of reach is just going to create … an exponential impact on those communities that are already marginalized,” Arrambide said.
“These are unprecedented circumstances and we would hope that elected officials would focus on legitimate public health concerns,” said Dr. Kari White, principal investigator of the Texas Policy Evaluation Project (TxPEP) and associate professor of social work and sociology at the University of Texas at Austin. “Even before this crisis, people seeking abortion in Texas faced numerous barriers to obtaining timely care: state-mandated visits that are medically unnecessary, cost, and long-distance travel for some… If Texas clinics are required to suspend services for the duration of this executive order or longer, it is unclear … how many [patients] will be forced to continue their pregnancies.”
Texas lawmakers will have to come up with some answers, and soon. On Wednesday afternoon, Planned Parenthood, the Center for Reproductive Rights, and the Lawyering Project filed a lawsuit against the state, calling the COVID-19 order unconstitutional and requesting a restraining order.
“Forcing people to remain pregnant during a public health crisis is unbelievably cruel,” Amanda Beatriz Williams, executive director of the Lilith Fund for Reproductive Equity, which provides financial support to women seeking abortion in Texas, said in a statement shortly after the lawsuit was announced. “A pandemic is not the time to play politics with people’s lives.”