When Fiona Earnhart* from Philadelphia discovered she was pregnant in March, the 31-year-old became anxious. Although she’s married and does want to have children someday, she was in the midst of job hunting and couldn’t envision searching for employment while pregnant. There was also another complication looming: the ongoing coronavirus pandemic that sparked a global health crisis. Earnhart made her decision. She was going to get an abortion.
There’s no denying that reproductive rights have always been in jeopardy in this country. Ever since the U.S. Supreme Court recognized safe and legal abortion as a constitutional right in 1973, anti-abortion politicians have challenged that right. According to data from the Guttmacher Institute, 32 states enacted 394 new abortion restrictions from 2011 to 2017. Even in the face of these restrictions, people continue to seek abortions. In 2017, medical practitioners provided 862,320 abortions in the United States, per the Guttmacher Institute’s most recent national abortion incidence data.
The coronavirus’s impact on access to abortion has been multifaceted. People in search of an abortion during this crisis often grapple with very valid fears of getting the virus while trying to receive medical care. What’s more, the pandemic has created an opportunity for some anti-abortion government officials to attempt to strategically enforce additional restrictions on reproductive rights.
Government officials in states including Texas, Ohio, Arkansas, and Iowa have restricted or banned abortion at various points during the pandemic, according to the Guttmacher Institute. In April, for instance, a federal appeals court in Texas placed a temporary ban on abortion as part of the state’s coronavirus response, stating the procedure was “nonessential.” Also early on in the pandemic, federal courts in Ohio limited surgical abortions while allowing patients access to medication abortion (also called the abortion pill), which is often used when people are 10 or fewer weeks along in their pregnancies. While these kinds of bans are no longer in effect, according to the Guttmacher Institute, for a time they further complicated the already complex process of getting an abortion in the United States.
As a result, some people seeking to end their pregnancies when their states limited abortion access during the pandemic had to take extra, burdensome measures to receive that care, often traveling out of state to a clinic.
“Crossing state lines to obtain abortion care is always an added hurdle and difficulty,” Tam Nickerson, clinic operations director at Preterm in Ohio, tells SELF.
Even in pre-pandemic times, it was more strenuous than it should have been to get an abortion in Ohio. “Ohio has made it particularly difficult to access abortion care in our state by passing medically unnecessary laws that require patients to wait and to receive medically inaccurate information, and require doctors to jump through hurdles that have nothing to do with medical care,” Nickerson says. Then came the temporary yet still harmful pandemic-era legal limitations.
At the end of March, a federal court granted Ohio abortion providers, including Preterm, a temporary restraining order that enabled them to keep performing abortions during the pandemic. According to Vanessa Arenas, deputy director at Preterm, “the state was using the pandemic as an attack on abortion care.”
In the state of Tennessee, where abortion access had similarly already been under attack before the pandemic, COVID-19 only adds to abortion advocates’ frustration.
“There’s a lot more anxiety around being able to access care,” Katy Leopard, director of external affairs at Choices—Memphis Center for Reproductive Health, tells SELF. “This not only applies to abortion services but our midwifery and birth services as well.” At various points people have been so afraid the clinic will shut down that the center’s call volume was up significantly due to patients asking if they were even still open, Leopard says.
Although the clinic does remain open, the pandemic has naturally changed its status quo. Leopard explains that her team is following clinic safety guidelines from the Centers for Disease Control and Prevention (CDC). A staffer does a phone screening with each patient before every appointment to inquire about the patient’s exposure to COVID-19. The team also performs temperature checks and maintains a socially distanced waiting room. They are also requiring that patients wear masks.
Leopard goes on to explain that these precautionary steps apply to patients seeking both urgent and routine care; she has seen waiting times for an annual Pap smear take longer than waiting for an abortion during the pandemic. This is primarily due to the limited capacity of the clinic, which only consists of two waiting rooms, she says. Leopard and her team have to do more with a lot less. Nevertheless, they persist.
“We will always be open to provide care for people during the pandemic,” Nikia Grayson, director of prenatal services at Choices, tells SELF. “The pandemic hasn’t changed our commitment. It’s definitely made us more innovative in how we provide our care and screen our patients, but it’s also made us examine the shortcomings of the medical model of care and how we can fill in those gaps to deal with this fragmented, broken system.”
For Earnhart, the pandemic only complicated her experience of terminating her pregnancy. Although the state of Pennsylvania hasn’t seen new restrictions on abortion access during the pandemic, the 31-year-old did undergo state-mandated “counseling” and had to wait 24 hours before getting a medication abortion. She also spent four hours in a waiting room, surrounded by an array of patients who weren’t wearing masks.
“I was definitely scared and really didn’t want to be there,” Earnhart tells SELF. “I just wanted to get it over with and move on.”
Additionally, Earnhart says the compounded stress of not making a lot of money was an added factor in her decision to terminate her pregnancy. The pandemic is having a clear and devastating financial effect on millions of people. In the week ending on September 12 of this year, 26.5 million people claimed some kind of unemployment insurance benefits, compared to 1.4 million people in the comparable week of the prior year, according to the U.S. Department of Labor. Losing your health insurance often follows losing your job. If you can’t afford to buy health insurance on a private plan, paying out of pocket is often the only choice for receiving medical care. But it can be difficult or even impossible to pay out of pocket for an abortion, which typically costs around $500 at baseline not to mention additional costs like childcare if necessary and lost work wages.
Texas is one of the 26 states that at least partially restricts private or public insurance coverage for abortion, according to the Guttmacher Institute. (The state makes an exception for cases of life endangerment.) So even if you’re fortunate enough to have insurance in the state of Texas, it can’t help cover your abortion except for life-threatening circumstances. Add a global health crisis into the mix, and trying to receive quality health care becomes a puzzling task.
“When we first heard about the bans on nonessential surgical procedures, we were worried,” Kamyon Conner, executive director of the Texas Equal Access Fund, tells SELF. “This is the time when health care access actually needs to be the most available it can be, not the least available.”
Conner’s work at the TEA Fund often centers around providing financial and emotional support to people who need abortion care throughout Texas.
“Many Texans already struggle to access abortion care due to coverage bans in our state,” says Conner. Additionally, she explains, “They have to come more than once to have their procedure, so they have two appointments, which during a pandemic can increase their risk and the provider’s risk around COVID-19.”
The people Conner and her team assist are often young and live in rural areas. Many are students or are parents already. A majority of them are women of color.
For centuries racist medical practices have continuously marginalized women and people of color and prevented them from receiving the reproductive care they need. Systemic inequities and disenfranchisement—resulting in poverty, unemployment, and lack of access to education and insurance—can all impact someone’s ability to seek and receive quality health care. It’s impossible to ignore that many of these same systems (and people perpetuating them) are also to blame for COVID-19’s disproportionate impact on Black and brown communities.
“These communities have always historically been kept at the margins of health care access,” says Conner. “I think this crisis has illuminated it more, but I’m hoping it will help ignite a little bit of fear and help people to advocate for these communities.”
Abortion is and should remain a fundamental right, regardless of race, class, economic status, or other factors—especially during a global health crisis. But as states continue placing limitations on essential reproductive care—and the potential confirmation of anti-abortion judge Amy Coney Barrett to the Supreme Court looms—protecting abortion access is becoming more difficult throughout the country. The pandemic has only amplified that.
“States should not be using the pandemic as a reason or opportunity for limiting access to health care,” says Arenas. “Everyone should be coming together as communities to make sure everyone can get health care safely, instead of actively working to deny neighbors the health care they urgently need—including and especially abortion care.”
*Name has been changed to protect privacy.