- As abortion clinics across the US shut down, the ones remaining open are instituting new rules.
- Intakes are happening over the phone, support people are no longer allowed to be present for the procedure, and providers might wear gloves, gowns, and masks.
- There is a renewed interest in medication abortions, instead of in-clinic abortions, and some clinics are now offering abortion via telemedicine.
- Many women are panicking about the possibility that they will not be able to access abortion care in the future.
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On March 26, Dr. Jamila Perritt performed an abortion. It was a few weeks into America’s coronavirus outbreak, and one-in-three Americans were under orders to stay home and shelter in place. Over 80,000 Americans had been infected with the new coronavirus, Congress was debating a trillion dollar stimulus bill to boost an economy that had come to a screeching halt, and only workers deemed essential were going to work.
That included Perritt, a doctor who provides abortion care in the Washington, DC, area. Her patient had an ultrasound weeks prior, revealing that the foetus had a genetic abnormality. The woman was trying to schedule an appointment at a DC hospital to have it handled, but hadn’t been able to get in.
“For her, in the context of a pandemic and limited access to abortion in hospitals, that meant she really had some decisions to make,” said Perritt. “She was afraid that she wouldn’t be able to get in to see us, either.”
Perritt says she’s seen many women express similar fears, as clinics across the country shut down. There’s been an uptick in women calling to inquire if the clinics Perritt works at are still open. Travelling across state lines has always been something some women in America have had to do for abortions, but with new travel restrictions, that is impossible.
“People are afraid they will be forced to carry a pregnancy that they don’t want to term,” said Perritt. “Folks are afraid they’re not going to be able to get in tomorrow, or next week, or next month if they need to.”
In Texas, Ohio, and Oklahoma, patients have reported being turned away from clinics, citing the coronavirus abortion ban, in which six states – Indiana, Iowa, Mississippi, Ohio, Oklahoma, and Texas – have prohibited abortion. According to the New York Times, one woman drove 250 miles to a Texas clinic, where she camped out, waiting for the clinic to figure out a way to see her.
Telabortion has never been an “easy” solution – 18 states require abortion pills to be taken in front of a provider, the FDA mandates that providers be on a registry, and that patients sign extra forms. But with a national push to limit human contact, providers are now having to confront these hurdles to provide their service.
Clinicians and lawmakers are urging the government to lift a ban on mail-order abortion pills so women don’t have to travel for care
Since the pandemic reached the US, Perritt’s clinics have been doing intake sessions on the phone, there is a ban on support people being present during abortions, and providers wear gowns, masks, and gloves at all times, even if the patient has no symptoms.
But their focus is, increasingly, on understanding how to provide remote treatment.
“What we’re seeing during this pandemic is people are talking about medication abortions and thinking about it more often, because of the decreased need to be in the health centre for a longer period of time,” said Perritt, adding that all the restrictions make medication abortion challenging. “As a provider it’s particularly frustrating that we can’t practice medicine based on the evidence that’s out there,” she said.
While there aren’t a lot of studies on telabortion, there is plenty of evidence that the healthrisksof medical abortions are low. One 2019 study found that the outcomes were equivalent to those who had in-clinic treatment, and a 2018 study saw similarly positive results.
However, under FDA rules, mifepristone and misoprostol, can’t be sold by brick-and-mortar or mail-order pharmacies.
It’s a barrier to care that, according to 21 attorneys general who sent a joint letter to the Trump administration on March 30, could “force women to travel at a time when many States and the federal government are urging people to stay home to curb the spread of COVID-19.”
How a telabortion works
Carafem, a reproductive healthcare provider in Maryland, Georgia, Tennessee, and Illinois, is exempt from some of the FDA restrictions around sending abortion pills in the mail, as one of a handful of centres participating in an FDA-approved telabortion research study.
While trying to continue providing in-clinic care for those who need it, COO Melissa Grant believes it is high time the spotlight was shone on telabortion.
“In some ways, coronavirus has pushed innovation,” Grant told Insider. “We think that this is a great opportunity in order to expand care.”
At carafem, telabortion intakes, in which a patient’s medical history is collected, happen on encrypted video conferences. The patients are directed to local medical facilities where they can get ultrasounds, pelvic exams or blood tests, if needed.
Once consent forms are signed, pills and pain medication are sent in the mail, along with a phone number where a carafem staffer is available 24/7. After a final follow-up the process, which costs $US350 out-of-pocket, is over.
“When you look at the way medications are provided in the health care centre and you look at the way that it’s provided over telabortion, there is very little difference,” said Grant. “I take that as a hopeful indication that maybe at some point we can expand the use of telabortion to provide medication to people in remote areas or who can’t travel.”
Disruptions to the supply chain during the pandemic may also threaten telabortion access
Though telabortion can help to replace the service for many patients, there are concerns the pandemic could also impact the production of abortion pills, and other necessary medicines.
“We may see shortages of medications-such as contraceptives, antiretrovirals for HIV/AIDS and antibiotics to treat STIs-due to disruptions in supply chains overall,” Zara Ahmed and Adam Sonfield wrote in a paper for the Guttenberg Institute.
Chris Purdy, CEO of DKT International, one of the world’s top providers for abortion tools and medications, told Insider the coronavirus pandemic has disrupted the active pharmaceutical ingredients, manufactured in China, that are used in the abortion pill.
While not currently a major concern in the US, it will be if the pandemic continues to disrupt society as it is doing well into the rest of the year and 2021.
“We are concerned about what’s gonna happen in the coming weeks and months around the availability of these products around the world,” Purdy said. “And on the ground what we’re seeing is doctors, and in some cases midwives, just closing their clinics and hunkering down.”
Abortion providers are determined to provide care for as long as they can
Marie Stopes International, a global reproductive health provider, estimated that a loss in abortion services could result in 11,000 deaths and 2.7 million unsafe, self-administered abortions.
The American College of Obstetricians and Gynecologists, too, has issued a rallying cry for abortion to be recognised as essential, time-sensitive healthcare.
“To the extent that hospital systems are categorising procedures that can be delayed during the COVID-19 pandemic, abortion should not be categorised as such a procedure,” ACOG said in a joint statement with a number of medical boards, adding that a delay of even a few weeks can make it inaccessible.
As the coronavirus spreads across the US, Perritt knows that there is an increased likelihood that someone may have the virus at one of the clinics she works at. “The risk is there, but we show up,” said Perritt. “This is what I’m supposed to do.” She added that she is lucky enough to have PPE (personal protective equipment) to protect herself at work.
Perritt says the woman who got an abortion on March 26 left the office sad, but relieved. “It was a desired pregnancy for her, as they are for many of the folks we care for,” said Perritt. “She was relieved that she didn’t have to carry a pregnancy and deliver a baby that she knew would die soon after birth. But she was still sad, because it’s hard.”
Ultimately, Perritt says, people will continue to make choices about their lives and their bodies, and it’s essential that medical professionals can help them do that safely.
“People deserve to make decisions about how their lives play out and abortion services are part of it,” Perritt said.
Have you been trying to get an abortion during the Covid-19 shutdown? If you had an abortion, what was the process like? We want to hear your stories. Please email [email protected] to tell your story.