Are abortions emergency procedures that should continue during a pandemic? Health systems around the world don't agree.
Many reproductive technologies are controversial, but perhaps none more than abortion.
It's no surprise, then, that as health systems race to shut down non-emergency procedures, to cope with the deluge of COVID-19 patients, there is no consensus on what to do about abortion. Mastectomies, heart valve replacements and kidney transplants have been postponed. Should abortions be postponed too?
The argument is that we need to reserve as much personal protective equipment as possible for emergency personnel on the front lines. Hospital capacity — in particular ICU capacity — must also be made available. Not to mention that non-essential contact should be limited to help halt the spread.
As many people have pointed out, however, abortions are time-sensitive and cannot typically be delayed by months or even weeks. As well, ongoing pregnancy care may require more protective gear than an abortion, as will backstreet abortions gone wrong.
Some providers are converting as many surgical abortions as possible into medical abortions, which use pills and can be performed at home. But that too sometimes involves difficult decisions and changes to existing policy.
Below, an overview of some of the decisions, interpretations, challenges and about-faces surrounding abortion care during COVID-19.
No — yes — no — maybe
Several states restricted abortion rights as part of their COVID-19 response. As abortion rights advocates fought the bans, some were lifted, some were partially lifted and some were lifted only to be restored.
On March 17, the Department of Health ordered that all non-essential elective surgeries should be cancelled. The order did not specifically mention abortion.
But on March 20, the attorney general issued cease and desist letters to four providers. They were ordered to "immediately stop performing non-essential and elective surgical abortions. Non-essential surgical abortions are those that can be delayed without undue risk to the current or future health of a patient."
A judge granted a 14-day restraining order on the ban.
According to the Columbus Dispatch, the state later clarified that some abortions could still go ahead. These included medical abortions and surgical abortions that had to be done in order that a "patient's ability to secure a pre-viability abortion" was not jeopardized.
On March 22, an executive order in Texas called for the postponement of "all surgeries and procedures that are not immediately necessary" — but it was not clear what that would mean for abortion.
The following day, however, the attorney general clarified: "...abortion that is not medically necessary to preserve the life or health of the mother" was prohibited. Anyone violating that order could be subject to a $1000 fine or 180 days in jail.
"March 24 is a day my staff and I will never forget," said one Texas abortion provider, who had just days earlier told her patients their procedures would be unaffected. "We spent the day calling up our patients, one by one, to tell them about the state’s ban." Providers stopped doing surgical abortions, but they continued to offer medical abortion to terminate pregnancies of up to 10 weeks.
"Abortion providers who refuse to follow state law are demonstrating a clear disregard for Texans suffering from this medical crisis," the attorney general said in a statement. "My office will continue to defend Governor Abbott's Order to ensure that supplies and personal protective gear reach the hardworking medical professionals who need it the most during this health crisis."
On March 24, the order went out about non-essential surgeries. Days later, the governor clarified that it included "any type of abortion services... which are not a medical emergency... or otherwise necessary to prevent serious health risks." All abortion services ceased.
Women in Oklahoma were redirected to a clinic in Kansas.
On Monday April 6, a judge granted a temporary restraining order. Abortion services resumed.
On March 27, the Department of Public Health banned abortions during the COVID-19 crisis and on March 30, a judge signed a temporary restraining order on that ban. It will last until April 13.
Abortion providers and the state reached an agreement that abortions may go forward in cases where a woman would otherwise be forced to carry a child to term. That followed an order to halt all non-essential procedures.
In the UK there was also confusion. But there, the concern was over whether it was safe, in the midst of the coronavirus pandemic, for women to attend an abortion clinic in person to receive abortion medication.
The law stated that, in England, the first of the two abortion pills had to be taken in a clinic. (In Scotland and Wales, women can take both pills at home after attending a clinic.)
On March 23, the Department of Health and Social Care published a statement saying that women in England would no longer need to attend a clinic in person in order to receive abortion medications — instead, they could consult electronically. Hours later, however, that decision was revoked. “This was published in error," said the Gov.UK website. "There will be no changes to abortion regulations.”
Not so. A week later, on March 30, the original plan was reinstated. Shortly after, the governments of Scotland and Wales issued similar orders, allowing almost all UK women who need medical abortion before 10 weeks to seek it without leaving their homes. The order stands for two years.
Left out for now are women in Northern Ireland. Abortion has only recently been decriminalized there; until last month, patients mostly travelled to England for abortions. There is disagreement still about whether the telemedicine abortion services available in England should now be extended to women in Northern Ireland during the crisis.
The coronavirus crisis has severely limited a woman's access to abortion in Italy, where the procedure has been legal for almost 40 years. Abortion pills still require in-person visits to hospital — and are only available up to seven weeks of pregnancy.
On March 23, France classified abortions as "urgent interventions." The country is turning to more medical abortions. Abortion advocates have asked the government to make abortion available till the 14th week of pregnancy, extending the current limit by two weeks.
Every province and territory has committed to providing abortions during the pandemic. However, even before the crisis has struck full force, the country is experiencing a shortage of the drugs that are used in at-home medical abortions.
"Red States Are Exploiting Coronavirus to Ban Abortion." New York Times. 06 Apr, 2020
"As more states look to ban abortion during pandemic, legal battles erupt nationwide." Washington Post. 01 Apr, 2020.
"State Officials Try to End Legal Abortion During COVID-19 Crisis." Rewire. 23 Mar, 2020.
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