Make Abortion More Available During the Pandemic — Not Less

It’s hardly new for anti-abortion politicians to seize on any excuse to try to restrict women’s bodily autonomy, but it is a new low to exploit a pandemic that’s already cost hundreds of American lives, and threatens many thousands more.

In recent days, leaders in several states — including Texas, Ohio and Louisiana — have pushed to close abortion clinics or severely curtail access, arguing that abortion is a nonessential procedure that ought to be delayed.

The “nonessential” bit is obvious nonsense and the delay a transparent attempt to put abortion out of reach for those who need it. As several major health care groups noted in a joint statement last week: “Abortion is an essential component of comprehensive health care. It is also a time-sensitive service for which a delay of several weeks, or in some cases days, may increase the risks or potentially make it completely inaccessible. The consequences of being unable to obtain an abortion profoundly impact a person’s life, health and well-being.”

These state leaders know that once an abortion clinic closes for any significant period, it becomes difficult to reopen. That’s why Texas has fewer clinics today than it did before the enactment of its restrictive 2013 anti-abortion law, which aimed to regulate clinics out of existence. Though the law was struck down by the Supreme Court three years later, many clinics were never able to staff back up and become operational again.

Surely all of this is top of mind for Louisiana’s governor, John Bel Edwards, a Democrat opposed to abortion, as the Supreme Court prepares to decide on a case involving a Louisiana law that’s nearly identical to Texas’. That decision, expected in June, could close all but one abortion clinic in Louisiana. But that might be a moot point by then, if all the clinics in the state already have been closed under the pretense of public health.

It’s important to note that these state leaders may not be successful — clinics in Ohio have remained open while the matter makes its way through the courts.

But these efforts underline a real problem for people seeking reproductive health care amid this crisis: Much more of this care needs to be able to happen from home.

Experts say that most patients seeking birth control and even abortions performed via medication can do so safely without traveling to a health care facility. But there are political and regulatory roadblocks that must be cleared to make widespread at-home access to reproductive health care possible.

In the coming weeks, unintended pregnancies could rise as a result of people being stuck in their homes, potentially without consistent access to birth control. Among those who would choose to have an abortion — there were about 860,000 abortions in America in 2017 — an increasing number might not be able to get those services, either because of the dangers of traveling (for patients and abortion providers alike), a growing inability to afford the procedure or the need to take care of homebound children and other family members.

The stakes of any disruption to reproductive health care are always high, and especially so during a crisis. A lack of timely access to abortion, in particular, threatens the health and economic stability of women and families at a time when so many people are losing their income and their health insurance.

But there doesn’t have to be a disruption. There are steps that states and the federal government can take now to ensure that women get the care they need. Here are a few.

Make Abortion Pills Available by Mail

Medication abortions, which are approved by the Food and Drug Administration up to 10 weeks of pregnancy, are already popular, making up about 40 percent of all abortions in the country today. That number would most likely be higher still if it weren’t for a years-old F.D.A. regulation on mifepristone — the first of two drugs that are taken during a medication abortion — requiring patients to take the drug at a clinic or a hospital after it’s dispensed by a certified prescriber. (Patients are then sent home with a dose of misoprostol, which starts the active bleeding process.)

The F.D.A. says that the regulation, known as a REMS (risk evaluation and mitigation strategy), is needed “to ensure that the benefits of the drug outweigh its risks.” But reproductive rights experts note that the drug is very safe and argue that it is overregulated.

Given the coronavirus pandemic, it is incumbent on the F.D.A. to relax its regulation on mifepristone, at least temporarily. Doing so would allow many women to get a prescription for abortion-inducing drugs from a doctor via telemedicine, at which point the medications could be mailed to the patient.

Unfortunately, 18 states effectively ban abortion care via telemedicine — measures that also ought to be lifted, at least for the time being.

Don’t Criminalize Women Who Seek Abortions

It’s an enduring truth that when access to legitimate reproductive health services are limited, women desperate to end their pregnancies will turn to other means. Before Roe v. Wade, that often meant coat hangers and dangerous back-alley providers. Today, it much more often means ordering abortion pills off the internet, from overseas websites — generally a safer option, but one that carries legal risk.

Though in most states it is not explicitly illegal to self-induce an abortion, overzealous prosecutors have on occasion charged women whom they’ve suspected of ending their pregnancies, under laws intended to protect fetuses.

It’s not hard to imagine the number of self-induced abortions increasing during this period of American semi-lockdown. Doctors and prosecutors would do well to remember that tying those women up in the legal system will do nothing to keep them, their families or the greater public safe.

Birth Control for All

Making contraception affordable and easy to get is the best way to avoid unintended pregnancies. Unfortunately, the United States has been moving in the opposite direction.

To address this, the federal government and states need to pump money back into the Title X family planning program, which the Trump administration recently obliterated.

In addition, all states ought to allow people to get a full year of contraception at a time. And according to Dr. Daniel Grossman, a professor of obstetrics and gynecology at the University of California San Francisco, physicians would do well to refill birth control prescriptions without an annual exam if their patients have had normal blood pressure and Pap smear tests in the past.

Telemedicine is having a moment during the present crisis, with patients and medical professionals moving many routine consultations online. Contraception is already widely available via telemedicine, and such services could be expanded during the pandemic.

Help Women Pay for Abortions

Finally, it’s long past time to end America’s bans on government funding for abortions, like the federal Hyde Amendment and similar state measures. These bans mean that poor women already struggle to afford reproductive health care — an issue that’s sure to be exacerbated during the coronavirus crisis and the economic fallout from it.

With so much about the future uncertain for countless Americans, it’s more important than ever that everyone has control over their reproductive choices, at least.

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