Disclaimer: Posts are solely the views of the author and do not represent the views of Brandeis University or The Institute on Assets and Social Policy.
Government responses to COVID-19 have demonstrated how crisis policy can reinforce and expand inequalities. At the ISAP Lab, we have written about pandemic disruption to employment, and housing security, the exclusion of millions from federal aid packages, and how place and race matter in COVID-19’s social policy legacy. Policy responses to coronavirus have defined what in our society is an essential service, and these shifting decisions vary greatly depending on where you live.
For state governments hostile to abortion services, the pandemic has been an opportunity to withhold reproductive rights and ban access to health care. Denying people full control over their own reproductive lives excludes them from the protective economic effects of abortion, and for Black women, continues the long history of sexual coercion and control to subjugate Black health and wealth.[i] Abortion is an essential service, and pandemic bans are not in the interest of public health.
As COVID-19 cases continue to rise and states reverse reopening plans, we cannot repeat these policy failures to ban abortion that have been declared unconstitutional.
Starting in March and continuing to May, 12 states used stay-in-place emergency orders to declare abortion non-essential.[ii] Alaska, Arkansas, Mississippi, and Texas explicitly banned abortion under their executive orders. Abortion providers are currently allowed to resume patient care in every state, and this would not have been possible without rapid legal response and practical support networks. As COVID-19 cases continue to rise and Governors reverse reopening plans, we cannot repeat these unconstitutional policy failures to ban abortion.
Obtaining an abortion in the United States is an arduous process as patients and providers navigate new regulations every state legislative session. Arkansas is one of the most hostile states for abortion access. The state government controls every step of the process, from mandatory waiting periods to restrictive insurance coverage and a ban on telemedicine. For patients who can afford the cost of care and want to stay close to home, appointment options are limited to three clinics in either Memphis or Little Rock. Last year Governor Hutchinson was proud to make Arkansas the fifth state to enact a “trigger ban” to outlaw abortion if Roe was overturned. This year, Arkansas public officials found a way to ban abortion that did not involve the Supreme Court.
When most states are urging people to stay home, states like Arkansas are forcing abortion patients to make multiple visits to multiple places
Governor Hutchinson used COVID-19 to roll back reproductive rights to the 1970s by banning abortion unless immediately necessary to protect the patient’s life or health. While Governor Hutchinson was one of a handful of leaders that did not issue a shelter in place order, Arkansas abortion providers were the last in the country allowed to resume operations. Under the new requirements, abortions are “elective surgeries,” which are allowed if patients had at least one negative COVID-19 test within 72 hours (previously 48 hours).
When most states are urging people to stay home, states like Arkansas are forcing abortion patients to make multiple visits to multiple places — two trips to the clinic and another visit to a COVID testing site. According to the COVID Testing Project, Arkansas continues to fall below the minimum daily testing requirements to mitigate the virus’s spread. The current testing guidelines for Arkansas based test availability on symptoms and exposure rather than an individual request. Abortion clinics may be open in Arkansas, but patients’ journey to access care is daunting and nearly impossible.
At a time where fear of coronavirus was wide-spread and reliable information was scarce, several other Governors issued confusing and contentious abortion restrictions. Governor Holcomb in Indiana specifically named abortion providers in the stay-at-home order requiring all medical providers “to postpone or cancel all elective or non-urgent procedures, unless doing so would cause harm to the patient as determined by a healthcare provider.” As abortion is a highly time-sensitive procedure (banned in Indiana 22 weeks after the last menstrual period), and the term elective denotes moral judgment, providers in Indiana complied with Governor Holcomb’s order by quietly continuing to see patients. However, it remains unknown if the appearance of a ban in Indiana kept people from accessing care under the assumption that clinics were closed or unsafe to visit during the stay-at-home order.
People need abortions during pandemics.
An estimated 1 in 4 women will have an abortion during their lifetime, and almost one million women have an abortion each year.[iii] To add some perspective, the American Academy of Orthopedic Surgeons estimates surgeons perform about half as many total knee replacements each year. Abortions are outpatient procedures that do not require medical resources, including hospital staff, ventilators, blood transfusions, surgical PPE, or ICU beds. There is no medical reason for abortion, an ordinary, urgent, and critical procedure, to be excluded from essential services.
Policy does not need to be punitive, and we have the opportunity to reimagine abortion access when we prioritize public health.
Despite the intention of anti-abortion advocates, state restrictions do not decrease the demand for abortion.[iv] Abortion patients will seek care in friendlier state policy environments when denied services at home, even when that travel is a risk during a pandemic. COVID-19 has not changed the fact that people need abortion care. Instead of understanding this need, state leaders have chosen to obstruct access to care and place undue burdens on their residents.
Reimaging Abortion Access
Policy does not need to be punitive, and we have the opportunity to reimagine abortion access when we prioritize public health. Places friendlier to abortion used stay-in-place orders to protect abortion access. The Governors of New Jersey, Virginia, and Washington issued orders to preserve the healthcare system’s capacity that explicated exempted family planning services. The City of Austin recognized resident needs and contracted with an advocacy organization, Jane’s Due Process, to provide logistical support for abortion access.
Actions are available for state and local governments to support abortion patients through policy. Governors prioritizing public health should reduce COVID-19 exposure risk for patients, doctors, and clinic escorts by eliminating mandatory waiting periods that require patients to visit the clinic multiple times and expanding access to telehealth services.
Abortion cost creates inequality of care with expected out-of-pocket fees ranging from $400-$3,000 depending on timing, location, and access hardships. In 2017, KFF found that over one-half of reproductive age women on Medicaid live in states that restrict coverage. To address financial barriers to care, national advocates have moved to repeal the Hyde Amendment and allow federal spending on abortion. Alternatively, 34 states and D.C. can expand Medicaid abortion coverage on their own accord. Economic equity in this policy space is not only about paying for care; abortion is a resource that transforms lives. As the Turnaway Study found, abortion does not harm women, but being denied an abortion is detrimental to women and their children.
Policy is a reflection of values. We will never have justice in reproductive health policy until we value everyone’s right to decide how and if they have children. As the infection rates continue to rise across the country without a national response, state and local governments must step up to ensure their residents can access essential abortion care.
Author Note: Incidences within the text that refer to abortion patients as “women” reflect the language of the study cited. All sorts of people have abortions who do and do not identify as women.
[i] Roberts, D. E. (1999). Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. New York, NY: Vintage.
[ii] Language on these executive orders has varied amongst Governors and changed over time. California uses “stay-at-home order”; Texas officials say, “essential services and activities only”; Washington has a “Stay Home, Stay Healthy” order, and New York issued “Policies Assure Uniform Safety for Everyone (PAUSE).”
[iii] Jones, R. & Witwer, E. (2019, September 11). Abortion Incidence and Service Availability in the United States, 2017. Guttmacher Institute. https://www.guttmacher.org/report/abortion-incidence-service-availability-us-2017.
[iv]Medoff, M. H. (2010). State Abortion Policies, Targeted Regulation of Abortion Provider Laws, and Abortion Demand. Review of Policy Research 27(5), 577–94.