Abortion providers in Ohio say they are still open for business, still performing abortions, and still providing care for patients in their communities after an order to stop ‘non-essential’ surgeries last week.

“Abortion is an essential and time sensitive procedure,” said Iris Harvey, CEO of Planned Parenthood of Greater Ohio, “we are in compliance.”

Iris Harvey
Iris Harvey, CEO of Planned Parenthood of Greater Ohi

On Wednesday March 18, the Ohio Department of Health ordered that “all non-essential or elective surgeries” be stopped in an effort to preserve personal protective equipment like masks, gloves and gowns during the COVID-19 pandemic.

The health department said “a non-essential surgery is a procedure that can be delayed with undue risk to the current or future health of a patient.”

Examples of criteria to consider include:

  • Threat to patient’s life if surgery or procedure is not performed
  • Threat of permanent dysfunction of an extremity or organ system
  • Risk of metastasis or progression of staging; or
  • Risk of rapidly worsening to severe symptoms (time sensitive)

AG sends letters to abortion providers

Just two days later, the Attorney General Dave Yost’s office said it was forwarded complaints that abortion clinics weren’t complying with the non-essential surgery order.

Ohio Attorney General Dave Yost
Ohio Attorney General Dave Yost

On Friday March 20, the Attorney General sent letters to the Planned Parenthood of Southwest Ohio and the Women’s Medical Center in Dayton ordering they “stop performing non-essential and elective surgical abortions.”

The letters went on to say, “Non-essential surgical abortions are those that can be delayed without undue risk to the current or future health of a patient.”

The letter then threatened unspecified action, “If you or your facility do not immediately stop performing non-essential or elective surgical abortions in compliance with the attached order, the Department of Health will take all appropriate measures.”

Essential or Non-Essential?

“I don’t think there is a ‘non-essential’ abortion,” said Harvey.

At their daily briefings, Governor DeWine and Dr. Amy Acton have been pressed by reporters to clarify which abortion procedures would be determined “essential” and which would be considered ‘non-essential’.

Governor DeWine and Dr. Acton Saturday

Neither the Governor nor Dr. Acton would answer those questions but referred them to the Attorney General, who declined our request for an interview.

In an email, the AG’s communications director Bethany McCorkle wrote News 5: “As our client, if Dr. Acton’s office determines that her order was violated by any surgical facility in Ohio, they can refer it to our office to pursue legal action on behalf of the Ohio Department of Health. We cannot provide legal interpretations of her order.”

On Saturday March 21, the Attorney General also sent a letter to stop elective surgeries to the Urology Group in Cincinnati.

McCorkle also wrote, “This is not an abortion issue. A letter was also sent to a urology group that was allegedly performing elective surgeries.”

Lawmaker Appalled

State Senator Nickie Antonio, a Democrat who represents the west side of Cleveland and its suburbs, disagrees.

“I was so appalled at the vehemence of the order,” said Antonio.

Nickie Antonio

Ohio State Senator Nickie Antonio (right)

“I put the total focus of this whole interpretation of the original order on Attorney General Yost,” she said. “To selectively, just to focus on clinics that provide abortion care, put it into a political nature.”

Now is not the time “to politicize anything,” she said.

Antonio said she has spoken with abortion care providers about the order to halt elective surgeries.

“These clinics are in full compliance with the governor’s orders,” she said. “The misnomer was that somehow they weren’t.”

She also said it is critical women continue to have access to health care, including abortion services, during the coronavirus pandemic.

“Not only is it essential, it’s also time-sensitive,’ she said, due to Ohio’s restrictions on abortions services.

“The AG (attorney general) should not practice medicine without a license,” said Antonio. “It is not his job to identify what is essential for women’s reproductive health care.

”He should just stay in his lane,” she said.

Source: https://www.news5cleveland.com/news/continuing-coverage/coronavirus/local-coronavirus-news/ohio-abortion-providers-remain-open-despite-ags-order?fbclid=IwAR19CG_nMLzOG9afId_V4_RkIr9Nm0abv56QcZZEKEX–kkKoXsPBz9DiM4

Provisions tucked into the fine print of the 880-page bill take direct aim at Planned Parenthood, the reproductive healthcare provider and eternal GOP target over its role providing abortions.

WASHINGTON — A hard-fought battle over abortion raged just beneath the surface of the Senate’s $2 trillion coronavirus economic rescue plan. And it looks like Republicans won.

Provisions tucked into the fine print of the 880-page bill approved by the Senate Thursday take direct aim at Planned Parenthood, the reproductive healthcare provider and eternal GOP target over its role providing abortions. Those details make it harder for the group to shelter from the economic storm unleashed by the coronavirus pandemic, which has already profoundly disrupted the American healthcare system.

The bill makes it much more difficult, if not outright impossible, for Planned Parenthood to access new multi-billion dollar funds aimed at stabilizing the U.S. economy in the midst of the historic downturn, according to experts who spoke with VICE News.

The bill is complex and lengthy, and advocates on both sides of the abortion debate said at first they weren’t entirely sure what was hiding in its pages.

Democrats succeeded in striking one controversial passage from the bill that had seemed tailor-made to keep Planned Parenthood from accessing federally-backed loans. But a team of Republicans led by Sen. Marco Rubio of Florida gave the Trump administration other options for blocking federal funding, according to experts who read the bill as well as Planned Parenthood itself.

Trump’s Small Business Administration will have broad latitude to deny Planned Parenthood access to emergency rescue loans created by the new stimulus package and available to other nonprofits. The bill also includes language that blocks state and local governments from using coronavirus rescue funds from being allocated to cover abortion services.

“Anti-choice activists in Congress and the White House used a pandemic response to target sexual and reproductive health care and its providers,” said Clare Coleman, President and CEO of the National Family Planning & Reproductive Health Association. “It is wholly disappointing that Congress failed to support the entirety of the nation’s public health infrastructure.”

Sen. Josh Hawley, a Republican from Missouri and diehard abortion opponent, said he’d been assured pro-life forces had emerged victorious from the legislative battle, even though the text of the bill didn’t make that obvious.

“I’m not happy negotiators took out language that excluded Planned Parenthood from receiving government subsidies,” he tweeted. “But I have been assured Planned Parenthood will still NOT be eligible.”

Crisis loans

The bill puts the Small Business Authority in charge of overseeing a massive $350 billion lending program aimed at helping a wide variety of small-time operations across the country meet their payroll and pay rent. But it also gives Trump’s SBA leeway to decide that Planned Parenthood doesn’t qualify.

The bill says that nonprofits with fewer than 500 employees can receive loans. But the SBA gets to rule on whether any of the dozens of individual Planned Parenthood affiliates scattered around the country should be counted by themselves or as a whole, according to experts who reviewed the bill.

There’s also a similar upper ceiling on revenue that functions essentially the same way, creating another avenue for officials to bar Planned Parenthood, legal experts said.

“The Small Business Administration retains discretion to exclude certain providers” from the massive new loan program, said Mara Youdelman, an attorney with the National Health Law Program, a civil rights advocacy group. “This is troubling, especially in the middle of a crisis in the health care system when we need every provider available to provide services.”

In a statement, Planned Parenthood Action Fund, the group’s advocacy and political arm, acknowledged the impact of the provisions and criticized Republicans for including them.

“The Trump administration and Republican Congressional leadership once again used this must-pass relief bill to advance their anti-abortion agenda,” the group said. “The bill gives the Small Business Administration broad discretion to exclude Planned Parenthood affiliates and other non-profits serving people with low incomes and deny them benefits under the new small business loan program.”

Hyde Amendment provision

The stimulus package also includes language designed to keep states and local governments from using emergency funds for channeling money to pay for abortion.

The restriction links to the Hyde Amendment, which generally bars the use of federal funds to pay for abortion unless the life of the mother is at risk, or in cases of rape or incest. In this instance, the limitation was quietly tacked onto a $150 billion regional stabilization fund designed to help governments cope with the coronavirus, legal experts said.

While those funds can be doled out with plenty of leeway for the most part, the new legislation manages to attach Hyde language by referencing the current appropriations law, “Public Law 116-94,” in an otherwise extremely bland-looking paragraph tucked 600 pages deep into the text.

“The state can’t step in and say, [abortion] is going to be included in the package of healthcare that we are using this stabilization money to cover,” said Leila Abolfazli, Director of Federal Reproductive Rights at the National Women’s Law Center. “It ties their hands if they start providing healthcare services.”

Cover: Sen. Josh Hawley, R-Mo., talks with reporters after the Senate Republican Policy luncheon in Russell Building on Tuesday, March 17, 2020. (Photo: Tom Williams/CQ-Roll Call, Inc via Getty Images)

Source: https://www.vice.com/en_us/article/y3mjm5/how-republicans-snuck-anti-abortion-measures-into-the-coronavirus-bailout-bill?utm_source=vice&utm_medium=ppact-fb-covid&utm_campaign=ppact-fb-covid&utm_content=032820&fbclid=IwAR0ap3CuPGM4BMxVnqNlompo4ZrXwZcmuwwfajoUCIbFqv0s4amLy6nJNQ4

With anti-abortion state officials using COVID-19 to stop legal abortion and millions losing their jobs, abortion funds are seeing a crush of requests.

“If people don’t have jobs, they can’t afford to put anything towards the procedure and have to pinch pennies to get by. We have to get people their health care access, and abortion is health care,” O’Brien said.

For people seeking abortion care, the COVID-19 pandemic has made an already difficult situation harder.

In recent weeks, millions have lost their job, and parents are struggling to afford necessary childcare as schools across the United States have closed until further notice. People are faced with abortion costs that, for most, were difficult to afford in the first place. To make matters worse, states like Texas and Oklahoma have classified abortion care as “nonessential” in their COVID-19 response.

Organizations that help cover the costs of abortion care are already seeing the grim effects of a record 3.3 million people in the United States filing for unemployment benefits and Republican state officials using the crisis to interrupt abortion access.

Yellowhammer Fund, an abortion fund based in Alabama, has heard from callers who have lost their job as wide swaths of the economy shut down to slow the spread of COVID-19.

“It’s upsetting to see people become more impacted by what’s going on, and one of the things that’s upsetting is not seeing a better response [from our government] because people are hurting,” Candace E.C. O’Brien, associate director of health services for Yellowhammer Fund, told Rewire.News. “We have a low-income community [that’s] being heavily impacted by the virus that don’t have the same protections as [the] middle and upper class. They don’t have the same financial security—it’s impacting their health care and will impact it in the future as the pandemic grows.”

“If people don’t have jobs, they can’t afford to put anything towards the procedure and have to pinch pennies to get by. We have to get people their health care access, and abortion is health care,” O’Brien said.

Because of the increased need Yellowhammer is seeing during the COVID-19 pandemic, the organization has increased the amount of funding they provide callers and implemented a gift card program to provide more support. The gift cards will be mailed to clients and can be used anywhere, because, O’Brien said, limiting people to gas or groceries could increase the barriers they’re experiencing, and not everyone has access to a debit card or state-issued ID.

The Northwest Abortion Access Fund (NWAAF) was already seeing a high number of callers in January, something board member Nilofar Ganjaie said normally would have decreased by now. They’ve had to make changes to accommodate the skyrocketing demand by callers concerned they won’t be able to have an abortion during the pandemic.

People seeking abortion care in Washington state, Oregon, Idaho, and Alaska can call NWAAF’s 24/7 hotline, and  volunteers call back to assist with the cost of abortion and related travel and lodging. But because of concerns about spreading COVID-19, instead of volunteers opening their homes or driving patients to their appointments, NWAAF is reserving hotel rooms and booking transportation through rideshare apps to limit physical contact. Ganjaie pointed out the safety precautions rideshare companies have taken, adding that their organization is screening volunteers and callers for COVID-19 symptoms.

NWAAF has also struggled with providing food assistance during the COVID-19 outbreak. “We provide grocery delivery, and because delivery services are backed up three to five days, we’ve been having volunteers—and even our board of directors—deliver no-contact groceries or takeout to callers. We drop it off to where the person is staying and leave it on their doorstep,” Ganjaie told Rewire.News.

NWAAF has updated its hotline database so that it allows “hotline advocates to indicate if a caller is experiencing any additional barriers or hardship to access[ing] abortion due to the COVID-19 outbreak,” like if they need financial assistance because they’ve lost their job, or if the situation has made it harder to get to the clinic.

“Our purpose for tracking data is to adjust our plan, [because] we want to start collecting this information immediately so we can pivot [as an organization] as needed. We want to do what we can to shift our budget and allocate our money [to people seeking abortions],” Ganjaie said.

The organization also plans to provide funding assistance to people seeking abortion care in states outside the Northwest where Republican officials have suspended abortions.

Sarah Lopez, program coordinator for Fund Texas Choice (FTC), an organization that provides logistical support to Texans needing abortions, told Rewire.News that while people traveling out of state for care usually do so because of gestational limits, FTC has recently heard from people of “varying gestational ages” needing to travel because of canceled appointments. Access in Texas is already severely limited after a sweeping anti-abortion law shut down over half the state’s clinics, leaving some people 300 miles from the nearest provider.

“As of last week we haven’t been able to purchase bus tickets, but we’re still able to book flights, help with gas, and book whichever remaining hotels are open,” Lopez said. “The major effects of the crisis were kicked into full gear this week, as clinics were forced to cancel appointments. I’ve been doing my best to keep folks at ease and prepare them for out-of-state travel by maintaining that if they need to travel even further to reach a clinic, we will still help them get there.”

Lopez said she’s angry the state is using the COVID-19 outbreak as an opportunity to “politicize health care,” but she’s “feeling so much solidarity” with her partner organizations and clinics.

“I know that it feels harder than ever to access abortion care right now, but I want folks to know that they’re not alone and they have a whole community of people rallying behind them to make sure access isn’t pushed entirely out of reach.”

Source: https://rewire.news/article/2020/03/27/paying-for-an-abortion-was-already-hard-the-covid-19-economic-downturn-has-made-it-even-harder/

The Center for Reproductive Rights has filed an emergency lawsuit against the Governor of Texas and other state officials to ensure that patients can access essential, time-sensitive abortion care during the COVID-19 pandemic. In the lawsuit, the Center joins Planned Parenthood Federation of America and the Lawyering Project in representing a group of Texas abortion providers.

Earlier this week, after Governor Greg Abbott issued an executive order requiring the 30-day postponement of all surgeries and procedures not deemed immediately medically necessary, Texas Attorney General Ken Paxton issued a press release singling out abortion providers and interpreting the order to include “any type of abortion that is not medically necessary to preserve the life or health of the mother.” As a result of the ensuing confusion created by the Attorney General’s statement, Texas providers have had to turn away dozens of patients and cancel hundreds of appointments, preventing patients from accessing essential care.

“It’s unconscionable that the Texas Attorney General is exploiting this pandemic to end abortion in the state,” said Nancy Northup, president and CEO of the Center for Reproductive Rights. “Abortion care is time-sensitive and essential health care that has a profound impact on a person’s health and life, which is why it is protected as a constitutional right. Texas is abusing the state’s emergency powers and we are filing suit to stop it.”

The lawsuit claims that the executive order and the Attorney General’s interpretation of it are unconstitutional since they impose a de facto ban on abortion. Plaintiffs are seeking a temporary restraining order and ultimately a permanent injunction against the executive order and its interpretation. The lawsuit asserts, “By selectively burdening patients’ fundamental right to abortion without justification and singling abortion providers and their patients out for differential treatment from providers of other medical services and their patients, the Executive Order and corresponding Attorney General interpretation and the Emergency Rule, as enforced, violate Texans’ right to equal protection guaranteed by the Fourteenth Amendment to the U.S. Constitution.”

According to medical experts including the American College of Obstetricians and Gynecologists and the American Board of Obstetrics and Gynecology, abortion is an essential, time-sensitive procedure, and delaying this care could “profoundly impact a person’s life, health, and well-being.”

The state of Texas has some of the most restrictive abortion laws in the country as well as one of the country’s highest rates of uninsured residents.

Source:  https://reproductiverights.org/story/center-files-emergency-lawsuit-texas-protect-essential-abortion-access-during-pandemic?fbclid=IwAR1dmqF4ajDigCxV5CyTerhPry4pftxtYzVlch2cpRVMxzGR_POaPJKJdQc

Last weekend, Ohio Attorney General Dave Yost ordered Ohio reproductive health clinics to cease providing abortions—claiming that abortion services are not “essential” medical care during the COVID-19 pandemic.

When Ohio state House Representative Tavia Galonski—chair of the Ohio Women’s Democratic Legislative Caucus—first heard the news, she felt rage.

“It is not the job of the state to take away women’s agency,” Rep. Tavia Galonski—a long-time advocate for women’s rights—told Ms. Pictured: Galonksi in September 2019 co-sponsoring a bipartisan bill to shield crisis counselors from being forced to testify. (WSOU)

“Now is not the time to overturn the U.S. Constitution in the middle of a pandemic,” she said.

After his announcement, Attorney General Yost faced immediate pushback from abortion rights advocates and pro-choice state legislators.

Following a round of intense negotiations, Ohio clinics remain open.

Ohio’s Clinics Stay Open in the Midst of the Coronavirus Confusion

The clinics are closely complying with current state recommended medical guidelines for all procedures—including taking steps to reduce the use of personal protective equipment (PPE), one of Yost’s cited concerns about abortions continuing amidst the pandemic.

Planned Parent of Greater Ohio said in a March 24 statement:

“Our doors remain open. There has been some confusion in coverage over abortion access during the COVID-19 pandemic. Planned Parenthood is in full compliance with the Ohio Department of Health orders and continues to operate while responsibly using personal protective equipment during this pandemic crisis.

“Abortion is a time-sensitive and essential medical service. Ohioans can continue to rely on us for safe, legal, surgical abortions.”

Galonski and other abortion advocates maintain that unlike elective surgeries, access to safe reproductive care can’t be delayed. They say abortions are time-sensitive for health reasons—as some women have medical conditions that can make each additional day of a pregnancy life-threatening—and some states prohibit abortions beginning as early as 20 weeks into a pregnancy.

“When you’re talking about a medical issue that’s so complex, you just cannot have the state playing a heavy-handed role in this,” Galonski told Ms. “It is a gigantic abuse of power. It is not the job of the state to take away women’s agency.”

The American College of Obstetricians and Gynecologists has also recommended that abortion not be included in the list of medical procedures that could potentially be postponed.

Galonski feels medical decisions limiting access to abortion should be made by medical experts—not politicians.

“It must remain a medical decision with medical guidance from a provider,” she said. “I am not a doctor. Mr. Yost is not a doctor. We cannot pretend to practice medicine all for the sake of our own political opinions.”

While Galonski understands the importance of conserving vital medical supplies for the emergency response to the ongoing COVID-19 pandemic, she sees Yost’s original decree as an opportunistic political move to ban abortion in Ohio completely.

“Once we started to dive into his order, what we found out was that the abortion clinics were more than prepared to make available [personal protective equipment],” she said. “They were more than happy to conform with the medical guidance given—so it wasn’t necessary for Yost to come in with that heavy hand on top of all it and say, ‘You guys need to close.’”

Rep. Galonski and her colleagues in the Ohio state legislature have been working closely with abortion care providers and advocacy groups like Planned Parenthood Ohio and NARAL Pro-Choice Ohio in response to the attorney general’s order. Rep. Galonski was tapped to take the lead on the response in the state legislature—alongside co-chair Rep. Kristen Boggs and policy chair Rep. Alison Russo.

“Just because it is a pandemic doesn’t mean that you can just make wholesale sweeping decisions and take away everything that people have known under the Supreme Court,” said Galonski. “It took a bunch of people coming together to say no, and to say it in the best kind of way, and really to let people know that we’re still at work.”

“The women’s caucus is at work every day during all of this, and we’re watching,” she continued. “We’re awake … We’re at work, and the answer is no.”

Galonski asserts that Yost’s weekend declaration created more confusion at a time when there is already an overabundance of misinformation related to public health and the response to COVID-19.

Yost’s order also suggested that clinics aren’t already adhering to best practices, she said—even though there is no evidence of clinics not following the strict guidelines in place for medical practitioners and facilities. She also pushes back against the idea of abortion being deemed non-essential.

“The people who need an abortion or who are going in to speak with an abortion provider—nothing about what they’re doing is elective. To try to be reductive and to suggest that this is the same as whether or not I’m going to have a root canal tomorrow is missing the point: No matter how you come down on the issue, it should not be the state directing what women do with our bodies,” Galonski said. “We have to have our own agency.”

Texas, Louisiana and Others Attempt to Follow Ohio’s Lead

In the wake of Ohio’s move to restrict abortion access, state leaders like Gov. John Bel Edwards in Louisiana and Attorney General Ken Paxton in Texas have used the pandemic to suspend abortions outright—and Nebraska may be the next state to pass a similar decree.

And breaking these edicts comes with a steep price: In Texas, “any type of abortion that is not medically necessary to preserve the life or health of the mother” can result in penalties up to $1,000 or up to 180 days of jail time.

Louisiana’s few remaining abortion clinics have temporarily suspended abortion care for the time being.

“Any state that decides to do this—that makes me very sad,” said Galonski. “We have this [pandemic] going on, and we need to be … trying to help people through this crisis—not creating new ones. We don’t have to be our worst selves during the middle of this tragedy; we can actually rise above all of it and focus more on what people need during the pandemic instead of creating additional burdens because you believe this is a great time to do it.”

Galonski is prepared to fight to secure abortion access in Ohio.

“We’re going to fight,” she said. “We’re not going to take this.”

Still have questions?

Source: https://msmagazine.com/2020/03/24/heres-how-ohio-women-legislators-are-working-to-keep-abortion-clinics-open/?fbclid=IwAR2TxVkw91OnRpgNaAdy89lyvwiJ5CsVCHbQL5Be-hZQ7KKTJ3ygXP09xPM

The growing COVID-19 pandemic has impacted every facet of American life, shuttering schools and businessescausing the economy to grind to a haltoverwhelming hospitals, and decimating once-thriving industries. Something the new coronavirus won’t do, according to providers and clinic directors, is stop their patients from accessing abortion care.
But efforts are already underway to paint abortion as “elective” and “nonessential” health care. On Saturday, Ohio Attorney General Dave Yost (R) ordered clinics in the state to halt abortions, going against the recommendations of medical professionals. Still, clinics and physicians have continued to provide abortion care despite the order. On Monday, Texas Attorney General Ken Paxton (R) followed suit, ordering a ban on abortions in the state unless the life of the pregnant person is threatened.
In the week leading up to Ohio and Texas’ executive orders, abortion providers presciently expressed their concern that some lawmakers would use the pandemic as an opportunity to further restrict abortion care—and abortion access is already being strained as the full force of the novel coronavirus is unleashed across the United States. Prism spoke to OB-GYNs, clinic directors, and abortion funders from Washington state to Maine to learn more about the concerns of their patients, the challenges providers are facing, and the strategies they’re developing to continue providing abortion care.
‘Oh, shit. This feels totally different.’
In early March, the first person in North Carolina tested positive for the novel coronavirus. Calla Hales, director of A Preferred Women’s Health Clinic (APWHC) in Charlotte, North Carolina, said that in the days since, “it’s a whole new reality.”
“Ever since there were reported cases in North Carolina, there has been no way to have a solid plan. Things are shifting from day to day. You go to bed and you don’t know what the [Centers for Disease Control and Prevention] will tell you in the morning,” Hales said. “I feel like all of us had that moment where it was like, ‘Oh, shit. This feels totally different.’ We heard for so long that this wasn’t a big deal, and then it was a pandemic.”
In North Carolina, existing restrictions already make accessing abortion a challenge. For example, a person must receive state-directed counseling that includes information designed to discourage them from having an abortion, and then wait 72 hours before they can access care.
“There are restrictions and then there’s just general life issues that come into play when you’re trying to receive abortion care, like the cost, transportation, logistics, and finding child care. Child care has always been a huge issue for people trying to access care and now schools are closed,” Hales said.
According to the providers who spoke to Prism, continuing to offer abortion care is their primary concern, along with reducing any risk of contracting the virus. Many clinics are implementing new safety measures in the face of COVID-19. APWHC and other clinics have started to stagger their appointments and increase their already stringent cleaning protocols, and staff will now be gloved between patient interactions. Clinics are also rearranging waiting rooms to create more “barrier spaces” and removing chairs so there is more distance between patients. Some safety measures will have a more direct effect on patients’ experiences. Like many health centers, clinics offering abortion care now ask patients not to bring companions with them to the clinic waiting room. APWHC has also added a pre-appointment screening call to their process as a way of learning if a person has any COVID-19 symptoms.
While Hales and her staff are doing everything they can to calm patients’ fears, she told Prism there are some questions she doesn’t have answers for.
“I’ve had patients ask what happens if they change their mind and keep the pregnancy, they want to know what happens [to the fetus] if they get coronavirus. Patients have asked if coronavirus causes miscarriage. It’s such a kick in the teeth that I can’t give them an answer. Because we don’t know, and I’m saying that as someone who is pregnant right now,” Hales said. “I’ve also been asked what happens if you show up to a clinic and you’re exhibiting symptoms and have to quarantine. Abortions are time-sensitive and the longer you have to wait, the more the possibility that the price and the options available change.”
As patients continue to seek out abortion care, increased testing for COVID-19 has revealed cases are exploding nationwide and states, cities, and counties are preparing for the inevitable hospital overcrowding and supply shortages. APWHC’s four locations in North Carolina and Georgia are feeling the squeeze of shortages of personal protective equipment like face masks and disposable gloves. Hospitals are receiving priority for these items, leaving clinic directors like Hales scrambling to find alternate sources.
Patients going to APWHC in Charlotte, North Carolina, also have to contend with the dozens of anti-abortion protestors who congregate outside of Hales’ clinic on a daily basis. On Saturdays, the number of protestors easily rises to hundreds. They yell on loudspeakers, jump in front of cars, and generally harass patients. Even after North Carolina Gov. Roy Cooper (D) banned gatherings of more than 100 people, Hales reported on social media that anti-abortion protestors were still showing up en masse. In fact, protestors seem to be encouraging protest during—and in spite of—the pandemic.
“I wish I could say that [the] pandemic scares people away, but Governor Cooper said there should be no gatherings over a hundred people and there were 151 protesters out on Saturday [March 14]—and that’s actually kind of small for us on a Saturday. We had protesters out [on March 16] that were sticking their heads in cars and holding babies on the sidewalk,” Hales said.
Telemedicine abortion: A game changer
Telemedicine could make abortion more accessible and eliminate potential exposure to COVID-19 while enabling people to maintain a safe social distance. As Christine Grimaldi reported for Vice, telemedicine would enable providers to prescribe abortion pills from a distance, but “longstanding federal regulations require that clinics dispense mifepristone, one of the two drugs commonly used together in medication abortions, in person—meaning the drugs can’t be picked up at a pharmacy or sent in the mail.” This means that while a patient can take their medication at home, they can’t get it without leaving their home. According to the Guttmacher Institute, 18 states “require the clinician providing a medication abortion to be physically present during the procedure, thereby prohibiting the use of telemedicine to prescribe medication for abortion remotely.”
During the coronavirus pandemic, states like Texas are lifting restrictions on telemedicine, but they are not including abortion in their “emergency adoption” of the technology. Clinic directors and abortion providers told Prism that being able to utilize telemedicine abortion at any time, but especially during a pandemic, would be a “game changer.” As Grimaldi reported for Vice, telehealth and telemedicine abortion can take various forms. “Clinics that practice telehealth may text their patients with instructions before their abortion, whatever type it may be, and with follow-ups after. Under a telemedicine model, medication abortion patients may video conference with perhaps the only provider able to serve multiple clinics across several states,” Grimaldi wrote.
Nurse Leah Coplon uses telehealth for abortion and can attest to the difference it makes. Coplon is the program director at Maine Family Planning, where she runs the clinic’s abortion services. Maine is just one of a handful of states that offers telemedicine abortion. When Coplon spoke to Prism on March 16, Maine had 31 cases of the coronavirus. As of today, it’s more than 100.
“We have a pretty robust telehealth system with medication abortions throughout our state,” Coplon said. “As [much as] possible, we want to limit how much contact patients and staff need to have. If a patient absolutely knows when their last period was, if they don’t have any contraindications, if they are within the gestation that is safe to do a medication abortion, then we don’t need to do an ultrasound. We don’t need to do lab testing. We are actually able to do all of the informed consent pieces via a telehealth video conference prior to their arrival. Then we can actually just pass them the medications, be available to them over the phone if they need us, and do a follow-up via telehealth.”
Maine Family Planning provides medication-based abortions at 18 of their facilities throughout the rural state, and since telehealth patients typically only need to visit the clinic once, it drastically reduces their travel time and expenses.
Coplon said that clinic directors, abortion providers, and abortion funds nationwide are in communication with each other. They’re a “close-knit family,” she said, and trying to strategize about best practices during the coronavirus. The program director said that because of Maine Family Planning’s “unique experience with telehealth,” others have been reaching out for guidance.
“Folks from other states are reaching out to talk about ways they may be able to provide care for their patients, they want to know how we can collaborate or learn from each other,” Coplon said. “I think people are really recognizing the gravity of this situation. They want to make sure that we ensure that people can get abortions who want them. It’s actually the bright side of all of this. Abortion providers care so deeply about patients. That’s really being highlighted right now. What’s paramount to them is making sure people get the care they need.”
Abortion is not elective
Coplon is referring to providers like Dr. Ghazaleh Moayedi, a board-certified OB-GYN and the only actively practicing abortion provider who lives in her Texas community and provides care to the legal limit, which is 20 weeks. When Moayedi spoke to Prism, she was at home with her young child because daycares and schools in the area are closed. Both Moayedi and her partner are physicians caring for vulnerable populations and the pandemic is hitting them hard. Complicating matters further, Moayedi’s mother, who often provides backup child care, is stuck in Iran due to COVID-19.
As a Texas resident and abortion provider, Moayedi has seen how natural disasters highlight the urgency to remove the state’s targeted regulation of abortion providers (TRAP) laws, which are intended to close abortion clinics through medically unnecessary state-level regulations, like requiring clinics to be outfitted like miniature hospitals. During a pandemic, the doctor said, laws like these “have the potential to harm even more people than they already do.”
But TRAP laws don’t just stop at the clinic building. Texas also has a mandatory in-person follow-up for medical abortion, which Moayedi says isn’t needed.
“This means that rather than providing medical abortion without any in-person contact, which is safe, effective, evidence-based, and would be the ideal option in the setting of a pandemic, we’re instead requiring [providers] to see people three times,” the OB-GYN said, noting that Texas also continues to a ban telemedicine abortion.
“I already see patients every week who drive hundreds of miles for abortion, but encouraging or requiring long distance travel for health care during a pandemic doesn’t make any sense, and it’s dangerous,” Moayedi said.
The Texas provider told Prism that some advocates are worried that during the pandemic, it’s “risky” to even have public conversations about the laws that force people seeking abortion care to make multiple visits to the clinic.
“The fear is that rather than actually loosening these restrictions, it might go the other way and prompt states to further restrict abortion,” Moayedi told Prism. “I definitely understand [the fear], but we have to be bold. We have to be brave. We have to stand up for the people that we serve. There is nothing but fear right now and so we have to act. Our actions should be guided by our mission.”
Nationally, there is growing concern that more state officials will take a cue from Ohio and Texas and pounce on the opportunity to further restrict abortion care by deeming it “elective.” Moayedi said calling abortion care “elective” is an “age-old argument,” though it’s an especially dangerous one now that hospitals nationwide are canceling nonemergency and elective procedures as they prepare for a spike in coronavirus cases.
Providers know that abortions are time-sensitive, that they are not elective, and that people seeking them need immediate care. But coronavirus may force a conversation in each state about whether abortion is elective and providers are justifiably nervous about where things will land.
Moayedi anticipates there will be “conflicts” during the pandemic at every single hospital or institution that provides abortion care as they weigh whether resources should be used for abortion. The American College of Obstetricians and Gynecologists and other medical organizations released a statement making it clear that obstetric and gynecological procedures for “which a delay will negatively affect patient health and safety should not be delayed.”
“To the extent that hospital systems or ambulatory surgical facilities are categorizing procedures that can be delayed during the COVID-19 pandemic, abortion should not be categorized as such a procedure,” the statement read.
‘Open and providing care’
Few understand the importance of continuing to provide care during a pandemic quite like Dr. Melissa Paulen, an OB-GYN and a University of Washington family planning fellow who provides abortion care throughout the Seattle area. Until relatively recently, Washington was considered the coronavirus epicenter in the United States.
Paulen told Prism she feels supported in continuing to provide abortion care through the pandemic, especially because when Washington Gov. Jay Inslee (D) announced new restrictions on nonurgent medical procedures, Paulen’s department chair made it clear that abortion care was not going to be treated as “elective.” Generally, the OB-GYN said one of her biggest concerns is misinformation circulating that hinders people from accessing care.
“I want to make it very clear that abortion does not fall under the category of ‘elective.’ I want people to know that abortion providers, both independent clinics and those housed in other institutions, are open and providing care,” Paulen said. “We are going to do everything possible to make sure patients are still able to receive the abortion care they need. It would take the governor or the president telling us we need to shut down, and even then it would be a fight.”
This was echoed by Dr. Laura Sienas, also a Seattle-based board certified OB-GYN, who told Prism that her hospital is one of the “first line responders” for COVID-19 patients, and it continues to provide abortion care.
Sienas is a maternal fetal medicine specialist who specializes in high-risk obstetric care. Because maternal fetal medicine doctors are usually concentrated in larger cities, patients often have to travel across the state to see her, especially because there are limited providers of second trimester procedures in her state. As many other providers have noted, Sienas said that the pandemic and its requirement of social distancing has shone a “giant spotlight” on all of the barriers that pregnant people experience trying to access abortion care.
“Abortion is an essential part of health care. Unfortunately, it’s often not treated that way,” Sienas said. “Now more than ever, if people are financially able, it’s a great time to donate to abortion funds, especially funds that help people travel long distances for abortions. Those funds are going to become so important as maybe smaller clinics are forced to reduce care during the pandemic.”
‘Abortion matters just as much’
Every clinic director and abortion provider who spoke to Prism discussed the importance of donating to abortion funds in this moment. Not only has the Trump administration worked diligently to dismantle abortion rights and attack abortion funding, but Republican elected officials are now attempting to use the pandemic to further restrict care, as we’ve seen in Ohio and Texas. This is also happening federally. As Rewire.News reported, amid negotiations over a proposed federal coronavirus relief package comes “the White House’s reported insistence that the federal response to a rapidly growing pandemic include ‘Hyde Amendment’ language to ban federal funding of abortion.” The Hyde Amendment bans federal funding for abortion except in cases of rape, incest, and life endangerment.
Abortion funders are already reporting the impact that COVID-19 has had on their fundraising efforts.
Ariella Messing is a doctoral candidate in bioethics and health policy who is writing her dissertation on abortion funds. She is also a volunteer and fundraiser with the Baltimore Abortion Fund (BAF). Each spring, abortion funds nationwide roll out their fundraising campaign, known as the fund-a-thon, and they each set goals for how much money they will raise. BAF, for example, set a goal for $60,000, but Messing made it clear they could use “many multiples of that.” These fundraisers provide a substantial chunk of each fund’s budget for the year and just a few large checks can make “all the difference in the world,” Messing said.
BAF provides financial assistance to people who live in Maryland or are traveling to Maryland for abortion care. Maryland and the Washington metro area are home to two of the East Coast’s four clinics that provide later abortion beyond 24 weeks, which can cost as much as $10,000. BAF provides just a portion of that funding for their patients, and the rest often comes by way of pledges from abortion funds across the country.
“Because of the pandemic, if people can’t get the abortion they need now, more people will have to travel to Maryland for later abortion at the two clinics here that offer it. That means we’ll need thousands and thousands of dollars more because people couldn’t get the care they needed when they needed it. It feels very bleak,” Messing said.
The doctoral candidate told Prism it simply “feels hard” asking people for money right now, given that so many are now out of work or on the verge of losing their jobs and their homes. The problem is that abortion funds’ inability to fundraise now impacts people seeking abortion care for the rest of the year, and COVID-19 has essentially significantly disrupted people’s ability to access care in a timely manner.
This is reflected in the online postings of pregnant people who have upcoming appointments for abortion care. As co-founder and co-director of the Online Abortion Resource Squad (OARS), a group of volunteers who organize to ensure every post on Reddit asking for help with an abortion experience gets an accurate response, Messing said that people appear deeply concerned about how the pandemic will impact their ability to access care. In the last week or so, Reddit has been flooded with posts about COVID-19, including posts from people concerned that their packages containing abortion pills may not come in the mail. Aid Access, one of the only organizations that provide telemedical abortion services to pregnant people, is currently unable to mail the abortion drugs mifepristone and misoprostol because their pharmacy is in India.
All signs point to COVID-19 being a “disaster for abortion access,” Messing said. But providers nationwide are committed to providing care through the pandemic—and for pregnant people who want to access care, that’s a bright spot during an otherwise terrifying time.
“I truly understand that there are life and death problems right now, but abortion matters just as much,” Messing said. “There are people going to the clinic each day risking exposure so that other people can get an abortion. To me, that’s heroic.”

Abortion providers face a complex interplay of questions about how to balance their own health, the need to physically distance, and the potential of COVID-19 to limit patients’ ability to travel for abortion services.

A recent report by the Guttmacher Institute warned of an “extreme strain” on reproductive health-care workers’ ability to serve patients in the midst of the COVID-19 outbreak.

When Dr. Sheila Ramgopal woke up on March 15, the COVID-19 warning signs were there. A dry cough. A sore throat. Some tightness in their chest, and a temperature slightly over 100 degrees.

“Not even a fever in my mind,” Ramgopal, medical director of Pittsburgh’s Allegheny Reproductive Health Center, told Rewire.News. But the symptoms met the criteria to be tested for COVID-19. All that was missing was a known exposure to someone who had tested positive for COVID-19.

“I see patients from all over central and western Pennsylvania and Ohio and West Virginia, it’s hard to know [where I might have been exposed],” Ramgopal said.

Ramgopal, who described their symptoms as “super mild,” called the state department of health and the Wolff Center at the University of Pittsburgh Medical Center to ask to be tested. They were told instead to quarantine at home for 14 days if they suspected they might have COVID-19. But as a doctor providing abortion care, which is not widely available in their area, “obviously, that was not possible,” they said, without trying to find out if they actually posed a risk to patients.

As Ramgopal awaited their test results, they were confronting the reality faced by abortion providers across the country, as the COVID-19 pandemic takes a drastic toll on services and the accessibility of abortion care. With confirmed cases in all 50 states, abortion providers are facing a complex interplay of questions about how to balance their own health, the need to physically distance, and the potential of COVID-19 to limit patients’ ability to travel for abortion services—all of which jeopardize the future of the independent clinics that provide 60 percent of abortions in the United States.

“I feel very powerless and I feel guilty, truly guilty for not being able to provide direct patient care in a really critical time,” Ramgopal told Rewire.News last week.

A recent report by the Guttmacher Institute warned of an “extreme strain” on reproductive health-care workers’ ability to serve patients in the midst of the COVID-19 outbreak. “These are truly unprecedented times,”  Nikki Madsen, executive director of the Abortion Care Network, the national association for independent abortion providers, told Rewire.News in an email. “We are feeling anxiety of the unknown. … The challenges that independent abortion clinics and their patients have had to contend with all along remain true and will likely be amplified.”

In Atlanta, Kwajelyn Jackson, executive director of the Feminist Women’s Health Center, said she and her staff have rescheduled and delayed all elective wellness services to prioritize abortion care, which is particularly time-sensitive. “That’s not a simple decision to make,” Jackson said. “We don’t want to prevent people from getting other kinds of health care … but in order to prolong our ability to provide abortions, we want to make sure our staff are not encountering too many people at once.”

Atlanta’s Feminist Women’s Health Center has staggered appointments and instructed non-clinical workers to work from home. “Our priority is going to be ensuring access to everyone who needs it and keeping people safe and healthy,” Jackson told Rewire.News.

Then there is the question of how these clinics, like other independent businesses, will remain open and can ensure their staff have a workplace to return to once the country has weathered the social and economic upheaval unleashed by COVID-19.

“We are likely going to have to dip into our reserves and … really reallocate our budget to ensure that people can get paid appropriately,” Jackson said. “I’m not going to pretend that this is not taking an emotional toll on me.”  The center’s development team, she said, is considering how future fundraising efforts can frame the potentially devastating impact of the coronavirus crisis on the clinic’s ability to survive.

“We’re monitoring the best circumstances to keep our doors open,” Jackson said.

“People are facing real financial pressures right now,” Madsen said. “And that can be a real challenge for fundraising.”

For Ramgopal’s clinic, the COVID-19 crisis has hit in the middle of a fundraising push for the local abortion fund, coinciding with the National Network of Abortion Funds’ annual fundraising campaign.

As clinics and providers grapple with their new professional reality, telehealth services have seen a surge in usage. Ramgopal, for example, was able to provide virtual consults while waiting for their test results, and 40 percent of their clinic’s staff started working from home.

But while telemedicine can increase patients’ access to reproductive health care, including medication abortion, obtaining an abortion via telemedicine remains prohibited in 18 states. And the Food and Drug Administration has refused to remove its restrictions on telemedicine abortions, Vice reported.

For Madsen, the COVID-19 “pandemic [is] …highlighting just how harmful abortion restrictions can be. That’s true of abortion-specific telemedicine bans, but also of other medically unnecessary restrictions like forced waiting periods, bans on insurance coverage for abortion, physician-only laws, and parental consent and notification laws. … Those barriers have the potential to become increasingly insurmountable now.”

And with a national lockdown and potential domestic travel restrictions looming, access to abortion could become even more fraught. “Abortion is not elective. People are going to … need abortions and [other forms of reproductive care],” Ramgopal said. “If we have travel bans, it’s going to create much worse issues and much more burden on our health-care system and on those people’s communities and their families.”

“There is never an appropriate time to have unnecessary restrictions on abortion,” said Erin Matson, an organizer and co-founder of the direct action group Reproaction, “but the time to lift them is now.”

Meanwhile, Ramgopal is ready to return to clinical work; after several days at home, their test came back negative.

Source: https://rewire.news/article/2020/03/23/i-feel-very-powerless-how-abortion-providers-are-dealing-with-covid-19/?fbclid=IwAR1arSetDw0UEncgDVGredorXBLjseaNZ7UwOwNJe4w0rWQvxOTBCB9vfNs