The ruling is a win for the state’s only abortion clinic, which challenged the law on behalf of its patients.

Protesters on both sides of the abortion debate gather outside the U.S. Supreme Court in January 2018. (AP Photo/Susan Walsh)

CINCINNATI (CN) — The Sixth Circuit refused Tuesday to reinstate a Kentucky law that would require physicians to perform a so-called fetal demise procedure before a standard second trimester abortion, ruling the law imposes a significant burden on women seeking abortions.

A divided three-judge panel upheld a permanent injunction granted by U.S. District Judge Joseph McKinley, who found House Bill 454 unconstitutional last year following a bench trial.

EMW Women’s Surgical Center in Louisville, the last operating abortion clinic in the Bluegrass State, sued the state’s Cabinet for Health and Family Services after the bill was signed into law by former Republican Governor Matt Bevin in April 2018.

In his ruling, McKinley said the dangers inherent in the fetal demise procedures outweighed any interest of the state.

“The commonwealth’s legitimate interests do not allow the imposition of an additional required medical procedure – an invasive and risky procedure without medical necessity or benefit to the woman – prior to the standard D&E abortion,” he wrote, referring to the dilation and evacuation method. “Here, Kentucky’s legitimate interests must give way to the woman’s right.”

The case was argued before the Cincinnati-based appeals court in January. U.S. Circuit Judge Eric Clay, an appointee of Bill Clinton, wrote Tuesday’s majority opinion.

Kentucky argued that HB 454 is not a de facto ban on second trimester abortions because its requirements regarding fetal demise procedures are “reasonable alternatives” to the D&E procedure.

Judge Clay stopped that argument in its tracks and pointed out a “fundamental flaw” in the state’s claim.

“Fetal-demise procedures,” he wrote, “are not, by definition, alternative procedures. A patient who undergoes a fetal-demise procedure must still undergo the entirety of a standard D&E. Instead, fetal-demise procedures are additional procedures. Additional procedures, by nature, expose patients to additional risks and burdens.”

The judge added, “No party argues that these procedures are necessary or provide any medical benefit to the patient. The district court’s findings suggest that these procedures impose only additional medical risks. Thus, we consider them inherently suspect.”

Clay proceeded to sift through the evidentiary findings of the bench trial regarding each of the proposed fetal demise procedures – which include injections of digoxin and potassium chloride and umbilical cord transections – and found that McKinley’s ruling was not clearly against the evidence presented during trial.

Clay classified each of the three fetal demise procedures as “medically risky and unreliable,” and rejected the state’s arguments regarding their benefits, including the reduction of fetal pain.

Evidence presented to the district court suggested that a fetus does not feel pain until around 24 weeks into a pregnancy, at which point D&E procedures are no longer performed, and so the appeals panel’s majority found McKinley’s decision was not clearly erroneous.

Senior U.S. Circuit Judge Gilbert Merritt Jr., a Jimmy Carter appointee, joined Clay’s opinion.

U.S. Circuit Judge John Bush, an appointee of President Donald Trump, dissented from the majority and authored a separate 10-page opinion.

In the dissent, Bush said it was odd that “not a single person whose constitutional rights are directly impacted by the law is a party to the case,” and argued the case should have been dismissed for lack of standing.

While physicians and abortion providers are generally granted third-party standing to sue on behalf of their patients, Bush was skeptical that the providers in this case could satisfy the “closeness requirement” of such a position.

Bush cited expert testimony from the trial that showed a large percentage of women seeking second trimester abortions prefer to have a fetal demise procedure before the abortion, and said this created a conflict of interest between the abortion providers and the patients they represented in the suit.

“At the very least,” he wrote, “the proof at trial reflects a potential conflict between the interests of the EMW physicians and some, perhaps the majority, of the patients that they seek to represent. All of the evidence presented at trial about patient preference circumstantially supports a finding that at least some – and potentially, most – of patients seen by plaintiffs would favor the effect of H.B. 454 because those patients would want fetal demise before a D&E.”

He added, “The statute essentially requires that abortion providers at EMW receive the necessary training, which in turn would allow those women who prefer fetal demise to obtain it before the D&E procedure is performed.”


Kenia was sentenced to 30 years in prison in El Salvador for abortion after she said she miscarried.

Seven months pregnant, Manuela, a mother of two, said she miscarried at her modest home in rural El Salvador. But the police, and a judge, didn’t believe her. They charged and convicted her for aggravated homicide, sentencing her to 30 years in prison.

But Manuela only served two of those years. In 2010, she died alone in a hospital of Hodgkin’s lymphoma, a disease her lawyers say caused her to miscarry.

More than 140 women have been charged under El Salvador’s total ban on abortion since 1998, incarcerated for up to 35 years in some of the world’s most notorious prisons. Like Manuela, many say they never had an abortion, but instead claim that after suffering a miscarriage they were wrongfully convicted when their doctors accused them of intentionally terminating their pregnancies.


A photo of Manuela on display at her mother’s home in El Salvador. Manuela was convicted of homicide after what she said was a miscarriage. She was sentenced to 30 years in prison and later died of lymphoma.GILAD THALER

At a moment when Roe v. Wade appears more vulnerable than ever to legal challenges, El Salvador provides a glimpse of what the United States could look like if bans on the procedure are permitted.

For more than 20 years, El Salvador — a tiny Central American country struggling with brutal gang violence and a record-high homicide rate — has completely banned abortion, including in situations when the procedure could save the patient’s life. The total ban was lobbied for by the Roman Catholic Church, an institution that became particularly powerful in the country after its devastating civil war. In 1998, the church was successful in cementing the ban into El Salvador’s constitution, adding an amendment to say that “life begins at conception.”

“No one should act against a life once it has been conceived,” said Father Edwin Banos, a social media savvy millennial priest based in Metapan, El Salvador, who’s thrown public support behind the country’s anti-abortion laws. “A doctor will always want to save both lives,” Banos said. “The mother and the child.”

But Dr. Ronald Lopez, an OB-GYN  based in San Salvador, says that’s not always possible and the ban has prevented him from saving the lives of some of his patients. Lopez recalled one patient, a woman who  came to him with a heart disease that made her pregnancy a life-threatening condition.

“We couldn’t make the abortion, so the woman died about nine weeks later,” Lopez told CBS News during an interview from the maternity ward of San Salvador’s public hospital for women. “And the baby, too.”

Because of the ban, Lopez says his hands are tied. Performing an abortion, even if the procedure would save the patient’s life, can carry a prison sentence of up to 12 years, according to El Salvador’s penal code.


Dr. Ronald Lopez, an OB-GYN at the National Women’s Hospital in San Salvador, El Salvador.GILAD THALER

Doctors like Lopez are also responsible for reporting potential abortions, even though according to Lopez, it’s next to impossible to tell the difference between an abortion and a miscarriage in many cases. If a patient comes into a hospital with a miscarriage but a doctor suspects it was an abortion, the physician is required to call the National Police, who come to the hospital to investigate. Indeed, over half of the women jailed for abortion in El Salvador were first accused by their doctor, according to the Center for Reproductive Rights.

But that hasn’t stopped patients from seeking the procedure.

“Abortions are performed every day, in every country,” Lopez said. “Ban or no ban on abortion, it will be the same.”

An estimated 5,000 abortions happen illegally in El Salvador every year, the Center for Reproductive Rights estimates. While some are performed by sympathetic doctors trained to provide the procedure, many aren’t. The World Health Organization estimates about 11% of clandestine abortions cause the patient to die.

One doctor, who said he was discreetly trained to provide abortion services in medical school, told CBS News he  feels compelled to do the illegal work to offer patients a safe option.

“[If] those of us who are technically trained don’t help, women will have to go elsewhere,” said the doctor, who requested anonymity given the nature of his work. “They will always seek solutions in the black market.”

Both El Salvador’s president, Nayib Bukele, and its attorney general, Raúl Melara, declined interview requests. José Apolonio Tobar Serrano, the country’s Attorney Solicitor of Human Rights, deflected questions asking if a total abortion ban was a violation of women’s human rights.

“As public officials we are not permitted to act beyond what is allowed by the Constitution,” Tobar said. “The rights of the person who will be born are the same as the rights of the person already born.”

Limited options exist for those hoping to loosen El Salvador’s abortion laws. Two years ago, the country’s lawmakers failed to pass legislation that would have carved out an exception for victims of rape and when the patient’s life was at risk. And only a constitutional amendment can remove the provision that was added in 1998.

But a lawsuit brought on behalf of Manuela’s family after her death may bring change. Next year, the Inter-American Court of Human Rights is expected to hear her case and if the international body sides with Manuela and her family, El Salvador could be barred from prosecuting women who say they miscarried, according to an attorney for the Center for Reproductive Rights, the law firm representing the family.

Speaking from her  modest, rural home, Manuela’s mother said she was hopeful.

“These poor women need help,” she said. “I don’t want them to suffer like my daughter did. It’s the youth, the women, who need to fight.”

On a humid, overcast day in November, a delegation of U.S. lawmakers visited the women jailed for abortion at Izalco Prison in El Salvador, a detention facility in an area so dangerous that prisoners rarely recieve vistors. The five politicians — all of whom  support abortion rights but come from states that heavily restrict the procedure — teared up as the 14 women told their stories. Every woman at Izalco says they never had an abortion, but instead lost their child to a miscarriage.


Kenia was sentenced to 30 years in prison in El Salvador for abortion after she said she miscarried.GILAD THALER

As she left, Alabama State Representative Merika Coleman thought of her home. In 2019 Alabama passed the most restrictive abortion law in the United States, a near-total ban on the procedure with no exceptions for victims of rape or incest. Under the law, which is currently on hold due to court challenges, doctors could be punished by up to 99 years in prison for providing the procedure. The purpose of the law, its author says, is to provide a “direct attack” on  the legal frameworks that currently protect access to abortion nationwide.

“If these types of laws continue to pass in our country, if the Supreme Court continues to be appointed with very conservative judges, if we don’t do something to protect Roe v. Wade in this in our country, things that are going on in El Salvador could actually happen in the United States,” Coleman said.


The pandemic has “really laid bare the fiction” that physical clinics are needed to safely provide abortion services.

Doctors are finding innovative ways to provide medication abortion without subjecting patients to unnecessary visits to a medical facility.

The ACLU is suing the Food and Drug Administration (FDA) over its refusal to loosen outdated restrictions on medication abortion during the COVID-19 pandemic. But some advocates are pushing a workaround, arguing that the FDA rules don’t actually prevent providers from sending abortion pills through the mail.

It’s not the only way the pandemic has prodded doctors to ease the process for telemedicine abortion, eliminating some of the in-person visits usually required even for patients trying to access care remotely. Doctors are finding innovative ways to provide medication abortion without subjecting patients to unnecessary visits to a medical facility, said Elisa Wells, co-founder and co-director of Plan C, an organization that advocates for self-managed abortion care and medication abortion pill access.

The safest way for people to access early abortion care during a pandemic—at home, under remote medical supervision—has been hampered by onerous FDA restrictions since medication abortion was first approved in 2000. One of the pills, mifepristone, is under a set of FDA restrictions called a Risk Evaluation and Mitigation Strategy (REMS) that require it be dispensed by a specially certified medical provider in clinics, medical offices, or hospitals—not pharmacies.

That means that even people who manage to see an abortion provider over telemedicine will likely have to go to a clinic to receive mifepristone in person—unless their provider is part of an FDA-approved research study—even though medication abortion is safe and common. Experts argue there’s no medical reason for this, and have urged the FDA to lift the regulations and allow patients to access mifepristone like any other medication.

“Of the more than 20,000 drugs regulated by the FDA, mifepristone is the only one that patients must receive in person at a hospital, clinic, or medical office, yet may self-administer, unsupervised, at a location of their choosing,” says the lawsuit, which the ACLU filed last Wednesday on behalf of a coalition of medical experts, including the American College of Obstetricians and Gynecologists (ACOG).

“When used for purposes other than pregnancy termination, the FDA permits mifepristone to be mailed directly to the patient’s home in higher doses and quantities,” the lawsuit notes.

According to the legal complaint, the FDA restrictions require patients to pick up mifepristone in person. A growing group of advocates and providers, however, believe the FDA regulation has been interpreted more restrictively by doctors than it needs to be.

The REMS “specifies that mifepristone be dispensed to patients only in clinics, offices, or hospitals by the provider, but nobody exactly knows what that means,” said Elizabeth Raymond, senior medical associate at Gynuity Health Projects. “If the certified prescriber is in the clinic, office, or hospital mailing the pills to the patient, does that count? Some people think it does.”

One of those people is Wells, whose organization, Plan C, has been urging providers to mail mifepristone for months. In April, as the COVID-19 pandemic took hold in the United States, it stepped up the efforts.

“Dispensing is the act of preparing a drug for distribution to the patient (identifying the correct medication, dosage, labelling, instructions, etc). There is no language in the REMS that says you can’t mail the pills, though providers have largely interpreted the REMS to prohibit mailing,” Wells said in an email.

“More providers are stepping up to actually mail the pills,” Wells said. “And that’s what we’ve been working a lot on, is talking to providers and asking them: Now that we have these new test protocols, and it’s clearly the new standard of care, won’t you just do the next step of mailing the pills as a harm reduction approach? It’s the safest and most convenient for everyone.”

The demand is there

As the pandemic increases demand for all kinds of telemedicine services in the United States, and Republican governors throughout the country use the pandemic to push for more abortion restrictions, access to telemedicine abortion has become particularly urgent.

The reproductive health-care provider carafem has seen a spike in inquiries about medication abortion since early March, when states began issuing COVID-19 lockdown orders, said Melissa Grant, carafem’s chief operating officer.

“We went from serving a couple [medication abortion] clients a week to serving between 30 and 40 clients a week,” Grant told Rewire.News.

Carafem, which operates health centers in four states, is part of the TelAbortion project, a research study evaluating the use of telemedicine for providing medication abortion. The TelAbortion study started in 2016 and serves 13 states—Colorado, Georgia, Hawaii, Illinois, Iowa, Maine, Maryland, Minnesota, Montana, New Mexico, New York, Oregon, and Washington.

Providers participating in the TelAbortion study are explicitly allowed by the FDA to mail mifepristone to patients; one of the goals of the study is to gather data on the effectiveness and safety of mailing mifepristone.

In April and May, TelAbortion has served more than twice as many patients as in January and February, said Elizabeth Raymond, senior medical associate at Gynuity Health Projects, which sponsors and runs the TelAbortion program.

“We’ve had a tremendous increase in TelAbortion during the pandemic,” Raymond told Rewire.News. “The limitations people have in getting medical care in person are really leading them to utilize this type of service more.”

A new protocol eliminates unnecessary testing

Meanwhile, the pandemic’s impact on abortion access has ushered in a new medical protocol for medication abortion that experts say is just as safe.

Before the pandemic, the medical community’s standard of care meant patients first had to undergo a blood test and an ultrasound or pelvic exam so that the provider could determine the duration of the pregnancy. Even patients using telemedicine had to first visit a nearby clinic for the physical tests—an expectation that had nothing to do with the FDA’s REMS requirements.

Many carafem patients get an ultrasound or pelvic exam wherever was most convenient for them and not necessarily from the abortion provider, but COVID-19 has made this much more difficult for patients. For some, it’s impossible.

“It was much more challenging for many of our clients not only to come into the health center but even to obtain an ultrasound,” Grant said. Carafem has typically allowed some patients, on a case-by-case basis, to forgo the in-person tests if necessary to protect health and wellbeing. Since March, they’ve expanded that option.

“Evaluation with ultrasound before medical abortion has (up to now) been the accepted standard of care among providers,” Raymond said. “Professional organizations have given mixed guidance [but] nearly all providers have been doing ultrasounds. … Almost no providers until recently have provided [medication abortion] with neither test.”

The pandemic changed that, as more providers recognize the challenges to obtaining an ultrasound, and the lack of medical rationale for it. “Since COVID, all U.S. abortion guidelines organizations have explicitly stated that ultrasound is not needed, and most have endorsed no ultrasound or pelvic exam,” Raymond said. “We don’t know yet the extent to which providers are taking this up.”

Gynuity recently lead a collaborative effort to develop a “no-test protocol” for medication abortion, citing research from 2015 to 2016 that reviewed 406 medication abortions provided in the United States, Mexico, and Moldova without ultrasounds or pelvic exams. The participants reported no serious adverse events that resulted from the elimination of these screening tests.

“This is a huge innovation, an acknowledgment within the medical community that an ultrasound is not needed,” Wells said. “Many doctors have known this, but it’s really hard to change the standard of care in our litigious society. The pandemic has really laid bare the fiction that physical clinics are needed to safely and effectively provide abortion care.”

While these innovations in telemedicine abortion are expanding abortion access during the pandemic, more needs to be done to ensure access in a post-COVID-19 society, advocates said. Currently, 18 states prohibit the use of telemedicine for medication abortion, and Republicans in the U.S. Senate introduced a bill this year to ban telemedicine abortion on the federal level.

“I think this happens in crisis situations, that innovations arise that maybe otherwise would have taken years,” Raymond said. “But there’s a lot of forces working against this too. So we have to pull a silver lining out of this COVID [pandemic] … really try to get as much out of it as we can, so we can counter those forces that are going to be operating after the epidemic is resolved.”


Pro-choice activists marked the change in Northern Ireland’s abortion laws when MLAs met at Stormont to debate the issue last October. Picture by Niall Carson/PA Wire


THE redrafted regulations governing the provision of abortion in the north of Ireland were laid at Westminster on Wednesday May 13.

These regulations have been described as “extreme”. In fact, they are not at all extreme but mirror the recommendations of the Citizens’ Assembly in the south in relation to the kind of abortion law that should be available.

Up to 12 weeks, there are no restrictions and one doctor can provide the pills which are used in more than four out of five abortions in Britain.

The Citizens’ Assembly recommended that “the termination of pregnancy without restriction should be lawful”.

They did this after hearing testimony from those who worked with the survivors of rape about the potential trauma for anyone having to explain – or worse, prove – that their pregnancy was the result of rape.

In fact, a majority of the Citizens’ Assembly thought abortion should be available up to 22 weeks “without restriction”, although the Dáil rejected that proposal.

Allowing abortion without restriction is even more important for rape survivors here in Northern Ireland where, under Section 5 of the 1967 Criminal Justice Act (Northern Ireland), failing to report a crime is an imprisonable offence.

From 12 to 24 weeks, abortion is legal if two doctors agree that continuing the pregnancy would risk injury “to the physical or mental health of the pregnant woman which is greater than if the pregnancy were terminated”.

Anyone who has watched Call the Midwife will know the many ways in which an otherwise healthy young woman can develop unforeseen complications in pregnancy.

During the Repeal Referendum in the south we discovered that, even with modern advances in medicine, pregnancy is still a risk to women’s physical, as well as mental, health.

Of course, when we are happy to be pregnant, we accept those risks and give over our body to grow a baby. But no-one should be forced to risk their health, so there is nothing “extreme” about this regulation.

The new law allows “abortion up to birth” we are told. Well, yes, but there is nothing new about that.

Results from the NI Life and Times survey and its predecessor survey going back 30 years have found a majority of people in the north support abortion being legal for reasons of fetal impairment

It has been the case since the 1930s that abortion is legal at any stage in pregnancy in order to save a woman’s life.

But Part Three of the Regulations – ‘Grounds for termination: cases with no gestational limit’ – is about more than saving women’s lives.

It also includes abortion for reasons of fatal fetal abnormalities and in the case of “severe fetal impairment”.

What constitutes severe fetal impairment is likely to depend on each family’s circumstances.

For example, if there is already a child with significant disabilities in the family, having another child with any additional needs could be too much.

This regulation does not make any judgment about the lives of disabled people because an embryo or a fetus is not a person.

Results from the NI Life and Times survey and its predecessor survey going back 30 years have found a majority of people in the north support abortion being legal for reasons of fetal impairment.

For the first time, health care professionals here are given a statutory right to conscientious objection under the Regulations.

It is true that this does not extend to “ancillary, administrative and managerial roles”.

Rather, the Supreme Court has already ruled conscientious objection refers only to health care professionals “actually performing the tasks involved in the course of treatment”.

Contrary to some of the myths circulating, the new regulations do not mean there is no offence committed if an unscrupulous partner puts abortion pills in a pregnant person’s food or drink.

This is assault and is treated as such by the PSNI and the Public Prosecution Service.

The abortion regulations mean that women living in the north will no longer have to travel to England or go onto the internet to access abortion. They end the hypocrisy that says “there is no abortion in the north of Ireland” because they are happening elsewhere.

If you want to reduce the number of abortions in Northern Ireland, there are a number of things you can do besides putting women on boats to England.

You could, for example, campaign to end the two-child policy and the benefit cap which families tell us make it difficult for them to welcome another child.

Finally Ireland, north and south, has accepted we cannot continue exporting our problems but have to face up to the reality that women need abortions.

Now that abortion is legal here, we need to make sure that services are available across the region.

And we must ensure that the introduction of a modern abortion service is supported by timely access to the best contraceptive services and by proper sex education in our schools.

Goretti Horgan is a Social Policy lecturer at Ulster University, Director of ARK’s Policy Unit and a pro-choice activist.

Hervey, T.K. and Sheldon, S. (2017) Abortion by Telemedicine in Northern Ireland: Patient and Professional Rights across Borders. Northern Ireland Legal Quarterly, 68 (1). pp. 1-33. ISSN 0029-3105


In this photo illustration, a person looks at an abortion pill (RU-486) for unintended pregnancy from Mifepristone displayed on a smartphone on May 8, 2020, in Arlington, Va. Under federal law, even in states where telemedicine abortion is legal, there are strict rules surrounding how the pill is dispensed.

Even before the coronavirus crisis, there were lots of abortion restrictions in South Dakota. But now the procedure has become unavailable, officials say.

“I called to make the appointment and they said the Sioux Falls location was closed [for abortions] because of the coronavirus,” said 34-year-old Heather. NPR agreed not to use her last name because she doesn’t want people in her largely conservative community to know about her abortion.

During the coronavirus pandemic, more healthcare is moving online — including abortion. In many states, abortion pills can be prescribed remotely, and abortion providers are reporting a growing number of women seeking medication abortions through telemedicine. But others are finding obstacles in their way.

Heather lives in Sioux Falls, S.D., and has two small children. One of her kids is being treated for a rare form of cancer and Heather said she and her partner felt they couldn’t handle another pregnancy now.

“Somebody can only take so much, I guess,” she said.

Between layers of restrictions on abortion, and a lot of social stigma, Planned Parenthood officials say they’ve been unable to find a South Dakota-based doctor to perform abortions. So for 25 years, the organization has been flying physicians in and out, several times a month, to provide the procedure at the state’s only abortion clinic in Sioux Falls.

But now, even that’s not possible, said Sarah Stoesz, president and CEO of Planned Parenthood North Central States.

“It’s been very difficult for women to access abortion since COVID-19 because of course we can’t fly doctors to South Dakota anymore,” she said.

Stoesz oversees clinics in several Midwestern states. Her region has seen a 250% increase in the use of telehealth for all types of care since social distancing restrictions took effect. In Iowa, where telemedicine abortion is legal, the organization reports a 33% increase over about a month.

But abortion through telemedicine is not legal in South Dakota.

“That means that there is no abortion access in South Dakota right now,” Stoesz said.

According to the Guttmacher Institute, which supports abortion rights, 18 states prohibit doctors from prescribing abortion pills remotely. In places where the practice is legal, doctors say they’re hearing from more patients seeking abortions this way.

“I think what they’re seeing is that most of their health care has moved to an online or a tele-platform,” said Dr. Colleen McNicholas, an abortion provider in Illinois, Kansas, Missouri and Oklahoma. “So we are constantly getting folks asking questions about that. And unfortunately, in most of the places that I work in the Midwest, that’s just not an option.”

In New York, a state with more liberal abortion laws, Dr. Meera Shah is chief medical officer at Planned Parenthood Hudson Peconic, outside New York City. Shah said she has stepped up the use of telehealth for all types of reproductive health care, including abortion for patients in the early stages of pregnancy.

“I had a patient the other day who is an emergency responder who was sitting in her ambulance and accessed abortion care via telemedicine and then drove her ambulance to our health center to pick up the meds,” Shah said. “And she was so grateful that she was able to do that and only take, you know, max 15 minutes away from her work.”

Under federal law, even in states where telemedicine abortion is legal, there are strict regulations surrounding how mifepristone is dispensed.

Reproductive rights advocates want policy makers to ease restrictions on the drug – especially during the pandemic. They point to the United Kingdom, where regulators have eased rules for medication abortions in response to the coronavirus crisis. The American College of Obstetricians and Gynecologists has sued the federal government, asking that rules requiring patients to pick up the abortion pill mifepristone at a medical facility be suspended.

But Dr. Christina Francis, with the anti-abortion rights group the American Association of Pro-Life Obstetricians and Gynecologists, supports strict controls on abortion pills. She opposes abortion, but said if a woman is going to have a medication abortion, she should see a doctor first to confirm how far along the pregnancy is and check for other complications.

“I will tell you as a woman, and as a physician who sees women: I love women; I think we are intelligent. But we are notoriously bad about knowing our last period and being able to date pregnancies that way,” Francis said.

Abortion rights advocates point to research suggesting patients receiving abortion pills through telemedicine have similar outcomes to other types of abortion, and the fact that groups including ACOG say the safety of medication abortion is well-established.

For Heather, South Dakota’s restrictions on telemedicine abortion meant taking a different type of risk: driving to a clinic in Omaha, Neb., about three hours each way, where she was prescribed abortion pills to take home. Several weeks ago, she and her partner packed cleaning supplies and loaded up the kids — even though she knew it could be dangerous during a pandemic.

“I just didn’t want them touching anything,” she said.

Heather isn’t alone; officials at Planned Parenthood say more than 60 patients from South Dakota have traveled to clinics outside the state for abortions since the pandemic began.

“It was something that I needed to do,” Heather said. “And I was gonna have it done, whatever lengths I had to go to, whatever obstacles they put in front of me.”


Doing away with abortion rights during the COVID-19 pandemic, like many abortion restrictions, is overwhelmingly unpopular.

Sixty-five percent of registered voters polled between May 8 to May 13 for Navigator said they don’t think lawmakers should fighting over or restricting access to “time-sensitive reproductive care.”

Using the COVID-19 pandemic as an excuse to suspend abortion rights is widely unpopular. Not even Republicans are into it.

Sixty-five percent of registered voters polled between May 8 to May 13 for Navigator, a left-leaning public opinion research organization, said they don’t think lawmakers should fighting over or restricting access to “time-sensitive reproductive care.”

Banning abortion as a response to the pandemic is unpopular among self-identified Democrats and independents: 79 percent of Democrats and 62 percent of independents said reproductive health care should not be restricted. Meanwhile, 51 percent of Republicans disagreed with restricting abortion services during the pandemic.

Only 21 percent of overall respondents—and 33 percent of Republicans—supported anti-abortion COVID-19 policies.

“This poll illustrates that the American public stands on the side of reproductive freedom and that anti-choice politicians’ attempts to ban abortion during a global pandemic are not only unpopular, they’re also politically stupid,” Amanda Thayer, a spokesperson for NARAL Pro-Choice America, told Rewire.News.

“As our country grapples with how to address this public health emergency, the majority of voters—even a majority of Republicans—oppose using the COVID-19 pandemic to undermine reproductive freedom and restrict access to healthcare women need,” Thayer added. “Now, more than ever, medical care should be determined by science—not an ideological agenda that threatens the health and safety of millions of people.”

Reproductive rights groups like NARAL have created digital ad campaigns that criticize anti-abortion efforts during the pandemic. Planned Parenthood Action Fund, meanwhile, is running ads in 11 battleground states to highlight access to reproductive health care.

Some lockdown orders issued by state officials in the first days of the COVID-19 outbreak classified abortion as an “elective” procedure that could be delayed, effectively banning abortion in at least seven states. The abortion bans, all implemented by Republican governors, were challenged in the courts, with conservative judges approving bans like the one in Texas.

In early April, Republican attorneys general across the country signaled they’d defend COVID-19 abortion bans when they signed on to an amicus brief supporting Texas Gov. Greg Abbott’s (R) pandemic policy suspending abortion care. Before the pandemic, no state had more than 23 percent support for total bans on abortion, according to a 2019 poll by nonpartisan research organization Public Religion Research Institute.

While COVID-19 abortion bans have largely been lifted as states slowly reopen, Arkansas’ onerous requirement that patients test negative for COVID-19 before having an abortion remains in place despite lawsuits against the state.

Navigator’s recent polling falls in line with public opinion research, which found that anti-abortion policies like near-total abortion bans have little support in the United States—when people actually know what the polices do.


Contraceptive pills in Malta are often out of stock, even before the pandemic hit, but the current crisis is affecting supplies of the medicine more than ever.

22-year-old Amy Sultana was prescribed the contraceptive pill Qlaira for a skin condition, as doctors can prescribe the medicine beyond contraceptive reasons. After trying various birth control pills, including one that took her to hospital for immediate intravenous medication, Qlaira improved her condition and she has been taking it for ten months.

However, the pill has been out of stock in Malta since at least February, meaning Sultana has been left without the medicine for months. Moreover, swapping medication is no easy feat, as different hormones and dosages come with varying side-effects, which can be considerably harmful.

“Too many women like myself have our backs against the wall because of the situation. Why am I being prescribed medication that will soon end up out of stock to then change and change again?”

“Why do I have to be told my medication is on its way and when it finally never arrives my skin has sores, cysts and I can’t move my lips?” she wrote in an Instagram story.

“This might not be a big deal to many, but the few that have suffered are desperate for a solution.”

However, it actually turned out to be a very big deal for several women, who flooded Sultana’s Instagram post with their own similar stories after different types of contraceptives pills suddenly go out of stock. 

All the women's responses to Amy's Instagram post

All the women’s responses to Amy’s Instagram post

“I know I am not the only one in this situation; I know two other people personally and god knows how many others have been in the same situation and are forced to change again and again,” one of them said. “I know that for me and many others changing the pill means having to get used to new hormone levels which has many negative side effects both mental and physical.”

“I’ve changed pill four times because of this and Qlaira is the only pill I’ve found that suits me because I suffer with severe acne and chronic periods,” one woman said.

“My pill has been out of stock for over five months and I had sent an email to the health authorities. I’ve had to go on a new pill now. It’s the third brand I’ve had to try because this keeps on happening,” another said.

“I’ve changed pills enough times to appreciate what a struggle this is, and it’s simply ridiculous that such an important drug with such strict rules to adhere to can be out of stock across the country.”

Another woman also on the out-of-stock medicine Qlaira said it is not an option for her to try another brand.

“Currently the contraceptive pill I’m on (Qlaira) has been out of stock for around three to four months and many other brands are also out of stock. No pharmacy is sure when it is going to be back in stock, which I find ridiculous.”

“I have already had to change pill because the previous pill I was on was out of stock for four months and I ran out. Now that I’ve changed brand, I realise it’s happening with many brands and I can’t just keep switching as it has a negative effect on my body. I am on the pill not only for contraceptive reasons but for medical ones too so I can’t just stop taking it until it is back in stock.”

Beyond medical reasons for taking the hormonal pill, one woman pointed out that the issue of blanket anti-abortion laws makes the availability of the pill even more crucial.

“Considering that in Malta abortion is illegal it is only right that all women have easy access to contraception and the pill is a very common form of that!”

“This really angers me because I’ve seen many comments calling women reckless for getting pregnant and opting for an abortion whilst in reality the country doesn’t even supply the proper birth control.” 

Lovin Malta spoke to Prof. Anthony Serracino Inglott, from the Medicines Authority, regarding the short supply of certain brands. He said that several factors have affected the availability of the pill.

“It’s a very concerning situation,” he said. “Malta imports many of these pills from the UK and Brexit has impacted the process, while the COVID-19 crisis has also made it worse. There is also a lack of competitors producing the active ingredients of the contraceptive.”

The global epidemic has disrupted supply chains of leading manufacturer giants like China and India, who produce Active Pharmaceutical Ingredients (APIs), a core component of all drugs, including contraceptives. The COVID-19 crisis forced factories in the two countries to shut their doors, leading to fear of a global shortages of essential medicines since the outbreak.

When the outbreak hit Malta, the government ordered a stock up of what it considered essential medicines to prevent such shortages. However, the contraceptive pill is not listed as an essential medicine.

Meanwhile, women have been kept in dark without an idea as to when they will be able to access these pills from local pharmacies again.

What do you make of the situation?