The Rise of Abortion Pills and the Implications of COVID-19
Taylor Rosemary Robinson 
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IMAGINE FOR A MOMENT that you are a 25-year-old Black woman living in Mississippi; let’s call you Jasmine. You are working as a cashier in a grocery store — it is one of the best opportunities you have found since the coronavirus (COVID-19) pandemic began. You and your unemployed partner are trying to make ends meet with one income and one unemployment check; meanwhile, any semblance of a savings account dwindles. Though you have been very diligent about birth control, you find out that you are five weeks pregnant.
Working as the sole provider, with a low wage job, in a pandemic, while pregnant? You are lucky enough to have insurance coverage through the Affordable Care Act and a partner with a car, but you are now faced with a life-altering choice: to drive to the singular abortion clinic in the state and miss three scheduled shifts (and risk getting fired and losing income) or to relinquish the opportunity to receive an informed and safe abortion procedure.
Jasmine is not an anomaly. This story details the fate of too many womxn [1] in America during and, frankly, before the pandemic. And for many womxn, this is much more than a story. The COVID-19 pandemic has severely limited movement. People are continuously reminded of the importance of staying at home and social distancing. Non-essential health appointments like dentist cleanings and yearly physicals have been delayed or canceled. Millions of people in the United States have grown increasingly wary of the future that the next weeks and months might hold. Exemplifying this weariness and uncertainty, over 40% of womxn report that the pandemic has changed when they want to have children and how many they wish to have — and a disproportionate number of these women are Black, Latinx, and queer, representing populations that have been hit hard by this pandemic. Despite changes in fertility preferences, accessing abortion-related care has become more difficult since the pandemic began. 33% of womxn have reported that they have had to either cancel or delay appointments due to COVID-19. More poignantly, 28% of womxn report an increased worry regarding their ability to receive sexual and reproductive health care — regardless of their decision to have (or not have) kids. The pandemic has influenced both reproductive care access and the fertility preferences of womxn around the nation in unprecedented ways. The COVID-19 situation has uncovered gaps in abortion care and provides a space for improvement.
Jasmine’s abortion access was limited by the type of abortion she was legally able to pursue in Mississippi. Were Jasmine to live in a different state, such as Georgia, she would have been empowered to decide whether to have the abortion in the comfort of her own home or in a clinic. In-clinic abortions are also known as surgical abortions. For medication abortions, Mifepristone and Misoprostol (Mife and Miso) are prescribed — these are FDA-approved medications that can terminate a pregnancy of up to 11 weeks. They work by causing cramping and bleeding, which empties the uterus. The efficacy of the medication depends on how far along the pregnancy is, but in Jasmine’s case, it would have been 94-98% effective.
The constitutional right to access abortion is dangerously complicated on a state-by-state basis. Since Roe v. Wade legalized abortion in all 50 states in 1973, there have been attacks on abortion rights in many states over the decades. 19 states currently restrict the ability of abortion providers to prescribe Mife and Miso via telemedicine, even though a federal judge ruled that “in-person requirements for telemedicine pose a substantial obstacle during the pandemic and are unconstitutional.” This restriction means that patients in these 19 states will have to visit a clinic for a consultation with a doctor or other provider, be prescribed and take the medication in their presence, and then go home and complete their medication abortion.
Abortion providers around the nation have expressed their dismay and frustration with some of the laws surrounding abortion — most notably, with the law requiring providers to be in the same physical space as their patients during consultation and prescription for the medication abortion. As many abortion providers detail, the experience of receiving a medical abortion is largely private and in-home already. Dr. Grossman, a guest on access: a podcast about abortion, said, “The whole process of even a facility-administered medication abortion is really self-managed by patients at home.” The most important part, the awareness necessary to notice complications, is on the patient either way. Whether Jasmine receives her two-pill prescription from her provider in the clinic or the pharmacist at the local CVS, she is ultimately responsible for monitoring for symptoms that may indicate an issue requiring further medical care.
AT HOME ABORTION MANAGEMENT has proved to be safe and effective. Multiple studies show that having a medical abortion via telemedicine is just as safe as receiving it in person. A clinic in Maine, Maine Family Planning (MFP), has been providing medication abortion via telemedicine for years, since 2014. According to certified nurse-midwife and MFP Program Director Leah Coplon, they started a pilot doing “telehealth medication abortions” when only a few states were doing that at the time. They began by having the patients connect with the provider in one of the 18 clinics in the state, and then go home and complete the medication abortion. They joined a study called Gynuity in 2017, which allowed them to mail pills to eligible patients (even patients in New York).
Since COVID-19 hit the U.S. providers around the country have taken action to improve patient access to telemedicine. The health infrastructure being built as a result of the pandemic provides an opportunity to shift away from some of the arbitrary and harmful practices and laws that create and sustain barriers to accessing safe, affordable, and timely abortion care. It is urgent and necessary for lawmakers to place Americans’ health and concerns at the forefront and ease restrictions on medication abortion pills. The transitions and logistical challenges that providers across the nation faced have prepared them for this moment of providing care to patients even when it is not physically safe to do so. At this point in time, we are perfectly positioned to legislate for abortion care to be practiced in the virtual space.
Politicians acting out of religious interests may believe that decreasing access to abortion will reduce abortion procedures due to the American population’s sudden enlightenment. Unfortunately for them, abortion restrictions do not lead to fewer abortions; rather, they lead to more dangerous and lethal abortions. It behooves all interested parties to restore the constitutionally granted access to abortion. This restoration includes removing the requirement that abortion providers need to be in the patient’s physical space. This requirement served as an underhanded strategy to reduce the number of abortions by adding hoops to jump through.
To keep patient well-being at the forefront and improve access to care, politicians in 32 states should remove the restrictions that physicians specifically provide medication abortions. Research shows that nurse practitioners, nurse midwives, and physician assistants can perform the abortion procedure just as successfully as physicians; allowing this would expand access by increasing the number of providers and making them more within reach. By removing these restrictions, womxn, even those not living through a pandemic, would gain more access to providers since they would no longer be limited to the ever-busy MDs. It has been shown that these types of harmful restrictions put forth by anti-abortion advocates do not make womxn safer. It simply makes it more difficult to access essential care.
This pandemic presents us with opportunities to enact overdue change in the realm of abortion access. Denying womxn access to abortion care is detrimental. Among many things, womxn denied abortion were deeper in debt and were more likely to stay in contact with a violent partner. Making abortion care widely available via telemedicine will have critical public health implications.
There will always be some patients who prefer the physical procedure that necessitates a visit to the provider’s office. In these cases, the proposed changes do not hinder the ability and agency of these patients. For Jasmine, though, having access to the medication abortion pill via telemedicine would have given her the freedom to receive quality medical treatment without having to risk her employment and financial well-being: an unfair trade-off to have to make. With the unique circumstances that the COVID-19 pandemic presents, it is imperative to keep access to safe, affordable, and informed abortion a reality so that people like Jasmine can make the best choice for them.
[1] This text acknowledges that “womxn” is the most inclusive term to use, considering that a person receiving an abortion may or may not identify as female or a woman.
