he notion that an unwanted pregnancy isn’t an “essential” issue or problem has terrifying and tangible repercussions, yet here we are. The rhetoric around much of this pandemic has been a bastardized binary running a ragged line down the middle of our lives in which we’re asked to decide what is necessary and what is sacrificable for the “greater good.”
And as per usual, women — especially poor women in conservative states — are bearing the brunt of this societal fallout; access to healthcare, doctors, contraception, and any means of abortion, medical or surgical, has fallen squarely on the chopping block.
Of course, we all know it’s not only folks who identify as women who get pregnant, but also nonbinary and trans people as well; an estimated 1–1.4 million adults the U.S. identify as transgender, and this figure is believed to be an understatement. These communities are not only more likely than the general U.S. population to be uninsured and face discrimination in health care settings but suffer at the ignorance of clinician knowledge or open refusal to provide care.
In recent weeks, leaders in several states — including Arkansas, Iowa, Kentucky, Ohio, and Texas — have pushed to close abortion clinics or severely limit access, arguing that abortion is, what else, a nonessential procedure that ought to be delayed while our nation’s medical infrastructure is strained under the weight of COVID.
The cruel joke being the fact that abortions — however ‘elective’ a procedure they might be — are the very definition of ‘timely’. There are no realistic means of waiting the pandemic out while pregnant. And bringing an unwanted child full-term is well-documented as one of the most destabilizing and destructive forces to wreak on a woman’s mental health, well-being, and future.
Kate, an abortion doula based in New York City, told me “the level of distress and fear and misinformation is worse than anything I’ve ever seen” right now. She says conservative states have simply repackaged the abortion bans they’ve already been keen to pass, but peg the restrictions to the pandemic.
“When it comes to ideology, the anti-choice movement has already won,” Kate sighs. “Abortion bans love disinformation, so people don’t know what is legal or not — that’s part of the tactic. And even those people that know they want an abortion are scared to travel — but they’re scared to spread it or get it.”
Kate says the predominant timbre of our time is confusion — where do I go and who do I trust? She explains Plan C — a reproductive rights organization based on the West Coast — has a report card of where and how you can order the abortion pill and serves as one vital means of self-advocation, combatting misinformation, and maintaining bodily autonomy.
And patients are flocking to these resources.
“We’re seeing a very large uptick in people ordering abortion pills online to self-manage their abortions,” says Kate. “And this sounds scary — like glorified coat hangers and knitting needles — but medical abortions are far safer than giving birth when done with proper medication in your own home.”
“There is so much misinformation!” Kate says. “People believe it’s a big scary procedure or that it causes breast cancer. But what I actually hear from people who get abortions is, wow! that was so easy! The worst part of that was the sedation! When I actually passed the tissue, it felt like a heavy period! I had 911 on speed dial, but I didn’t need it!”
She says the pursuit of the abortion pill has seen upticks in liberal states as well as people are worried about leaving their homes and going to a medical facility, and telemedicine has served as a saving grace. In New York, Oregon, Washington, and California for example, Kate tells me, Planned Parenthood is offering virtual appointments for prescriptions and it’s completely legal.
But telemedicine has not gained the ubiquity necessary — due to everything from federal regulations around medicare and slower rates of technology adoption among older folks to old fashioned bureaucracy — to meet the demands of those in need of abortions.
“Some people already have to travel due to restrictions in their states like 20-week bans,” says Kate. “Nearly all clinics stop the use of the abortion pill at 12 weeks or less — 10 being very common. You have people traveling from West Virginia and Ohio looking for care who don’t have any other options than to travel,” which only compounds the duress they’re already under.
Kate explains that while patients may be actively seeking out telemedicine resources, the supply-chain has been crippled during COVID, compromising an already fragile system.
“The main vector for abortion pills — Women on Web, based in the Netherlands (Aid Access is the American arm)— has not been able to supply pills to those countries where it’s not legal to procure pills inside the country for the past month due to restrictions in the U.S. Typically they provide telemedicine intakes for people, writing prescriptions to Indian pharmacies that then ship out the pills, but they can’t get pills shipped out of India during a nationwide lockdown.”
n the other end of the spectrum, those giving birth during the pandemic are also suffering; for a short while in New York, it was forbidden to have a partner present, which is to say nothing of doulas or midwives. “Thankfully New York is now allowing birthing people to at least have a support person because giving birth alone during a pandemic in a hospital is terrifying.”
Kate explains that in turning the pregnancy prism at another angle, you’ll see that America is having a massive increase in home-births from pregnant people who previously never would have considered it. Midwives have reported being asked to be taken on much later and folks are laboring at home for as long as possible. “Typically you should do that anyway — it’s recommended — but as hospitals are not allowing support people in like doulas, they’re having an increase of clients who only enter the hospital system once they’re a certain amount effaced.”
Kate believes the pandemic may fundamentally shift prenatal care for good, both practically and culturally. Pregnant folks are dramatically decreasing in-person appointments — which disrupt schedules and lives and may cause undue worry — couples are empowered to collect and share their own data with their doctors, and federal changes have come down the pipeline enabling providers’ to bill for telemedicine.
But again, all these resources only work if you have the means to access them; need is quickly outpacing the technology and legislation rising to meet it.
Patients can suss out their abortion rights — which are typically determined by state law — using IfWhenHow.
“The Reproductive Health Act in 2019 in New York made self-managing your abortion legal, for example, but in Mississippi or Texas, it’s a felony.”
Kate says that one of the most important facets of being an abortion doula is the “safety planning we have to do in restrictive states. If they go to the ER, we need to coach them on what to say. We tell people not to say you’ve self-managed your abortion. Say, I’m miscarrying, or, I’m having abdominal pain. There have been people who have gone to prison for self-managing their abortions based on loose evidence they ordered pills online ”
Abortion doulas have a number of scopes of practices, running the gamut from the uber practical — driving you to the clinic and holding your hand during the procedure — to folks like herself, who work primarily online providing information and resources.
“I’ll also help them fundraise,” Kate says. The majority of patients get their funding with the help of the National Abortion Federation — the main professional organization for clinics — who have a hotline. (There are also abortion funds in every state, most of which are members of the National Network of Abortion Funds.)
But the NAF hotline (which receives no federal money since the Hyde Amendment passed in 1973) is extremely difficult to reach.
“You have to call them like you are trying to win the national sweepstakes on the radio!” says Kate. “The system is intimidating and it can be frustrating. I tell folks to call first thing in the morning or at night — just put it on speakerphone and keep pressing ‘dial.’”
Kate explains an additional snag in the system is that the NAF typically doesn’t fund ‘day one’ appointments so in those states which require multiple appointments for an abortion this can be a big barrier. “The NAF is worried that folks might change their mind or cancel, so typically only fund the actual procedure itself. (With an exception for minors for judicial bypasses — meaning without parental consent who have gone before a judge to allow them to have an abortion).”
For a 1st trimester abortion, the cost averages around $600, but in low access states like Mississippi it can be even more expensive — closer to $900, she explains. “For someone who is even relatively stable, that is a lot of money. Most Americans couldn’t cover a $400 emergency pre-pandemic.”
Kate says that as an abortion doula she typically “pushes people” towards Ineedana.com, which provides — given your assumed gestation — the nearest clinics and local abortion funds available to you.
“In Knoxville, Tennessee you timeout at 14 weeks because there are no providers that will go above that — in that case, you’ll have to go to Memphis or Atlanta. It’s about access to skilled practitioners. It’s difficult to work in places like Jackson, Mississippi, or South Carolina — it’s dangerous for providers!”
And Kate explains, many people may not know their best option or nearest clinic is out of state until they’ve timed out of options locally.
Abortion access also crucially depends on “circuit riders,” abortion doctors who spend most of their time traveling to provide care in low access states and don’t live locally, says Kate.
“Someone who may live in Chicago, but goes to southern clinics to provide abortions and those people can’t get on planes now. They’re worried about their own families so people are cutting down on the days they can provide abortions due to lack of doctors.”
In short? Our most vulnerable populations needing the most vital procedures have been relegated to the unessential. People with uteruses. People who are poor. People of color. People whose education has failed them. And the patriarchal underpinnings of American society rage on more virulent than the very disease it pins it blood-shed upon.
In an atmosphere riddled with fear and distress, with depression, sickness, and copious death, it seems obvious that we’d do everything in our power to mitigate more pain to humankind — physically and psychologically, especially as we’ve long had the science to perform abortions safely.
But who am I to say? I’m just another woman.
How to help and where to donate:
In addition to abortion services, some members of National Network of Abortion Funds (like the Mississippi Reproductive Freedom Fund) will also provide full spectrum reproductive care as well as diapers or funds to help feed existing families with children. The NNAF is currently in the throes of hosting a national fund-a-thon by state, so sign up to attend a virtual event or donate to the cause!
Mississippi Reproductive Freedom Fund does their part by offering financial assistance and practical support to persons seeking abortion as well as free emergency contraception, community based comprehensive sex education, and fighting for reproductive justice in Mississippi.
If/When/How envisions a future when all people can self-determine their reproductive lives free from discrimination, coercion, or violence.
Holler Health Justice’s focus is on lifting up the voices of and helping to build power with West Virginian and Appalachian communities and individuals most disproportionately affected by health inequities, including people of color, those in rural areas, and LGBTQIA+folks.
Kentucky Health Justice Network was developed by women and people of color. We believe reproductive rights are human rights, and that all people should be able to decide if, when, and how to parent. To learn more the history of the reproductive justice framework, visit the SisterSong website.
ACCESS Women’s Health Network (serving California specifically) believes that reproductive rights are meaningless when you don’t know where to get birth control, no abortion provider accepts your insurance, you are afraid to seek prenatal care because of your immigration status, or the closest clinic is hours from your home. ACCESS was founded in 1993 by clinic escorts who witnessed the many barriers women were facing — especially young or poor women — to actually obtain an abortion.