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How States Amplify the Panic of the Pandemic for Women Seeking Abortion

Women

What unites opposing opinions on abortion as threads of the same conversation is, ideally at least, a foundation of facts. However, in response to the COVID-19 pandemic, Texas authorities have introduced false claims as they go back and forth—and back again—on whether or not abortion is allowed during the global crisis.

In an Executive Order on March 22, 2020, Texas Governor Greg Abbott (R) called for surgeries that are “not immediately medically necessary” to be postponed until after the coronavirus outbreak. The following day, the state’s Attorney General Ken Paxton (R) clarified in a news release that this interim ban included “routine dermatological, ophthalmological, and dental procedures… or any type of abortion.”

Unlike the sweeping span of surgeries with which they are listed, abortions are time-sensitive and cannot wait until the pandemic has passed, specifically for people in states that already have restrictive timelines on the procedure. 

Other states including Alabama, Arkansas, Indiana, Iowa, Louisiana, Mississippi, Ohio, Oklahoma, and Tennessee have added further panic to the pandemic for people who need access to abortion.

For many seeking the procedure in these states, traveling out of state is not an option within reach. Even if people have the means, traveling during the pandemic greatly increases their exposure to COVID-19 while pregnant and particularly susceptible.

State officials are passing these bans under the guise of preserving personal protective equipment for healthcare workers to fight the coronavirus. However, in 2017, medication abortions accounted for 39 percent of all abortions in the US, according to the Guttmacher Institute. Relying on pills alone, this type of abortion does not require any protective equipment and is viable for pregnancies up to 10 weeks.

This is not the first time that state lawmakers have used false claims to limit reproductive rights.

In April and November 2019, the Ohio General Assembly introduced two bills that included a fictitious procedure for ectopic pregnancies. Reading through the headlines, I might have skimmed past these Ohio bills had I not had an ectopic pregnancy two years ago.

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus where it develops in healthy pregnancies. The majority of these types of pregnancies implant in a fallopian tube which, unlike the uterus, cannot accommodate the growing embryo. An ectopic pregnancy is inviable and, if left untreated, can cause the fallopian tube to burst, leading to internal bleeding and possible death.

According to the Centers for Disease Control and Prevention (CDC), 1 to 2 percent of all pregnancies in the US are ectopic, yet these pregnancies are responsible for 3 to 4 percent of pregnancy-related deaths.

The two Ohio bills that addressed this type of inviable pregnancy primarily intended to limit access to abortion. Last April, to limit insurance coverage of abortion, Ohio State Representative John Becker (R) sponsored the first of the two, House Bill 182. Women, too, have been active in the fight to restrict access. Ohio State Representatives Candice Keller (R) and Ron Hood (R) co-sponsored the more recent bill, House Bill 413, which introduces “abortion murder.” This bill holds both the physician and the patient liable for murder in the case of an attempted or successful abortion, no matter how far along the pregnancy is or the circumstances, unless “it is highly probable that the pregnant woman will die… before her unborn child is viable.”

According to these bills, when a pregnancy is found to be ectopic, doctors are required to transplant the embryo into the uterus. This description, however, does not illustrate a real procedure; the bills’ authors fabricated an operation.

The Cincinnati Enquirer filed a public records request to gain access to Representative Becker’s emails. Instead of consulting a doctor about the proposed medical procedure, Becker sought line-item edits from Barry Sheets, a lobbyist for the Right to Life Action Coalition of Ohio.

To seek a professional opinion, I interviewed Dr. Erica Oberman, an obstetrician-gynecologist (OB-GYN) at the University of California, Los Angeles Medical Center. After learning about this supposed surgery, she stated that, “this procedure absolutely does not exist and there is no room for counseling patients regarding [a] fictional procedure when they have ectopic pregnancies.” It seems that the bills’ sponsors were so eager to ban abortion that they invented a fake procedure. Introducing the incorrect notion that ectopic pregnancies can be saved could postpone urgently needed action and create false hope or guilt for the person who is unable to keep the inviable pregnancy.

State Representative Becker told the Cincinnati Enquirer in December 2019 that he had never researched whether re-implanting an ectopic pregnancy was possible. “I never questioned it or gave it a lot of thought,” he said.

The co-author of Becker’s bill, Barry Sheets, founded the Institute for Principled Policy, an Ohio-based organization with the mission of addressing policy issues “from an historically Biblical perspective.” He stated that he found two studies that merely mentioned re-implantation in scientific journals from 1917 and 1980. From this, the policy consultant with a bachelor’s degree in political science deemed that the procedure was medically sound and proposed that it be written into law.

When I had my ectopic pregnancy, I can’t say I would have signed up for a surgery that had only been reportedly performed twice—once 40 years ago, once over 100 years ago—when I could choose a medically sound alternative. Maybe I’m just overly cautious.

The Catholic Telegraph reported that the 1917 case was found to be poorly documented with insufficient evidence. The 1980 case was found to have falsified its research.

In November 2019, State Representative Keller remarked of her bill that, “the time for regulating evil and compromise is over.”

From Keller’s perspective, allowing people to have the option to seek abortion would promote evil. In order to eliminate evil, she endeavors to deny people the right to make decisions about their own bodies. Her attempted law extends to forcing people to carry to term who would rather choose otherwise, including after surviving sexual abuse or assault.

Whether proselytizing to conquer evil or acting with sheer carelessness, the representatives’ resulting callousness would have potentially endangered the life of anyone in Ohio who becomes pregnant, as well as their doctor.

Neither of the Ohio bills passed into law. Each bill was referred to a committee but did not receive further hearings. But the struggle isn’t over. In the last year alone, Ohio legislators have introduced ten bills that would limit access to abortion.

Even by a millennial’s standards, Representatives Keller and Becker are both very active on Facebook; when I last checked, Keller had posted 11 times in the past 24 hours on her public profile. I reached out to both representatives for comment through multiple channels but did not hear back.

These legislative efforts go far beyond endangering women’s right to choose—these two proposed bills would hinder the only action that could save the life of someone with the same kind of pregnancy that I had.

~~~

I understand how these types of laws can affect a person in the midst of a heart wrenching moment. Two Thanksgivings ago, while visiting my family in California, an agony in my abdomen woke me up in the middle of the night. After rushing to the emergency room and receiving my test results, the statistic of the more than 99 percent effectiveness of my birth control, an intrauterine device (IUD), became meaningless. I was pregnant.

Because the pregnancy was ectopic, after a few frantic texts to my boyfriend, I was rushed into emergency surgery.

Being in California and having health insurance, I had access to the procedure I needed. If I did not have insurance, or had I lived in Ohio and had either of the bills been enacted into law, that night at the hospital could have been very different. If House Bill 413, the “abortion murder” bill, had passed, my doctor would have either faced criminal charges or been required by law to attempt a procedure which does not exist. If House Bill 182, limiting insurance for abortions and procedures for ectopic pregnancy, had passed, I wouldn’t have received coverage for the surgery that saved my life.

I had never envisioned what it would be like to become pregnant; IUDs are marketed as among the most successful methods of birth control and I trusted their effectiveness as advertised. But since having my procedure, I have been surprised by how many friends and family members have shared stories of pregnancies or other serious health complications while using IUDs.

My experience with pregnancy loss made an abstract discussion instantly tangible and changed how I think of reproductive rights. I was lucky that I did not have to hesitate before going to the hospital; I knew that California did not have restrictions that would limit my access to healthcare as a woman and that my insurance would cover the care I needed. That is not the case for far too many people.

~~~

Among high-income countries, the US has the highest maternal mortality rate, according to the United Nations Children’s Fund (UNICEF). UNICEF also reported that, while worldwide maternal death rates dropped by more than one-third from 2000 to 2015, outcomes for American mothers got worse.

These nationwide snapshots do not even speak to the discrimination within healthcare in the US. Geographic location, socioeconomic class, and limited access to health insurance are just some of the factors that create inequality in the healthcare system.

Racial discrimination can also keep women of color from getting the critical care that they need. Within the US, the CDC studied maternal mortality from 2011 to 2015 and additionally analyzed data from 2013 to 2017 which committees in 13 states provided. The CDC found that black women were 3.3 times more likely than white women to die related to pregnancy; Native American women were 2.5 times more likely to face pregnancy-related deaths than white women. This discrimination is unacceptable, and times of crisis only exacerbate this injustice.

During the COVID-19 pandemic in particular, women’s healthcare providers, advocacy groups, and activists have been tirelessly defending access to abortion.

The American Civil Liberties Union (ACLU) of Iowa, on behalf of abortion providers, filed a lawsuit on March 30 arguing that the Republican Governor Kim Reynolds’ action to limit access to abortion violated the state’s Constitution. Before the court hearing, the ACLU and the state of Iowa reached an agreement that will allow doctors to determine when an abortion is necessary on a case-by-case basis.

According to the ACLU, more than 42 percent of all Iowa hospital beds are in Catholic hospitals. I interviewed a certified nurse midwife who works in one of these hospitals. She chose to remain nameless.

In reflecting on the ongoing restricted access in several US states, she said that, “it’s generally a very hostile time for women’s health. The data show that with these types of restrictions, people will access care less and have more trouble doing so. Also, people are more reticent to seek care in general.” Those seeking the procedure are not the only ones harmed by abortion bans.

Although many categories of surgeries have been deemed elective during the pandemic, the nurse midwife noted that, “no state has singled out any other procedure that is to be considered elective. State lawmakers would never tell an eye doctor what is or is not considered essential. Abortion is the one procedure that is legislated to this extent even when many professional organizations affirm that this is an essential service of women’s healthcare.”

In Texas, Planned Parenthood, Whole Woman’s Health, and other women’s healthcare providers filed a lawsuit on March 25 against the state in response to the Governor’s Executive Order. Before this case could be heard in court, US District Judge Lee Yeakel in Austin ruled on the Executive Order’s constitutionality to decide if it was to remain in place.

I spoke with Dr. Bernard Rosenfeld, MD, PhD, an OB-GYN in Houston, two hours before Judge Yeakel announced his ruling. Dr. Rosenfeld is on staff at Texas Women’s Hospital and St. Luke’s Medical Center. He also runs Houston Women’s Clinic, one of only 22 abortion clinics in the entire state.

While the Texas Attorney General initially specified that the state’s Executive Order banned “any type of abortion,” abortions require minimal to no protective equipment. Dr. Rosenfeld explained that the Order’s motivations were “completely political with no medical basis whatsoever. We have masks which we’ve always had, and plain rubber gloves. There is no equipment that we have that that the hospital wants.”

Although the OB-GYN expressed that he was optimistic that Judge Yeakel would rule against the Executive Order and restore the ability of Texan clinics to provide abortions, Dr. Rosenfeld sounded somber on the phone. “It’s going to go on and on,” he explained, because “even if the Courts have an injunction, they will file an injunction against the injunction.” Even if Judge Yeakel were to stop the Executive Order, a Court of Appeals could reverse that decision.

With the ban in place, Dr. Rosenfeld said that his clinic had to turn away numerous patients who “were literally crying. We couldn’t see them because of this new law.” Even when the ban was lifted, the clinic was not able to reschedule with its patients because the restriction was reenacted the following day.

The Executive Order was in place from March 22 until March 30 when Judge Yeakel temporarily blocked the ban. In his statement, the Judge wrote that suspending abortion services violates the terms of Roe v. Wade, the 1973 Supreme Court ruling that supported the right to abortion as a constitutional right. The Due Process Clause of the 14th Amendment protects the right to privacy against state action, including the right to terminate an unwanted pregnancy. The 9th Amendment reserves the rights to the people, including the authority to make a decision regarding pregnancy.

Although the case was decided in federal court, Roe v. Wade was initially heard in Texas. Jane Roe, the pseudonym of Norma McCorvey, first filed the lawsuit against then District Attorney of Dallas Henry Wade.

In his ruling, Judge Yeakel wrote that, “patients will suffer serious and irreparable harm in the absence of a temporary restraining order” reversing the abortion ban. In other words, under the Executive Order, patients who are denied their constitutional right established by Roe v. Wade will experience harm or trauma. Judge Yeakel also wrote that the substantial injury to clinics and patients seeking abortion would outweigh any damage to the state. Additionally, halting the Order “will not disserve the public interest,” Yeakel wrote.

However, the day after the Judge released his decision, the Fifth Circuit Court of Appeals allowed Texas to resume its abortion restrictions.

Just over a week later, on April 9, Judge Yeakel issued another temporary restraining order on the Court of Appeals’ decision. Under the new policy, if patients wanted an abortion but risked being too late if they waited until the ban was lifted, they were allowed to get the procedure. And, once again, patients had access to medication abortion—fleetingly.

Two days later, on April 11, the Fifth Circuit judges blocked Judge Yeakel’s order, overturning the medication exemption. But, on April 13, the Fifth Circuit went back on their decision and ruled that medication abortions were allowed. Treatment using pills alone would no longer qualify as a “procedure” and would therefore not deplete the supply of medical and personal protective equipment.

The Executive Order remained in place through April 22, after which restrictions were lifted. Dr. Rosenfeld called the Order “a disaster.”

Using the pandemic as a political guise to ban abortion could cause a number of other disasters. People seeking abortions in states with restrictions could be forced to travel and risk exposure while pregnant and more vulnerable to COVID-19.

Additionally, these bans mean that women living with sexually abusive family members or partners would not have access to terminating pregnancies.

Furthermore, limiting access to abortion often does not actually stop women from getting abortions. In a March 2018 reported entitled, “Induced Abortion,” the Guttmacher Institute found that countries with bans actually have higher rates of abortion than those without restrictions.

The report states that, “The abortion rate is 37 per 1,000 women in countries that prohibit abortion altogether or allow it only to save a woman’s life, and 34 per 1,000 in countries that allow abortion without restriction.” This increased rate in regions that have limited access is due in large part to unsafe, or illegal, abortions.

The World Health Organization (WHO) classifies an unsafe abortion as “a procedure for terminating an unintended pregnancy carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.”

Before Roe v. Wade, the American College of Obstetricians and Gynecologists (ACOG) estimates that each year, 1.2 million women in the US had unsafe abortions.

Dr. Rosenfeld explains that today, “illegal abortion is one of the leading causes of maternal mortality.” Not only do abortion bans disproportionately impact women who already do not have access to comprehensive reproductive healthcare, but the bans also motivate unsafe abortions. In 2006, WHO published a paper entitled, “Unsafe abortion: the preventable pandemic.”

In practice, abortion bans threaten the health of women who seek abortions. In already challenging situations, women must face additional, sometimes insurmountable, obstacles.

During the coronavirus outbreak, while people are already economically strapped and may be stuck at home caring for family members or practicing social distancing, access to comprehensive healthcare is more important than ever.

Whether by choice or necessity, the process of ending a pregnancy can be excruciating; it is not a decision that people take lightly. Regardless, it can be a lifesaving decision. This authority does not force a certain option; having a choice simply gives each person the independence to choose for themselves based on their own beliefs, circumstances, and constitutional rights.

Understanding the meaning of law and policy, whether executive orders or Constitutional Amendments, requires subjective interpretation. However, what must unify the spectrum of perspectives as threads of the same conversation is an underlying foundation of objective science and facts.

While we have reaffirmed the essential role of healthcare workers during the pandemic, we are seeing governors and attorneys general in states such as Texas fail to allow medical professionals to be the experts in their own field. We also saw this same political pursuit from the Ohio lawmakers who falsified medical science and then attempted to write it into law.

This desperation, though, is not new and is part of a persistent pattern. How we act now will inform reproductive rights long after the pandemic. It is critical to confront this willful ignorance and ensure that the discussion on abortion rights is based in truth, guided by the wisdom of medical professionals and those who have lived experience.

I think now of the multitude of individuals who must face further obstacles during this pandemic to fight for the care that they need and overcome the experience of being denied their rights.

My own pregnancy loss shook my sense of grounding and acquainted me with a deep sense of solitude, one that begged relentlessly for rebuilding. Perhaps the silence of sheltering in place will create clarity through the understanding that striving for justice together ensures we are not alone.

May 12th 2020, 7:23 pm
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