A woman drives her car during a protest of Polish women’s rights activists using their cars and bicycles to block central Warsaw against a draft legislation that would ban the abortion of foetuses with congenital birth defects, on April 14, 2020. – Poland’s parliament is expected to debate fresh efforts to further tighten what is already one of Europe’s most restrictive abortion laws. (Photo by Wojtek RADWANSKI / AFP) (Photo by WOJTEK RADWANSKI/AFP via Getty Images)
Marta Gorczynska got in her car and started driving.
She didn’t have a destination as she passed through Warsaw’s mostly deserted streets, but, just before noon last Tuesday, she got a text with directions: go to Rondo Dmowskiego.
Gorczynska, a human rights lawyer, was among a throng of protesters that used their vehicles to defy Poland’s lockdown and block the main roundabout in the capital, honking their horns and shouting slogans against a citizen’s bill to tighten what are already some of the most restrictive abortion laws anywhere in Europe.
Some were holding black umbrellas — a symbol of Poland’s abortion rights movement — while others had “Women’s Strike” posters taped to their windows. Demonstrators dressed head-to-toe in black, and wearing face masks, circled on bicycles. Police shouted over megaphones, warning that assemblies were illegal during the pandemic and urging the women to go home.
As governments across Europe continued to grapple with the worst health care crisis of the modern era, Polish lawmakers debated draft legislation last week that would ban abortion in the case of fetal abnormalities — one of the few remaining circumstances in which the procedure is still allowed in the majority Catholic country.
Ultimately, Poland’s lower house voted to send the bill to a parliamentary commission for more work. But the timing, which was slammed by human rights campaigners, presented a fresh challenge for women’s rights activists who have been fending off an abortion ban for years: how to protest in the time of coronavirus.
Women protest from their cars with umbrellas, a symbol of the abortion rights movement.
“We saw this as an attempt by the government to use the lockdown to push for this controversial law, because, as history shows, all these attempts of the government to amend the abortion law have always triggered a lot of demonstrations,” Gorczynska said, referring to a nationwide “Black Monday” strike in 2016 that drew millions.
“If there was no lockdown, thousands of women would have been on the streets. So we were using other tools, especially online ones.”
Those who couldn’t come out found other ways of demonstrating. Protesters rallied around hashtags like “black protests” and “women’s hell” on social media, sharing photos of themselves in black and white or holding abortion pills in their palms. Others hung posters from their balconies or went out for their daily exercise with messages of resistance taped to their backs.
But the abortion bill is part of a wider problem, according to campaigners and academics who say that Poland’s ruling nationalist Law and Justice party (PiS) is using the pandemic to continue chipping away at democracy and tightening its grip on power.
“What’s happening now is the next stage in the destruction of our new democratic state,” Anna Materska-Sosnowska, a political scientist at Warsaw University, told CNN. She pointed to 11th hour changes to how Poland votes and proposals to extend the length of presidential terms as worrying signs of what’s ahead.
The government is still planning to hold a presidential election on May 10, though a majority of Poles — not to mention opposition politicians — want to postpone it because of the outbreak.
On March 28, the PiS rammed a bill through the lower house that would allow the election to go ahead by postal ballot, even though the country’s top court previously ruled that no changes can be made to the electoral code within six months of the vote. The bill has now moved to the senate for debate.
CNN has made several attempts to reach out to the PiS and the government for comment.
Materska-Sosnowska fears that changes to the electoral process would put the integrity of the vote at risk. While opposition candidates have had very limited opportunities to campaign, President Andrzej Duda, an ally of the PiS, has unfettered access to airtime and is ahead in the polls.
Protesters wave flags and hold posters emblazoned with a red lightning bolt.
The European Union’s parliament said Friday that holding the elections in the middle of the outbreak could endanger lives and was “totally incompatible with European values.” The parliament also singled out Poland’s ally Hungary — which recently passed a law allowing Prime Minister Viktor Orban to rule by decree indefinitely — for criticism.
On Monday, opposition lawmakers began talks with politicians from the junior party in the PiS’s ruling coalition about delaying the vote, hoping to capitalize on growing divisions in the alliance.
Draginja Nadazdin, the director of Amnesty International Poland, suggested that if the coronavirus was a test of whether governments are committed to human rights, then Poland was failing.
“If you want to use the coronavirus as a kind of test, to gauge how the government supports human rights, neither Poland’s approach to abortion, neither its approach to free and fair elections, nor its approach to the right to health, are good signals,” Nadazdin told CNN.
Campaigners in Poland worry that women’s access to health care is already being curtailed, with or without the latest bill.
Justyna Wydrzynska, an activist with Aborcyjny Dream Team, a charity that helps Polish women with access to abortions, says their hotline, which normally receives around 10 calls a day, started ringing off the hook after the government announced border closures to stop the spread of the virus.
Many of the callers were concerned that they would no longer be able to obtain abortion pills, which are illegal in Poland, and others feared they would not be able to reach clinics abroad in time to have procedures.
Abortions in Poland are only permitted in the case of some fetal abnormalities, rape, incest or a threat to the mother’s health. And even in cases when an abortion is allowed, many Polish women still struggle to find hospitals that will perform the procedure.
Wydrzynska was assisting one woman who had to cross the Polish border by foot into Germany, where she caught a train to Berlin and then flew to the UK. After the journey to London, she had an ultrasound and decided not to go through with the procedure.
“It’s incredibly stressful,” Wydrzynska said, adding that European countries who previously assisted with abortion procedures have told the charity they can no longer provide services to foreigners. “What can we say to them … we hope it’s not the end of the story.”
Protesters against the bill practicing social distancing.
And Poland isn’t alone — women’s access to abortion has become one of many healthcare provisions thrown into jeopardy globally.
In several US states, lawmakers have tried to introduce new restrictions on abortion, citing public health concerns. Some Republican governors, including Greg Abbott in Texas, have argued that abortion is a non-essential medical procedure and should be delayed during the pandemic to conserve personal protective equipment and other life-saving gear.
Critics have accused these states of exploiting the coronavirus crisis to limit women’s access to abortion, and the bans have ended up in the courts.
When it comes to women’s rights in Poland, protesters there say they’ll continue to fight — lockdown or not.
“It was even more important to show our strength, to show solidarity and to show that this lockdown doesn’t mean that we have our hands tied,” Gorczynska said.
Legal precedent means very little to judges and justices personally opposed to abortion rights, as we’ve seen during the COVID-19 outbreak.
The U.S. Court of Appeals for the Fifth Circuit once again put a halt on nearly all abortions in Texas, issuing a ruling Monday allowing the state to enforce Gov. Greg Abbott’s (R) COVID-19 ban. Shutterstock
It seems each day brings new developments on abortion rights in the time of COVID-19. It’s maddening and has left me with one lingering question: Will this shit ever end?
The U.S. Court of Appeals for the Fifth Circuit once again put a halt on nearly all abortions in Texas, issuing a ruling Monday allowing the state to enforce Gov. Greg Abbott’s (R) COVID-19 ban.
The decision represented a course correction for the conservative appellate circuit that had just a few days prior ruled abortion care could continue in Texas. Meanwhile, a federal court in Oklahoma on Monday issued a permanent injunction blocking that state’s COVID-19 abortion ban. Attorneys for the state of Oklahoma promptly appealed that injunction to the U.S. Court of Appeals for the Tenth Circuit. All the while litigation continues in six other states as advocates push back against Republicans’ attempts to weaponize the COVID-19 pandemic in their war on abortion rights.
So when will this shit end? That’s not a rhetorical question. Just one year ago, anti-choice lawmakers in Alabama passed a total abortion ban in an attempt to bait the freshly Trumpfied federal courts into overturning Roe v. Wade. Any day now, a court in Missouri will decide if the state’s only abortion clinic must close. Just a month and a half ago, my colleague Imani Gandy and I were at the U.S. Supreme Court for oral arguments in June Medical Services v. Russo, the poster child for bad-faith anti-choice attacks on abortion rights.
In June Medical Services, the Roberts Court will decide if they should uphold a Louisiana admitting privileges requirement—otherwise known as a clinic shutdown law—identical to a Texas admitting privileges requirement the Court previously declared unconstitutional in 2016. Since those arguments, Louisiana officials have tried to use COVID-19 as an excuse to ban abortion, prompting yet another lawsuit. Meanwhile, yet another lawsuit challenging the state’s web of anti-abortion restrictions is working its way through the federal courts. That brings the number of active lawsuits in Louisiana to protect abortion rights and access to three. Three lawsuits challenging three different attacks on abortion rights and access by Louisiana lawmakers, all happening at the same time.
So I ask again, in all sincerity: Will this shit ever end? Because while anti-choice lawmakers are smearing abortion providers in court filings as profiteering predators unable to advocate in court for their patients and using COVID-19 as yet another ruse to defund Planned Parenthood, pregnant people from Texas have been forced to travel hundreds of miles to Colorado, New Mexico, and Nevada for abortion care, or forgo care altogether.
There have been glimmers of good news. Some states have used the COVID-19 outbreak to reaffirm that abortion is essential health care, because well, it is. And while Fifth Circuit conservatives have gone rogue, other federal courts considering similar bans have so far done their jobs, seen these COVID-19 bans for the nonsense that they are, and have prevented states from enforcing them.
That’s all good news. But it’s good news tempered through the lens of a cascading attack on abortion rights that has only become more brazen as anti-choice lawmakers grow increasingly confident they’ve placed enough judges on the bench to re-criminalize abortion. That confidence is not misplaced. Here’s Fifth Circuit Court Judge James Dennis dissenting from Monday’s decision to once again allow the Texas COVID-19 ban to take effect.
This Circuit thus once again does not apply the applicable rules of law because of the subject matter of the case, and, equally troubling, ignores the words of its own ruling from less than two weeks ago. I again echo the words of a colleague in dissent in a case now before the United States Supreme Court: “It is apparent that when abortion comes on stage it shadows the role of settled judicial rules.”
Roughly translated, that passage of Dennis’ dissent poses a pretty basic question: Will this shit ever end?
Dennis makes the point that when it comes to abortion rights, precedent means very little to judges and justices personally opposed to abortion. That’s true for the Fifth Circuit judges like Kyle Duncan, a Trump appointee whoallowed the Texas ban to take effect, and it’s true for the conservatives on the Supreme Court. On Monday, Justice Brett Kavanaugh went out of his way to question the role of precedent in abortion rights case in a concurring opinion in a case having nothing to do with abortion rights. The opinion, like others issued by fellow conservative Justice Clarence Thomas, sends a clear signal that abortion rights precedent is on the ropes. And anti-choice lawmakers are listening.
So if precedent means little when it comes to abortion rights as Dennis suggested this week, then the answer to my question at the top of this piece is “yes.” The bad faith attacks on abortion rights will end as soon as the conservatives on the Roberts Court issue a ruling overturning Roe v. Wade entirely. And not one moment before then.
Clinic closures due to coronavirus in developing countries could lead to millions of unsafe abortions and thousands of maternal deaths if nothing is done, researchers said on Thursday.
The pandemic is decreasing women’s access to sexual and reproductive health care worldwide as supply chains are disrupted, transport is restricted and services deemed “non-essential” are shut down, said the Guttmacher Institute, a reproductive health think tank, in a report.
Just a 10% decline in access to care in low- and middle-income countries would result in an additional 15 million unintended pregnancies, 28,000 maternal deaths and 3 million unsafe abortions, the study showed.
That is a conservative estimate for what might happen in reality, with some experts predicting a decline of up to 80%, said Elizabeth Sully, senior research scientist at Guttmacher.
“There’s a lot to suggest that we could see this and we could see something worse,” Sully told the Thomson Reuters Foundation.
“We need to take action now in a preventative way before we start to see these types of impacts.”
Countries should make sure sexual and reproductive health services are essential and staffed, make contraceptives available without a prescription and explore innovative models of care such as telemedicine, the report recommended.
The International Planned Parenthood Federation (IPPF) reported last week that more than 5,600 of its clinics and care providers – representing 14% of the total – had closed because of the outbreak across 64 countries.
Countries particularly affected by closures included Pakistan, El Salvador, Zambia, Sudan, Colombia, Malaysia, Uganda, Ghana, Germany, Zimbabwe and Sri Lanka, said IPPF.
Charity Marie Stopes International (MSI), which provides contraception and abortion services in 37 countries, has estimated 9.5 million women and girls would lose access to its services in 2020 due to the pandemic.
In Nepal, where it performs more than 75% of all safe abortions, MSI was forced to shut down services due to the lockdown on March 24, it said.
It has since been able to reopen 12 of its 36 clinics at limited capacity but said it is far from meeting need.
“We are trying every day to open more in coordination with the government,” a spokeswoman said.
MSI was also forced to temporarily shut its clinics in India, where it is the largest provider of family planning services outside the public sector.
India’s government ruled that abortion was an essential service on April 14, several weeks into lockdown, but women said they were not sure how they would get to health centers with no transport options and movement restrictions.
“Every person who makes the decision to have an abortion encounters adversity—cost, travel, childcare, insurance coverage, stigma, protestors and the list goes on. But these barriers became walls in recent weeks.” Pictured: Pro-choice demonstrators outside the Supreme Court in 1989, Washington DC (Lorie Shaull)
Last weekend, like many weekends before, we traveled from our respective home states to Kansas to provide abortion care. A typical weekend is very busy, and we stay late to ensure everyone is seen and treated with respect, compassion and evidence-based care.
This weekend was different. Amid a pandemic, several state anti-abortion governors and attorney generals opted to use executive orders to restrict abortion to draconian levels in the name of stopping so-called “elective” procedures and preserving personal protective equipment (PPE).
This is at odds with the recommendations of the American College of Obstetricians and Gynecologists and six other national medical organizations, who unequivocally state that abortion access is essential, timely and necessary especially during this pandemic.
The state restrictions are nothing more than veiled political maneuvering at the expense of thousands of women, their partners and families. For Trust Women Wichita, Kansas, the state orders mean they are the closest clinic to receive abortion care for people in Oklahoma and Texas, which meant this weekend at Trust Women was decidedly different than any other.
Most patients we cared for had been seeking abortion care for at least two to three weeks, with multiple clinic appointments cancelled due to restrictions. Several of these patients would have been able to have a medication abortion, but due to the delays, were no longer eligible.
One patient had appointments at three clinics before making it to us, but they were all cancelled due to state government restrictions of abortion care during the coronavirus. Each time she got to a clinic, her appointment was cancelled—and as her gestational age increased, the possible places for her to go to receive care narrowed.
Many drove nine to eleven hours from Texas, or slightly less from Oklahoma.
One immigrant family was trying to get health insurance, but due to all immigration processes being halted, they opted to interrupt their pregnancy.
One patient tried to get a contraceptive implant but couldn’t because all of her local providers were not currently seeing patients. She found out she was pregnant and drove the seven hours to seek abortion care.
One woman had a contraceptive implant, but after it expired, she could not find a gynecology office who would replace it because they had cancelled all elective outpatient appointments.
Another had a scheduled sterilization procedure, which was deemed “non-essential” and was cancelled. She tried to make an appointment to be restarted on contraception, but that, too, was not available due to closed clinics during the pandemic.
Several women were survivors of sexual assault. Many took planes to seek abortion care. Most of the women we saw recently lost their jobs, were furloughed or are working so few hours they can’t make ends meet. All were terrified about how the coronavirus pandemic will progress and what it means for them.
“The state restrictions on abortion are nothing more than veiled political maneuvering at the expense of thousands of women, their partners and families.” Pictured: Stop Abortion Bans Rally in St. Paul, Minnesota, May 2019. (Lorie Shaull)
What we worry most about—what keeps us up at night—are the those who are still in Texas, Oklahoma and beyond who cannot afford a plane or a long car ride and thus will stay pregnant because their need for essential abortion care will go unmet.
Everyone is scared right now, and everyone is anxious. As a nation and planet, we are facing an invisible enemy, and each of our lives upended by it. Using a pandemic to restrict and stigmatize abortion is counterproductive, dangerous and preys on those in need of health care.
Health care providers are the experts in deciding what is and is not essential healthcare. We are bound by our ethical and moral oaths to serve our communities—this does not stop during pandemic.
Abortion is not elective. Abortion is timely and cannot be delayed.
Every person who makes the decision to have an abortion encounters adversity—cost, travel, childcare, insurance coverage, stigma, protestors and the list goes on. But these barriers became walls in recent weeks.
On our last day, we finished just in time to head to the airport. As we left, we received quiet waves from the clinic staff who were already busy answering continuously ringing phones with people seeking reproductive health care from around the country.
The struggle for reproductive health access will continue—despite the political leadership ignoring physician and medical organization collective recommendations that abortion care is essential medicine, abortion is timely and should not be delayed or cancelled, especially not due to the COVID-19 pandemic response.
We can attest that there is a profound negative impact on a person’s life, health, family and well-being if they cannot access abortion care. Physicians of all specialties are working tirelessly both to treat patients who contract this virus and to act as a whole to work for the best interest of our community and public health.
As we saw in Kansas, abortion care will continue to be sought despite the restrictions. We demand that state leadership put their political goals aside, listen to our stories, focus on the medicine and public health recommendations of experts, and reverse decisions that make essential health care impossible to access.
Dr. Angela Marchin checks the schedule at the Trust Women clinic in Wichita, Kan.(Fernando Salazar / For The Times )
WICHITA, Kan. — Right after she was laid off from her medical job because of the coronavirus outbreak, a single mother of two in north Texas found out she was pregnant.
The next day, when she called to make an appointment at a local abortion clinic, staff told her it had closed — and no other clinic in the state could provide her an abortion, either.
“They told me the governor had put a halt on it,” said the woman, who asked to be identified by her first name, Kris, after driving 350 miles north to a clinic in Wichita, Kan., this week, crying and trembling with anxiety.
“I just feel like the state of Texas has taken away a fundamental right of mine,” she said.
More than half a dozen states have tried to ban abortion during the coronavirus outbreak as an elective procedure. Texas abortion providers sued to block the bans, appealed to the U.S. Supreme Court, but withdrew their appeal this week after a circuit court allowed some abortions to proceed. Providers in Arkansas and Tennessee also sued to stop bans there this week, which could end up at the high court. Meanwhile, women whose appointments have been canceled have tried to self-induce miscarriages or driven hundreds of miles to out-of-state clinics, expensive and risky travel.
Texas Gov. Greg Abbott and other state officials insist abortions — even medication abortions that involve clinic staff dispensing pills — are elective procedures that require gloves and other protective medical equipment needed elsewhere during the pandemic.
“Abortion has been touted as a ‘choice’ by the same groups now attempting to claim it is an essential procedure,” Texas Atty. Gen. Ken Paxton said in a statement last week in which he vowed “to ensure that hardworking medical professionals receive the supplies and personal protective gear they need to successfully combat this health crisis.”
Texas Atty. Gen. Ken Paxton.
(Eric Gay / Associated Press)
The bans only added to the challenges abortion clinics have faced during the pandemic.
“We do not have enough staff, we do not have enough doctors, we do not have enough days in the week,” said Julie Burkhart, founder and CEO of nonprofit Trust Women, which operates the clinic in Wichita and another in Oklahoma City. “These anti-choice governors have created a health crisis within a health crisis.”
They and other abortion clinics rely on doctors from out of state whose flights were limited or canceled after the outbreak. Some clinics limited their hours, stopped providing surgical abortions or closed. Others like Trust Women found doctors to volunteer. Staff have to wear added masks and screen potential patients for symptoms of COVID-19. Three times as many patients showed up for appointments in Wichita this week, up to 45 a day, the lowest no-show rate clinic staff can remember. Patients had to be socially distanced in the waiting room. Some had traveled from as far as Austin and Houston — about 600 miles. One woman was homeless, another arrived with just $20. Nonprofit abortion funds helped them pay for the procedure, and have expanded in recent weeks.
Some clinics discourage women from bringing companions because they can no longer enter clinics due to COVID-19, forced to wait outside in their cars where protesters often linger. The fenced Wichita clinic has drawn crowds and even closed for several years after its director, Dr. George Tiller, was fatally shot by an antiabortion extremist. Protesters show up daily and have an office next door. Last week, a group with bullhorns was dispersed by police for violating the governor’s order barring large gatherings. This week they returned, as did a priest praying the rosary and a man with a sign that said, “Children are being murdered here.”
After Abbott issued the Texas order March 22, local abortion providers filed a federal lawsuit arguing that the “pandemic and its fallout do not reduce patients’ needs for abortion; if anything, they make timely access to abortion even more urgent.”
“It just shows how when it comes to reproductive health, we live in two different Americas,” said Amy Hagstrom Miller, president of Whole Woman’s Health, a Texas abortion provider.
Whole Woman’s Health sued Texas in 2013 to block a law that closed more than half the state’s abortion clinics before it was overturned by the U.S. Supreme Court. The latest ban has forced its clinics to cancel hundreds of appointments and send patients as far as the East Coast, some by plane, Hagstrom Miller said, calling it “the biggest uncertainty we have felt in our lifetimes.”
“It’s exposing people to COVID under the guise of protecting their health,” she said. “People are desperate.”
Planned Parenthood of the Rocky Mountains saw twice as many patients from Texas at the end of March because of the state ban, said President and CEO Vicki Cowart. While they have increased telemedicine to provide medication abortions by mail, they can’t do it in Texas.
“COVID-19 is being used as a tool by people who want to see abortion banned,” Cowart said.
Joan Lamunyon Sanford, executive director of New Mexico Religious Coalition for Reproductive Choice, said the number of women seeking help paying for travel to get abortions there has doubled in recent weeks, mostly from Texas. Two weeks ago, a 19-year-old arrived on a Greyhound bus from Louisiana, more than 900 miles away.
New Mexico clinics are booked for the next month, she said, forcing women to wait and have more expensive surgical abortions during the pandemic fiscal crisis.
“People are losing their jobs or they’re worried about losing their jobs, reluctant to take time off work or if they are taking time off work, having to justify it,” she said.
In Texas, Kris, 36, followed the legal battle over the abortion bans daily, trying to predict which clinics were likely to stay open.
“It’s been flipping back and forth,” she said. “Every day has been a nightmare.”
Governors have attempted similar bans in Alabama, Iowa, Louisiana, Mississippi, Ohio and Oklahoma. As state and circuit judges ruled, the Texas ban was lifted, then reinstated in part. Surgical abortions were available this week in Texas only to women nearing the legal limit of 22 weeks. Kris said she “worried I’ll be forced to have this baby.”
She had her first child when she was 17, pressured by Christian friends in her small town not to have an abortion. A year later, she had her second, and raised them both on her own. She later had an abortion, with no delays and no regrets.
This time, she had to make an appointment at a clinic in Fort Worth, then Oklahoma City and finally Wichita, on the recommendation of clinic staff. Kansas Gov. Laura Kelly has supported abortion rights.
“They told me to keep this [appointment] because Oklahoma keeps going back and forth,” she said — most recently when a circuit court Monday allowed clinics to dispense abortion medication.
Kris became pregnant six weeks ago after her boyfriend’s condom broke. They had only dated a few months. She opted for a surgical abortion because she wanted it done as soon as possible, by a doctor, without complications. Before she left for the clinic Monday, she called Kansas and Oklahoma highway patrol to ensure she wouldn’t be stopped for traveling during the pandemic. She stayed at a cheap motel, wiping down surfaces for fear of COVID-19. There were already a handful of virus hot spots in the county surrounding Wichita.
At the clinic, she steeled herself as she took a seat in the waiting room beside a sign that said, “Politicians are not doctors.” To drive herself back to Texas, Kris would have to have the abortion with a milder sedative than is usually used.
Dr. Angela Marchin finishes up her day Tuesday at the Trust Women clinic, where many women from Texas have been coming because clinics in their state have been sporadically closed.
(Fernando Salazar / For The Times )
“These politicians, they have no idea what it’s like for women in this situation,” she said shortly after arriving. “My life is in other people’s hands, my choice.”
Another Texas woman came to the clinic that day because her husband had just been fired, they paid their mortgage this month with savings and were afraid they might soon become homeless. She had wanted a baby, and cried as she showed the doctor pictures of her 4-year-old son. The doctor wanted to hug her, but couldn’t because of social distancing.
“The pandemic is making these decisions even more complicated for people,” Dr. Angela Marchin said.
On Wednesday, a 22-year-old stay-at-home mother of two traveled to the clinic from the central Texas city of Killeen, where her husband is a soldier based at Ft. Hood. The woman, who asked to be identified by only her first name,Cailyn, said she decided to have an abortion because she would soon have to move: Her husband was about to be stationed in Hawaii in June. Earlier this year, they had paid $10,000 for reconstructive surgery to repair abdominal muscles damaged during her last two pregnancies. She had taken the morning-after pill, but said it didn’t work.
Cailyn unsuccessfully tried to induce a miscarriage with multiple doses of vitamin C, then called two other clinics that referred her to Wichita because of the Texas ban.
“I don’t think it’s fair. If it’s not your body, it shouldn’t be your decision,” she said as she waited to get abortion medication.
Earlier this month, Austin waitress Heather Artrip, 30, had packed her car to drive to New Mexico with her two sons, ages 6 and 9, when a local clinic called to say it had reopened because of a court decision. By the time Artrip arrived the next day, the decision had been reversed, the ban reinstated.
“Turns out now, they can’t,” she said by phone from the clinic. “This is the third appointment I’ve had that’s been canceled due to the bans.”
Artrip, who has a prolapsed uterus that would make pregnancy risky, had also taken the morning-after pill, then tried to induce a miscarriage.
She said the abortion ban was “like slavery, like forced birth.”
“This is my right given to me on a federal level but on a state level I don’t have access. But Hobby Lobby is open because it’s essential. Liquor stores are open. Taco Bell’s open. It just does not add up,” she said.
A week later, when the ban was partially lifted, Artrip was able to get abortion medication at the Austin clinic.
Abortion advocates have mobilized in response to the bans, expanding appointments and paying for women to travel to nearby states. Austin-based Lilith Fund, which operates hotlines for women seeking abortions, increased its average payment by 30% to $363 after the ban, according to executive director Amanda Beatriz Williams.
Beatriz said the average Texas woman seeking an abortion since the state ban has had to travel about 700 miles round trip; one woman traveled to Atlanta.
At the Wichita clinic, the operating room white board was filled with dozens of patient initials, the parking lot replete with Texas license plates. The two doctors who had flown in from out of state worked double time.
Dr. Angela Marchin listens to staff member Lindsay Mills at Trust Women on Tuesday.
(Fernando Salazar / For The Times )
“Is everyone from Texas?” said Marchin who, because of limited flights, would have to fly back to Colorado on Wednesday at noon, but seeing as many patients as she could before she had to cut her day short. “This is the most procedures I’ve done in a day.”
An upcoming ruling could give state lawmakers a green light to ignore science for the sake of ideology
Pro-choice and pro-life activists demonstrate in front of the the US Supreme Court during the 47th annual March for Life on January 24, 2020 in Washington, DC. (OLIVIER DOULIERY/AFP via Getty Images)
In 2016, the U.S. Supreme Court ruled that it was unconstitutional for Texas to require abortion providers to have admitting privileges at a local hospital. Last week, the Court heard oral arguments in a case challenging the same requirement in Louisiana. The state in question may have changed, but the fact remains: These kinds of laws unfairly target abortion providers without improving public health.
But this case goes far beyond a single abortion restriction. If the Supreme Court upholds this law, it will give state lawmakers a green light to ignore science whenever they want for the sake of ideology.
Admitting privilege laws are among the slate of restrictions commonly known as TRAP laws, or targeted regulation of abortion providers. TRAP laws, which are in place to varying degrees in dozens of states, also include requirements that clinics conform to the physical standards of ambulatory surgical centers (ASCs). This can include installing more advanced and expensive equipment, requiring separate recovery rooms, or more advanced staffing than a typical clinic or medical office. These laws are often passed under the guise of protecting patient safety. After all, the reasoning goes, don’t more regulations mean better care?
As a doctor of public health, I care about the safety of patients seeking medical services, including abortion care. But research, including studies led by myself and my colleagues at Advancing New Standards in Reproductive Health, shows that TRAP laws do not make patients safer and are therefore unnecessary. The false arguments being made in support of such laws demonstrate the spread of anti-science sentiment among regulators, lawmakers, and the general public.
The data show that abortion is an overwhelmingly safe procedure. After analyzing 50,000 abortions provided in ASCs and clinics, we found that 96.7 percent of patients had no complications after their abortions, while 3 percent of patients had a minor complication. Ultimately, only 0.3 percent of patients had a major complication following their abortions—and there was no difference between the ASCs and office-based settings when it came to complication rates for abortions.
Furthermore, in the rare instances when patients did require hospital-based services, our research shows that providers obtaining admitting privileges did not change that process. Providers who referred patients to hospitals before performing abortions, such as for ectopic pregnancies, relied on existing protocols; these did not change once providers obtained admitting privileges. When patients sought follow-up care after the abortion in a hospital, they usually went to a facility near their home—where, again, their provider’s admitting privileges made no difference.
These kinds of laws do, however, make a difference when it comes to patients’ ability to access care. It can cost clinics hundreds of thousands of dollars to convert their facilities to match ASC standards, and physicians in conservative-leaning areas often struggle to obtain hospital admitting privileges for political reasons. After Texas implemented HB 2, which included both admitting privilege and ASC requirements, the number of clinics in the state plummeted—making abortion more difficult, and sometimes impossible, for people to get.
The safety of abortion and the consequences of making it more difficult to access means TRAP laws are similar to treating someone with steroids when they’re not even sick: an aggressive preventive measure that could, in itself, have harmful consequences.
To be clear, I believe that abortion facilities should have some level of regulation. Just like any other medical procedure, abortion should be subject to standards that ensure patient safety. It’s useful, in fact, to look at the way other comparable procedures are regulated. Usually, professional associations of clinicians who provide the procedures themselves set standards based on available research evidence and clinical expertise. In fact, multiple health care professional associations recently released such evidence-informed guidelines that apply to abortion facilities, clearly stating that admitting privileges are unnecessary for patient safety. When the government does intervene, laws that apply for other medical procedures like dental surgery — which is less safe than abortion — are generally based on the level of anesthesia being used.
The government’s approach to tobacco regulation is another useful comparison. When confronted with the evidence that tobacco use can lead to lung disease, heart problems, and other chronic health issues, policymakers implemented regulations around cigarette sales, manufacturing, and advertising. These regulations benefited public health and safety—and they were informed by research and clinical expertise.
Abortion restrictions, meanwhile, are rationalized with anecdotes and ideology. Unfortunately, they are just the latest example of the ways anti-science sentiment has emerged in state legislatures and the nation’s highest court. In the same way that climate change denialism and anti-vaccination rhetoric has held progress hostage, TRAP laws substitute feelings for facts. When that approach influences public policy, it puts everyone at risk.
In the past, Supreme Court justices have reasoned that abortion restrictions are unconstitutional because of the lack of data supporting them. Just four years ago, Justice Stephen Breyer wrote that the evidence Texas used to justify its admitting privileges law “does not show how the new law advanced the State’s legitimate interest in protecting women’s health.” It remains to be seen whether the 2020 incarnation of the Court, with its two new justices, requires a similar level of scientific evidence to justify regulating abortion — or if it will rule against science instead.
Anti-abortion-rights activists pray outside a Planned Parenthood clinic that offers abortions in 2016 in Austin. Texas has suspended most abortions during the coronavirus pandemic. Melanie Stetson Freeman/Christian Science Monitor via Getty Images
Planned Parenthood clinics in Colorado, New Mexico and Nevada are reporting an influx of patients from Texas, after an order from Texas Gov. Greg Abbott suspending most abortions in that state during the coronavirus pandemic.
New data provided to NPR by Planned Parenthood show a more than sevenfold increase in patients traveling from Texas to clinics across the Southwest for abortions since the order took effect in late March.
“It clearly shows that when individuals aren’t able to access abortion care in their own state, they will travel — or at least the patients who have the means to travel will travel,” said Dr. Kristina Tocce, medical director at Planned Parenthood of the Rocky Mountains, in an interview with NPR.
According to Planned Parenthood, clinics in Colorado, New Mexico and Nevada saw 129 patients from Texas between March 23 and April 14, compared with 16 Texas patients during the entire month of February, a 706% increase. During the same period in 2019, a Planned Parenthood official said those clinics saw 14 patients from Texas.
Tocce said she recently saw a patient who traveled 16 hours for a procedure. She said some patients are flying or making long drives at a time when travel is being discouraged because of the pandemic.
“This really is frustrating as a provider because it seems to be putting patients at additional risk of being exposed to COVID themselves as they travel and risk them getting an infection, versus them possibly unwittingly transmitting COVID if they are an asymptomatic individual who’s positive,” Tocce said.
Republican state officials and organizations opposed to abortion rights have argued that the procedure should be treated as nonessential during the pandemic, in order to preserve medical supplies for coronavirus patients, and to reduce the risk of exposure at clinics.
Tocce said her health centers are taking steps to mitigate those risks, including screening patients for symptoms, having patients wear masks at clinics and relying on technologies like telemedicine when possible.
Major medical groups say delaying abortion can be harmful to pregnant women. Abortion-rights groups have challenged bans in several states and have succeeded in scaling them back or blocking them, but some patients seeking the procedure have been turned away.
A federal appeals court recently ruled that medication abortions could continue in Texas, along with surgical procedures for patients approaching the state’s 22-week cutoff.
You want to help health care workers? Get us more PPE.
Clinic assistant Rachel Runnells calls patients to confirm appointments during a lull in patient intake at the Planned Parenthood clinic in Iowa City on Friday, Sept. 13, 2019. (Liz Martin/The Gazette)
On April 9, Bob Vander Plaats, the president and CEO of The Family Leader, a conservative advocacy organization in Iowa, wrote a piece for the Des Moines Register in which he argued that all surgical abortions should be halted throughout the COVID-19 outbreak. This came after Gov. Kim Reynolds had already issued a proclamation preventing surgical abortions as part of Iowa’s pandemic response.
For both Mr. Vander Plaats and Gov. Reynolds preventing access to abortions was done in the interest of preserving vital personal protective equipment for health care workers. It’s an incredibly flimsy excuse as months of checkups and the birthing process clearly use more protective gear even if there are no complications in the pregnancy.
Mr. Vander Plaats, however, wielded words such as “heroes” to discourage disagreement in a way that will be familiar to those who have heard “the troops” invoked by people who never served. He even cynically referred to health care workers who died of COVID-19 as a justification for a ruling that he is certainly aware will not make anyone safer from the virus. As an ICU nurse who lives and works in Iowa, I resent the use of my career to justify preventing women from receiving vital health care.
Blocking women from receiving safe abortion care is wrong during the best of times, but to do so now is particularly callous: a time when many people have no escape from domestic violence at home, when mental health services are difficult to obtain, when people are living with precarious finances and could be facing eviction, when chronic conditions that could be dangerously exacerbated by COVID-19 are further complicated with pregnancy. Health care workers have unwanted pregnancies, too. Facing the physically and emotionally exhausting task of working during a pandemic while unable to receive treatment for one’s own health needs can be a frightening prospect.
If Mr. Vander Plaats were truly interested in helping health care workers, there are many ways to do so: lobby for hazard pay, for example, or encourage greater use of the Defense Production Act so that we might actually obtain more protective equipment. What he should not do is use me and my colleagues to push his own political agenda.
For now, Gov. Kim Reynolds and Planned Parenthood have reached a truce since she first tried to use the COVID outbreak as a means to block access to surgical abortions. Planned Parenthood can still provide abortions considered medically necessary. However, there are always those willing to use any method to prevent women from receiving this much-needed health care. The use of buzzwords and a faux concern for “heroes” ought not obscure these actions for what they are: attempts to capitalize on a disaster to restrict our Constitutional rights.
Rachel is an RN working in an Intensive Care Unit. She is a nearly lifelong Iowan. She lives in Des Moines with her husband and two dogs.
In the latest sweep of legal filings, Arkansas, Louisiana and Tennessee now face legal challenges over attempts to ban abortion services amid the coronavirus pandemic. Officials claim the suspension of services is an attempt to preserve medical resources, but abortion rights supporters accuse states of exploiting the public health crisis to achieve a decades-long goal: banning abortion.
In a span of fewer than 24 hours, three new lawsuits were filed by the American Civil Liberties Union, the Center for Reproductive Rights and Planned Parenthood, requesting federal courts to block states from including abortion in directives temporarily halting “non-essential” medical procedure. Eight states have now been sued over similar orders: Arkansas, Alabama, Iowa, Louisiana, Ohio, Oklahoma, Tennessee and Texas.
“This is a shameful abuse of power,” Nancy Northup, president and chief executive officer of the Center for Reproductive Rights, said in a statement to CBS News on Tuesday.
Abortion rights supporters, including Northup, don’t see the recent wave of coronavirus-related bans any differently than the many other restrictions that similar states have levied on abortion services. Indeed, every state that has attempted to restrict the procedure amid the pandemic is considered to be “hostile” toward abortion access, according to the Guttmacher Institute, an abortion-rights research organization. Many states with similar directives restricting “non-essential” medical procedures have not included abortion services in those orders.
“It’s just another version of all those other restrictions,” Northup said on a call with reporters on Tuesday.
Major medical associations side with abortion rights supporters. The American Medical Association has accused states of “exploiting” the pandemic to restrict the procedure. In response to the bans, the American College of Obstetricians and Gynecologists has called out abortion as an “essential component of comprehensive healthcare.”
A spokesperson for the Attorney General of Louisiana said the office had not yet been served and had no comment. Emails to the Attorneys General of Tennessee and Arkansas were not immediately returned.
So far, courts have mostly sided with abortion rights supporters, allowing the procedure to resume despite state bans. On Monday, federal appeals courts ruled that medication abortion services in Oklahoma and Texas could resume, as well as procedures for patients who would be outside the legal gestational limit once the bans were scheduled to lift.
Up until today, the vast majority of abortion services had been unavailable in Texas since March 23. It’s the first time that’s happened in a state in nearly 50 years — when Roe v. Wade legalized the procedure. Beginning Tuesday, most abortion services will again be available to patients. Similar rulings have allowed abortion to continue in Alabama, Iowa, and Ohio.
Louisiana is already at the center of a high-profile lawsuit that could potentially shutter all of the state’s providers. In early March, the U.S. Supreme Court heard oral arguments in June Medical Services v. Russo, a case challenging a state abortion restriction that, if upheld, could close all three of Louisiana’s clinics that provide abortion.
Anti-abortion rights demonstrators and Abortion rights demonstrators rally outside the Supreme Court, in Washington, Wednesday, March 4, 2020, as the court takes up the first major abortion case of the Trump era Wednesday, an election-year look at a Louisiana dispute that could reveal how willing the more conservative court is to roll back abortion rights. (AP Photo/Andrew Harnik)
Saying Louisiana politicians are trying to exploit the coronavirus pandemic to further their goals, a national reproductive rights group Tuesday asked federal court in Baton Rouge to immediately block the state’s efforts to close the state’s three abortion clinics.
“This is a shameful abuse of power,” said Nancy Northup, President & CEO of the Center for Reproductive Rights, based in New York City. “Louisiana has been trying for decades to end abortion.”
The Center represents the Hope Medical Group in Shreveport in this action as well as in another case involving nearby hospital admitting privileges for physicians who perform the pregnancy ending procedures. Depending on how the U.S. Supreme Court rules in the admitting privileges case, abortion clinics in Louisiana and other states could close.
Northup told reporters in a telephonic press conference that Louisiana Attorney General Jeff Landry and his anti-abortion allies apparently couldn’t wait for the Supreme Court decision, which was due in late May/early June before the pandemic, and targeted an abortion clinics through an interpretation of a March directive by the Louisiana Department of Health. She said Louisiana, and other states with strong anti-abortion restrictions, have long interpreted medical policies as reasons for limiting the procedure.
The health department directive limits nonemergency medical procedures during the COVID-19 crisis. But Section A of the health department order excludes patients with an emergency or whose health would be undermined by waiting.
The Center argues that delays for abortions, which have limitations based on the age of the fetus, force patients into traveling hundreds of miles to states where the legal medical procedure is more readily available or force women to give birth against their wills.
Landry issued a statement Tuesday, noting that he hasn’t been served with the lawsuit yet. He added the abortion clinics are asserting that “the rules that apply to other facilities do not apply to them.
“While the rest of Louisiana has come together to fight COVID-19, it is disappointing that (Hope Medical) is once again claiming that they are exceptional and entitled to a blanket exemption.”
Landry last week launched an investigation into whether the state’s three abortion clinics were abiding by the health department directive.
Two assistant attorney generals burst in on the Hope Clinic – they visited clinics in Baton Rouge and New Orleans as well – demanding a review of the protocols put in place and equipment being used to check compliance with the directive limiting medical procedures during crisis, said Kathleen Pittman, Hope’s administrator. They also demanded to review the personal records of individuals who have received abortions since the beginning of the pandemic.
The visits came as something of shock, Pittman said. Usually, it’s health department personnel who perform inspections, not the state’s chief law enforcement agency.
Pittman said she needed to involve lawyers to keep the Attorney General’s Office from taking the charts of patients back to Baton Rouge. The clinic is practicing social distancing by allowing only the patient into the facility as well as doing all counseling on one day and all the procedures on the next. Twenty-four hours must pass between counseling and the actual abortion under state law. She also said that the clinic doesn’t use the medicines and equipment most needed by hospitals battling COVID-19.
At least seven states have issued medical procedures orders that have been interpreted as including abortion clinics. Legal challenges to similar closure orders are pending the states that include Arkansas, Alabama, Oklahoma and Ohio. So far, enforcement of the restrictions have been temporarily blocked. Iowa settled its case.
Republican state attorneys general, whose association Landry leads, have appealed those decisions. So far, the U.S. 5th Circuit Court of Appeals is the only appellate court to consider a trial court’s restraining order barring use of emergency COVID-19 orders as a pretext for closing the abortion clinics.
The 5th Circuit on April 7 upheld Texas Gov. Greg Abbott’s March 22 directive, thereby allowing state officials to shutter the clinics. That order has since been modified to allow abortions for women whose pregnancies have gone long enough that the procedure would no longer be allowed under existing state laws and, on Monday, to allow women to end pregnancies using medication in some cases.
Louisiana used similar language as Abbott in its order.
Landry’s teams started visiting Louisiana’s abortion clinics the day after the 5th Circuit’s decision.
On March 30, U.S. District Judge Lee Yeakel, of Austin, temporarily restrained Texas officials from enforcing Abbott’s order as it applied to abortion clinics. The state went to the 5th Circuit, which lifted the temporary restraining order, thereby closing abortion clinics while the courts figured what to do next.
In a 2-1 decision written by 5th Circuit Judge Kyle Duncan, of Baton Rouge, the majority used unusually sharp language in criticizing Yeakel for ignoring federal caselaw that oversees public health emergencies. The majority contended that the COVID-19 pandemic has created such “mounting strains on health-care systems,” that Texas is within its rights to ban non-emergency medical procedures, including abortions.
Fifth Circuit Judge Jennifer Walker Elrod, of Houston, joined in Duncan’s decision.
Judge James L. Dennis, of New Orleans, disagreed, pointing out that abortions are legal medical procedures that are time sensitive. He noted that the federal caselaw on which the majority relied comes from a 1905 decision that gave the state authority to force vaccinations on Massachusetts residents during a smallpox epidemic and therefore was not really on point.