LAFAYETTE, La. – In a part of the country where the rules about who can access abortion care vary dramatically from state to state, the COVID-19 pandemic has sewn another layer of confusion.
While a majority of Americans were under stay-at-home orders in April, Quita Tinsley was seeing patients travel to Atlanta from all over the South seeking abortion care. Tinsley is the co-director of Access Reproductive Care-Southeast, an abortion fund that provides financial and logistical help to low-income women seeking abortion care.
Starting in late March, legal battles ensued in Texas, Tennessee, and Louisiana, among five other states, over access to a service that medical professionals and reproductive rights advocates agree is an essential component to women’s reproductive healthcare.
By April, all states had issued public health emergencies requiring the mandatory closure of schools, non-essential businesses, and the postponement of elective and non-emergency medical and surgical procedures to ensure that scarce personal protective equipment would not be diverted from hospitals during the emergency.
However, in eight states, these executive orders did not make an exception for abortion services. Confusion mounted for women in states where it wasn’t immediately clear whether this procedure would even be an option during the pandemic.
“Texas was a day by day and week by week situation where the executive orders were changing constantly,” said Tinsley of ARC Southeast.
But as the pandemic continues impacting communities across the region, uncertainty over the availability of abortion services in the long run continues, according to Mia Raven, the deputy director of the Yellowhammer Fund. The fund provides financial support for low-income women seeking abortion care and emergency contraception in Alabama, Mississippi and the Florida panhandle.
“We have had people coming over here from Texas, Mississippi, Tennessee, Louisiana, overloading clinics, because they have no idea if they walk into a clinic in the morning if their state is going to come in with another rule,” Raven said. “It creates a whole load of people who are leaving their house who should not be leaving their houses.”
Women in the South often travel for abortions
Under typical circumstances in the South, it’s not unusual for Tinsley to work with women who have to travel out of state. ARC-Southeast provides support to women in six southern states including Alabama, Mississippi, South Carolina, Tennessee and Florida. The South has some of the most restrictive laws on abortions in the country.
Last year, 25 states, mostly in the South and Midwest, passed laws prohibiting abortions depending on the stage of the pregnancy. Alabama enacted a total ban on abortion at any gestational stage. Georgia, Kentucky, Louisiana, Mississippi and Ohio banned abortion after the detection of a fetal heartbeat, which is at about six weeks of pregnancy, according to the Guttmacher Institute, a reproductive health research and policy organization.
Lawsuits challenging these laws have been filed in all of these states except for Louisiana and the bans are currently not in effect. In Georgia, Gov. Brian Kemp said in previous comments that the ban was meant to “protect the innocent” and “champion the vulnerable. The three abortion clinics in Alabama remained open after the American Civil Liberties Union sued the state for not exempting abortion providers from the state’s order. As of May, the policy is not in effect.
An analysis of states that have issued orders conducted by the Guttmacher Institute showed how much farther people would have to travel to obtain access to abortion care. Even under ordinary circumstances, advocates say that the burden of travel comes with added costs such as finding child care, travel accommodations and safe transportation.
Travel would have increased exponentially, especially for people living in clusters of states that had issued these orders. In Texas for example travel distances would have increased from 12 miles to 447 miles, according to the analysis. Louisiana would have seen an increase from 41 to 189 miles and in Tennessee travel distances on average would have grown from 26 miles to 208 miles for most people.
“Even without a pandemic people in Louisiana often have to travel to Texas, Florida, Mississippi, Alabama, even Georgia to get abortion care. Each state has its own laws and regulations,” said Steffani Bangel, the executive director of the New Orleans Abortion Fund, a non-profit providing financing and logistical support for low-income women who need help paying for abortion services.
Pandemic creating uncertainty
Texas Gov. Greg Abbott issued an executive order on March 22 requiring licensed healthcare facilities and providers to postpone non-essential and non-emergency medical procedures, including both surgical and medical abortions, which involves taking a pill.
Three weeks later the order was challenged in a lawsuit filed by the Center for Reproductive Rights. The order was blocked and put into effect eight times throughout April as the case bounced between federal district court and the Fifth Circuit Court of Appeals. Texas ultimately agreed to allow abortion care to fully resume on April 22.
Dr. Daniel Grossman, the director of Advancing New Standards in Reproductive Health with the University of California in San Francisco, has been studying the impact of such delays. “Without access to safe facility-based abortion care, some patients may choose unsafe methods and would have to show up to the emergency room further burdening the health care system," he said.
The restrictions led dozens of women to travel out of state from Texas to access care in neighboring states, according to data from Planned Parenthood Gulf Coast.
Dr. Bhavik Kumar, the medical director of the Planned Parenthood clinic in Houston, said the clinic had to stop providing service halfway through the day. Patients were offered the option to reschedule or to try seeking care in neighboring states.
“This was happening in the midst of a pandemic where we are telling people not to travel except for anything essential,” Kumar said, adding that it creates another level of challenges for those who have lost employment.
“There is a lot of uncertainty around the pandemic. As a physician who takes care of these people every day, I worry that some governments are going to take advantage to try and make this more and more inaccessible,” he said.
A 'feeling of deep discouragement'
Louisiana experienced one of the earliest and largest outbreaks of COVID-19 in the South, reporting a spike of cases starting in New Orleans on March 9. The state health department ordered a postponement on all medical and surgical ‘non-emergency’ procedures as well as in-person health visits for 30 days starting on March 21. The order did not make an exception for abortion clinics.
Louisiana attorney general Jeff Landry defended the order, saying that it would ensure scarce protective equipment would be reserved for health workers in hospitals.
The Hope Clinic, one of three abortion clinics in Louisiana, sued the state after the order was issued. An agreement was eventually reached on May 1 ensuring continued access to abortion in the state throughout the pandemic.
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With states continuing to reopen at different stages, advocates are remaining vigilant to ensure continued access to reproductive healthcare throughout the pandemic.
“These restrictions are being passed down within an existing framework of restrictions,” Bangel said. “There’s this feeling of deep discouragement in their ability to access healthcare they know is stigmatized.”
Follow Maria Clark on Twitter @MariaPClark1.