Forty-eight years after the Roe v Wade decision that protected pregnant people’s right to abortion, access to abortion care has become increasingly dependent on where you live. The COVID-19 pandemic has brought this inequity, along with so many others, into sharp relief. Over the past decade, the number of restrictions on abortion has increased dramatically, putting care further out of reach for those who need it. These policies particularly affect Black, Indigenous and other people of color, as well as those living on low incomes — groups that make up the majority of those seeking abortion.
The Biden administration has an opportunity to ensure that one’s ability to obtain abortion care is unencumbered by restrictions that are out of step with scientific evidence and contribute to disparities in access.
Take Texas as an example. Early in the COVID-19 pandemic, Texas and 11 other states, which have some of the most restrictive policies around abortion, used the public health emergency as another opportunity to advance their anti-abortion goals. Governors issued executive orders that considered abortion ‘not medically necessary,’ despite recommendations from professional medical associations that abortion care should not be delayed and the publication of best practices on how to reduce risk of COVID-19 exposure for both those seeking and providing abortions.
We studied the effect of Texas’ executive order and found that the number of in-state abortions declined 38 percent last April, while the executive order was in effect, compared to April 2019. We also found that nearly 1,000 patients had to travel out of state to get care, driving hundreds of miles to the next nearest facility, risking exposure to the coronavirus and enduring economic hardship.
Not all patients could travel to another state and many were forced to delay care. Last May, after the order expired, we found that the number of second trimester abortions increased by 61 percent compared to the previous year. Black patients, who are more likely to need later abortion care, were likely most affected by these delays. In interviews we conducted with patients seeking abortion care while the order was in effect, we also found that pre-existing restrictions, such as mandatory waiting periods, pushed patients later in pregnancy. Job loss and economic uncertainty brought on by the pandemic made it even more difficult for them to afford the cost of care, which cannot be covered by insurance in Texas.
Some patients were unable to overcome the numerous barriers to care and they ultimately decided to continue unwanted pregnancies, knowing this would add further stress and economic challenges.
While the executive orders have expired or were challenged in the courts, the pandemic rages on and people living in restrictive states like Texas still face unnecessary obstacles to abortion care — particularly medication abortion — also known as the ‘abortion pill.’
Last July, a federal judge granted a preliminary injunction of an FDA restriction on mifepristone, a drug used in medication abortion. The ruling allowed clinicians to dispense the medications to eligible patients by mail during the public health emergency, rather than requiring patients to risk exposure by making in-person visits to a clinic.
However, the Trump administration asked the Supreme Court to reinstate the harmful in-person requirement, which it did earlier this month. And even when the injunction was in place, patients in Texas and the 18 other states that prohibit the use of telemedicine to provide medication abortion were forced to make medically unnecessary visits to clinics to obtain the service.
Those supporting the in-person requirement and many other restrictions on abortion argue that these measures are needed to protect patients and safely provide care.
Yet, the evidence consistently demonstrates that abortion restrictions harm patients by forcing them to delay care because delayed procedures have a somewhat higher risk of complications compared to those obtained earlier in pregnancy. Research also shows that patients who are forced to continue their pregnancy have poorer health and economic outcomes — both for themselves and their children — than those who are able to obtain a wanted abortion.
During the pandemic, we have seen that health care policy that is driven by political ideology rather than science is bad for public health. As the Biden administration formulates its pandemic response and plans to address underlying structural inequities that have exacerbated health disparities, it should also provide oversight to guarantee that science guides both federal and state-level measures for safe abortion care during the COVID-19 pandemic and at all other times. This includes removing restrictions on telemedicine and eliminating unnecessary waiting periods and insurance coverage bans, among others.
Essential health care, including abortion care, should be available to everyone — even during a pandemic and regardless of where they live.
Kari White, Ph.D., MPH, is an associate professor in the Steve Hicks School of Social Work at the University of Texas at Austin and Daniel Grossman, M.D., is a professor of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco. Both are investigators with the Texas Policy Evaluation Project.