Contraceptive and Abortion Care in a Pandemic: Harder Than it Has to Be
By Liz Borkowski
For people trying to avoid an unplanned pregnancy in the middle of the COVID-19 pandemic, there are multiple new barriers to contend with on top of a sense of urgency. The current combination of social distancing, economic upheaval, and U.S. policies at the state and local levels have now made it much harder than it should be to prevent pregnancies or obtain abortions.
Even before the pandemic, contraception wasn’t always easy to access, due to cost or the difficulty of visiting a provider for a prescription method. When people are trying to stay at home and businesses are operating with reduced capacity, getting in to see a healthcare provider can be even more difficult.
Under the Trump administration, access to family planning care for those with low incomes had already suffered under the “gag rule” policy affecting the Title X family planning network. For five decades, a strong network of providers received federal grants to provide high-quality family planning care to women and men with low incomes.
Under a new rule that prohibits providers from giving abortion referrals to patients who desire them and requires them to refer all pregnant patients to prenatal care, many of these providers have left the program and as a result have been forced to cut back care or close altogether. Before COVID-19, the Title X network had already seen its capacity cut nearly in half.
With the pandemic delivering a further blow to family planning clinics’ revenues and ability to operate, it’s become even harder for those seeking contraception to visit providers. Rescinding the Title X gag rule is one obvious way to restore provider capacity, but it’s also a good time to consider other ways to make contraception more readily accessible. One proposal is to make birth control pills available without a prescription. Several states now allow pharmacists to prescribe oral contraceptives, which eliminates the need for a separate clinician visit. And some states require insurers to cover a 12-month supply of birth control pills.
For those who are pregnant but don’t want to be, timely access to abortion is essential. However, when states ordered a halt to non-essential healthcare in order to limit coronavirus spread, several designated abortion as non-essential or elective. Courts have blocked many of these moves to halt abortions, but the policies have created additional burdens for those seeking abortion care in states from West Virginia to Texas. By contrast, states such as Illinois and Virginia have recognized contraceptive and abortion services as essential.
During a pandemic, medication abortion can become the preferred option for those who might otherwise have wanted to have a provider perform the procedure during an office visit. Again, though, policies create unnecessary barriers. Although research shown that outcomes from abortion via telemedicine are comparable to those from in-person care, several states ban the use of telemedicine for medication abortion. At the federal level, unnecessary barriers to prescribing and dispensing the medication abortion drug mifepristone make it harder than it should be for providers in any state to offer patients the option of ending a pregnancy at home using medications — and a new lawsuit seeks to change that for the duration of the coronavirus crisis.
Decades of misguided policy choices make it difficult for people, particularly those with the fewest advantages, to access comprehensive reproductive healthcare. Due to discrimination and structural inequities, Black women, Native Americans, immigrants, people with disabilities, and trans and non-binary people are among the groups who face the most barriers to receiving high-quality, respectful family planning care.
COVID-19 has exacerbated existing inequities, but advocates, providers, researchers, and communities are using this moment to advance solutions. Steps like removing barriers to contraceptive and abortion drugs and increasing telemedicine options can help advance reproductive autonomy and equity both during and after the pandemic. The long-term goal is sexual and reproductive health, rights, and justice for all.
Liz Borkowski, MPH, is the managing director of the Jacobs Institute of Women’s Health and a researcher in the Department of Health Policy and Management at the George Washington University Milken Institute School of Public Health.
