Columnist Carrie N. Baker: Ensuring safe abortion access during COVID-19

  • FILE - In this Wednesday, March 4, 2020 file photo, abortion rights demonstrators including Jaylene Solache, of Dallas, Texas, right, rally outside the Supreme Court in Washington. In some states, the 2020 COVID-19 coronavirus outbreak has fueled attempts to ban abortions. Where the procedure remains available, some abortion providers report increased demand, often from women distraught over economic stress and health concerns linked to the pandemic. (AP Photo/Jacquelyn Martin) Jacquelyn Martin

Published: 4/22/2020 4:36:11 PM

Anti-abortion politicians in states across the country are using the COVID-19 pandemic to block access to abortion — arguing abortion is not essential health care and supporting limitations in the interest of conserving personal protective equipment for COVID-19 cases.

Medical experts, however, are coming to the exact opposite conclusion.

The American College of Obstetricians and Gynecologists and seven other medical organizations recently issued a statement declaring that abortion is time-sensitive, essential health care and that lack of access may “profoundly impact a person’s life, health and well-being.”

In fact, physicians are calling for more and easier access to abortion, not less.

“Abortion is essential healthcare and it’s safe. The arguments attempting to close clinics based on conserving personal protective equipment (PPE) are not based in evidence. What we should be doing is expanding access to telemedicine provision of abortion during this pandemic,” said Dr. Daniel Grossman, an OB/GYN, abortion provider, and director of the University of California, San Francisco’s Advancing New Standards in Reproductive Health (ANSIRH).

In mid-March, under pressure from pro-choice advocates, health officials in Massachusetts issued a declaration that abortion is essential health care, thereby allowing continued access.

“Abortion is essential health care,” agreed Massachusetts Attorney General Maura Healey. “Any politician that says otherwise is doing what they’ve always done — wielding their power to block women from accessing the health care they need. Exploiting the COVID-19 crisis for their own ideological agenda is a new low. Restrictions on abortion at this time will harm the same people who are vulnerable to COVID-19 — people of color, people with low incomes, and their children.”

While I applaud this decision, Massachusetts needs to do more by expanding access through telemedicine abortion.

Telemedicine abortion combines medication abortion — which uses pills to end a pregnancy — and telemedicine — which allows health providers to supervise the use of abortion pills via videoconferencing or telephone consultations.

Approved by the U.S. Food and Drug Administration in 2000 for use during the first 10 weeks of gestation, medication abortion uses two types of pills: mifepristone, which interrupts the flow of the hormone progesterone that sustains the pregnancy; and misoprostol, which causes contractions.

Misoprostol alone — which is 80-85% effective — or in combination with mifepristone — 95% effective — is an extremely safe way to end a pregnancy in the first 12 weeks of gestation. About 60% of abortions that occur in the first 10 weeks are performed with abortion pills. Many people choose medication abortion because it is less invasive and more private than aspiration abortion (where the contents of the uterus are manually removed).

The growth of medication abortion has dovetailed with the expansion of telemedicine to provide new opportunities for pregnant people to access abortion in a safe and private way.

Telemedicine abortion is particularly important during the COVID-19 pandemic because it allows patients access to essential abortion health care while also social distancing. Telemedicine abortion also makes health care more accessible to people who live in rural or isolated communities and to people with limited mobility, time or transportation options.

However, numerous laws prohibit access to the abortion pill by limiting the reach of telemedicine abortion, reports the Guttmacher Institute. Eighteen states currently require the prescribing clinician to be physically present when prescribing the abortion pill. Thirty-three states require the clinician prescribing the abortion pill to be a physician. Neither of these requirements is necessary because the abortion pill is extremely safe and effective.

While Massachusetts does not have these restrictions, pregnant people cannot access telemedicine abortion in the state of Massachusetts because the FDA restricts the distribution of mifepristone.

“The FDA requires that mifepristone used for abortion be dispensed in a doctor’s office, clinic or hospital. It may not be mailed to a patient or dispensed on prescription from a pharmacy, ” Grossman said. “This restriction is not based on medical evidence.”

The American College of Obstetricians, the American Medical Association, and the American Association of Family Physicians all support removal of the restrictions on abortion pills.

An exception to the FDA restriction is a research study on telemedicine abortion, called TelAbortion, run by the organization Gynuity since 2016. The study allows clinicians participating in the study to provide medication abortion care by video conference and mail without an in-person visit to the abortion provider.

The study is currently running in 13 states: Hawaii, Washington, Oregon, New Mexico, Colorado, Georgia, New York, Maine, Iowa, Minnesota, Illinois, Maryland and Montana. But not Massachusetts.

Healey, the Massachusetts attorney general, recently joined 21 attorneys general in a strongly-worded letter to the U.S. Department of Health and Human Services and its FDA, urging the Trump administration to waive the restrictions on medication abortion.

“Forcing women to unnecessarily seek in-person reproductive healthcare during this public health crisis is foolish and irresponsible,” said co-signor Attorney General Xavier Becerra. “That’s why we’re calling on the Trump Administration to remove red tape that makes it more difficult for women to access the medication abortion prescription drug.”

Instead of restricting access to abortion, as so many states are now trying to do, we should remove longtime barriers, like the FDA restriction on the abortion pill mifepristone, and expand access to telemedicine abortion so that more healthcare can happen at home.

“These restrictions have never made medical sense, but now they risk making a global pandemic worse,” says Cynthia A. Pearson, executive director of the National Women’s Health Network, which sent a letter signed by 80 organization to the FDA urging them to lift the restrictions on the abortion pill. The network is also collecting signatures of individuals on a change.org petition: Tell the FDA: Let us get the abortion pill where we take the abortion pill — at home!

“In the midst of strict state stay-at-home orders,” says Pearson, “the FDA is requiring women and providers to leave their homes and travel long distances just to hand off a pill that could be mailed to their doorsteps or available at local pharmacies.”

“Abortion pills are safe and effective, and it’s long past time to make them easier to get,” agrees Erin Matson, co-founder/co-director of Reproaction.

Carrie Baker is professor and chair of the Program for the Study of Women and Gender at Smith College.



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