Texas Officials Make Emergency Changes To Public Health Services, Without The Health Of The Public In Mind

On Monday, March 23, Texas officials temporarily banned all abortions (except rare cases in which the woman’s life or health is in danger). Attorney General Ken Paxton explained that the ban was included in an emergency order issued the day before by Governor Abbott that prohibits procedures that are not “immediately medically necessary” in order to save medical supplies needed by coronavirus patients and their healthcare providers. 

The following Monday, March 30, a federal judge blocked enforcement of the abortion ban on grounds that it violates the U.S. Constitution. 

On Tuesday, March 31, a Texas appeals court paused the block on the ban, effectively making abortions in Texas illegal once again. 

As of Wednesday, April 15, medical abortions and surgical abortions for women at risk of passing the 20-week threshold are permitted, but this status is only a snapshot in time of a fiery battle between state and federal judges with hundreds of unwantedly pregnant women trapped in the middle. 

It is one thing to take a scientifically, ethically, or religiously grounded stance against abortion, but it is quite another to take irreparable sweeping legal action with complete disregard for what an abortion is and what the procedure entails. National emergencies often see the curtailment of liberties and rights, but it is up to us — the public — to stay informed and know which curtailments are necessary, and which only serve to further a political agenda. 

Texas officials are arguing that “elective” abortions are neither time-sensitive nor essential services and should be put on hold. They maintain that, except in rare cases where the woman’s health is in imminent danger, “elective” abortions will drain the medical supplies, workers, and hospital bedspaces so desperately needed by COVID-19 patients. 

Let’s get some facts straight. All abortions, other than those rare cases previously mentioned, are “elective” because a woman has to choose to undergo the procedure. Just because abortion activists are nicknamed pro-choice does not mean that abortion is a choice of the same caliber as a dentist visit or even an orthopedic surgery. (Pro-choice stems from the 1973 Roe v. Wade Supreme Court case that gives women the freedom to control their own bodies, under the right to privacy.) Most women who choose to end their pregnancies do so because they know they cannot take on the financial burdens and emotional responsibilities of raising a child at that point in time. Given the current economic downturn and the lasting repercussions it will have for years to come, it is even more essential and, indeed, constitutional that women have the opportunity and appropriate resources to make a choice about what is best for themselves given their individual circumstances. 

Moreover, Texas officials’ categorization of abortions as non-time sensitive is inconsistent with medical facts and hides glaring public health disadvantages of banning or postponing these procedures. 

The longer a woman waits for an abortion, the more she puts her own health at risk. After a certain amount of time, the procedure becomes illegal. In Texas, that deadline is 20 weeks into a pregnancy, earlier than the vast majority of other states. And even if it is within the legal time frame, some providers can refuse to perform the procedure after as few as 12 weeks. However, this short window of time is not the only barrier. Long waiting periods, mandatory counseling, high costs, and a shortage of providers can present additional obstacles to abortion access and are only exacerbated during the current pandemic. 

And still, one in four women in the U.S. will have an abortion by the time they’re 45 years old. 

There are two methods of abortion. One, an abortion pill (which actually consists of two pills), induces a miscarriage by stopping the progress of the pregnancy and compelling the body to shed the uterus lining. The pill requires neither a medical procedure nor equipment, and does not have to be administered in a hospital. The entire process takes 24 hours at most, but is only effective up to 10 weeks into a pregnancy. 

The other method is an in-clinic (also known as surgical) abortion. There are two versions of this method, both of which use a combination of suction and medical tools to terminate the pregnancy. Although in-clinic abortions must be performed at a health center, they usually last between 5 and 10 minutes and the full visit to the clinic is only a couple of hours. 

Surgical abortions now require personal protective equiptment such as masks, gloves, and gowns due to the COVID-19 outbreak, but the patient only occupies a bed for a couple of hours, and that bed is most often in an outpatient facility that specializes in reproductive health and would not be available for COVID-19 patients in any case. An in-clinic abortion does put the patient and her healthcare team at risk of exposure to the coronavirus, but if the woman were to instead carry her pregancy to term, prenatal care — which requires multiple doctor’s visits — would greatly increase the risk of exposure to herself, her prenatal team, and her newborn, as well as put a greater demand on hospitals and physicians. 

It benefits no one to keep women with unwanted pregnancies waiting for necessary care until Governor Abbott lifts his emergency order or to subject those women to the emotional turmoil and anxiety of a legal battle in which their futures are at stake. First, the longer a woman waits, the more likely she will be to require a surgical abortion. Although the abortion pill is legal at the moment, there are still hundreds of women trapped between the window of time for a medicated abortion and the 20-week limit. Second, though abortions are now permitted for women about to pass this limit, this legal status is subject to change and, as previously mentioned, the farther along a woman is in her pregnancy, the greater risk an abortion poses to her life and health. Third, if a woman can’t get an abortion in Texas, dire need might compel her to travel to another state to do so, which only increases the likelihood of spreading COVID-19. 

A course of action that would decrease both women’s health risks and the spread of COVID-19 would be for Governor Abbott to reduce barriers to abortion access and authorize the use of telemedicine, which omits human contact and reduces the use of physical resources. Because the majority of abortions occur in the timeframe allowable for the abortion pill, tele-abortions would close large gaps in abortion access and reduce the need for clinic visits. Often, a doctor can determine whether a woman qualifies for a medicated abortion based on the date of her last period, not an ultrasound. 

TelAbortion, a project that, since 2016, has conducted consultations and medicated abortions entirely by videochat and mail, would be an ideal solution for Texas’ current abortion predicament. TelAbortion is already active in 13 states, and a majority of states already permit telehealth services

If a woman chooses to have an abortion, it is an essential and time-sensitive procedure that does not hamper the state’s abillity to attend to coronavirus patients in the least. Officials in Texas, as well as Oklahoma, Iowa, and Mississippi, are using factually incorrect and constitutionally illegal arguments to further a political agenda that will actually result in an increased risk to public health in more ways than one. It is possible that, with easier access to contraceptives and comprehensive sexual education in public schools, Texas wouldn’t have so many women in need of abortions in the first place.



Categories: Domestic Affairs

2 replies

  1. Here is another perspective: Many people are suffering unusual stress under the lockdown, for reasons of which we are all well aware. Conflicting predictions and statements by politicians, doctors, and policy-makers and “all-corona-all-the-time” coverage by the media—which we are all plugged into as we huddle in our homes—have a lot of people in a state of high anxiety and uncertainty about the future. And there is decidedly much to be anxious about. 26 million people, after all, have lost their jobs. Spokeswomen from Planned Parenthood in the New York area have said that more women are making and keeping abortion appointments than usual. I volunteer as a pro-life “sidewalk counsellor” at my local Planned Parenthood clinic, which means I stand outside the clinic and offer to talk to women, as they go in, about alternatives to abortion and resources available to help them overcome the obstacles that have persuaded them that they can’t or shouldn’t bring their babies to term. Other sidewalk counsellors and I are hearing from a lot of women that they have decided to have abortions because of the pandemic. We are seeing a lot of “turn-arounds,” too; that is, women who come for an abortion but change their minds once they have a chance to talk to a sidewalk counselor about their fears and problems. What this says to me is that there is a real danger that many of the women having abortions now may well be mourning the decision a year from now when things look brighter: and things will look brighter. Humans have weathered worse storms than Covid-19. Unfortunately, abortion, like a lot of things we might do in a moment of passion or panic, can’t be undone. You can’t walk back in time: either to the time before you got pregnant, or to the time before you ended your pregnancy. Profound and abiding regret is a fact of life for many women who have had abortions. In thinking about how to help women who face challenging pregnancies during the pandemic, we should be even more concerned about making sure that no woman has to face this decision alone—for example, having abortifacients delivered to her apartment, after a consultation with a “telecounselor” (really?), and then suffering through the induced miscarriage and disposing of the fetus by herself. We should be talking compassionately to women about how to face their fears and helping them come up with concrete solutions to the problems that overwhelm them, problems of which the pregnancy in question is always, in my experience, just a piece in a bigger puzzle. I can assure you that is not happening at my local Planned Parenthood, where recently I spoke to a woman while she crouched on the sidewalk, chain smoking, 14 weeks pregnant and told to wait for her abortion outside, because they were practicing social distancing in the clinic’s waiting room. A temporary ban on abortions, and, most certainly, restrictions on at-home medical abortions, might give women some breathing space for which they—and their babies—will be most grateful in the not-too-distance post-corona future.

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    • Dear Anne,

      Thank you so much for taking the time to share your thoughts and also for your volunteer service. I whole-heartedly agree that women should never have to face this difficult decision alone and should always be educated about every single one of our options. Childbirth is a beautiful thing and the decision to terminate a pregnancy should never, ever be taken lightly. In a time and place where a women’s right to choose is legally protected, the work that you do is ever more important to ensure that women are able to make a rational decision in the face of intense emotions and know about all the services that are available.

      It is certainly tragic to hear that some women regret their decision to terminate their pregnancies. I think it is important to note that the decision to have an abortion is just as permanent as the decision to not. Also, the unforeseen stress of the pandemic that may be putting pressure on this life-changing decision is the same stress (https://www.marchofdimes.org/complications/stress-and-pregnancy.aspx#)
      that causes health problems such as high blood pressure in adults, and worse problems for pregnant women, such as premature births.

      A breathing space for some women at this time might be exactly what they need. But if, after knowing all the options, a woman chooses abortion, then her choice must be supported in the same way as if she had decided against it.

      Here is a little more information about tele-abortions, a very new field: For women who would prefer to speak to a counselor in person and have a medical professional by their side as they undergo this procedure, tele-abortion of course is not ideal. In the current situation, it is the best possible solution. The counseling provided is exactly the same as in person (performed by a state-certified doctor), just over video. The service is also still subject to the multiple restrictions already in place in each state, which in Texas would include high costs, a waiting period, and extensive paperwork that includes factually incorrect information (https://www.aclutx.org/en/know-you-rights/abortion-in-texas).

      Even before the pandemic, some women reportedly preferred tele-abortions because of its privacy, which is vital for those who would otherwise avoid abortion simply out of fear of castigation from protestors outside of Planned Parenthood clinics. (https://www.nytimes.com/2020/04/28/health/telabortion-abortion-telemedicine.html?referringSource=articleShare). I am thankful that sidewalk counselors do nothing of that sort.

      I think it is also important to note that greater access to abortions doesn’t mean women will be having them willy-nilly: it is still a very expensive, emotionally traumatizing, and physically painful medical procedure that induces prolonged cramping and bleeding, and in rare cases excessive bleeding, fevers, infections, and nausea, not to mention the permanence of a decision either way. (These side effects are the same whether the abortion pill is administered in clinic or not.) No woman will choose to have an abortion unless she herself deems it absolutely necessary, having considered the alternatives.

      I certainly agree that the question of pregnancy is often a piece in a larger puzzle of personal fears and problems that can already be overwhelming. That makes me wonder – if a situation is already so bad, would adding the responsibilities of a newborn to the mix not make it worse?

      Thank you again for sharing your perspective on this complicated, deeply personal issue. I hope you are
      well and staying safe.

      Eva Kahn

      Like

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