“Our doors will stay open because sexual and reproductive health care is extremely important, and we have to ensure access to it,” Meera Shah, chief medical officer for Planned Parenthood in the New York City suburbs of Long Island, Westchester, and Rockland, one of the hardest-hit regions in the country, told BuzzFeed News Thursday over the phone. “Pregnancy-related care, especially abortion care, is essential and life-affirming, especially now when there is so much insecurity around jobs and food and paychecks and childcare.”
One of Shah’s clinics is located in New Rochelle in Westchester County, the first jurisdiction in the country to be designated a containment zone due to a COVID-19 outbreak, where the National Guard was sent in to help with feeding and cleaning efforts.
A few patients have tested positive for COVID-19, the disease caused by the novel coronavirus, in her region’s clinics and have consequently not come in for their appointment, Shah said. The clinics have done everything they can to ensure all of their staffers and patients are safe, including going above and beyond suggestions from government agencies.
Despite the lockdown and social distancing occurring in her region, Shah said, she’s noticed more people making and keeping appointments than usual. Of the 19 patients who were scheduled for an abortion yesterday, 18 showed up, she said. In her experience, many end up canceling or not showing up to their appointments.
“It seems like patients are doing everything they can to get to their appointments at this time,” Shah said. “Some patients have expressed to me … that they were scared that they may not have health insurance in the future, that they may not be able to get their appointments, that childcare is becoming more of an issue now with all of the schools closed.”
Over the past week, the number of people who have tested positive for COVID-19 has escalated dramatically in the US (topping 16,017 cases), and particularly in New York state (7,245), according to the latest data compiled by Johns Hopkins University — as has the government response. Bars and restaurants all over the country are being forced to close, people are being told by the CDC not to gather in groups of more than 10, many organizations are asking employees to work from home, and some jurisdictions, like California, have issued shelter-in-place orders, requiring people to only leave their homes for essential reasons like food and health care.
As the situation changes daily, and people find themselves more and more unsure of what services are available to them, several people online have expressed concern or consternation at abortion clinics staying open, worrying about the health risks of patients occupying a waiting room together. Officials have called on health care providers to suspend elective procedures, and some critics have argued that abortion should be included.
“Why cant I go to the Dentist office but the ABORTION CLINIC in Kettering is OPEN for business?” one man in Ohio tweeted Thursday. “Elective surgeries are cancelled but you can get an abortion?”
But Planned Parenthood and other reproductive health clinics insist that the care they provide is essential, now more than ever.
Accessing birth control, PrEP and PEP (drugs that mitigate the chances of contracting HIV), and STI tests and treatment can be lifesaving care, the organization pointed out. The clinics are making an effort to continue providing that care while doing what they can to keep patients and clinic workers from spreading the virus.
The methods that clinics are using to mitigate the spread of the virus vary from state to state, or even clinic to clinic, depending on the orders coming from the state government, how much traffic that clinic has, and the state laws regulating the abortion clinic more generally. But in Shah’s 10 clinics, they are sticking to specific protocols.
“We’re complying with all the CDC and Department of Health Guidelines,” Shah told BuzzFeed News. “But everyone is still showing up, you know, because somebody wanting an abortion is still going to want an abortion despite there being a viral outbreak.”
The clinics in the New York area are screening all of their patients before treating them — asking them for any symptoms, travel history, or contact with someone who has tested positive for COVID-19 — first over the phone and then, if they pass the first screening, again at their first appointment. If there’s any sign they might have the virus, the clinic refers them to a coronavirus testing center.
The clinics are also limiting the number of people allowed in the waiting room, making sure they can stay 6 feet apart (the distance suggested by the CDC), by spacing schedules out and only allowing patients to come into the clinic. Any family members, friends, or clinic escorts have to wait outside until the appointment is over. Currently, all the clinic workers are wearing masks, Shah said, but like many other places in the country, they are running low.
One of the central longer-term fixes that abortion rights advocates across the country have been pushing for, even before the coronavirus pandemic, is treating patients and providing medication abortion via telemedicine, meaning over a video call either in a clinic set up for that purpose or to the patients’ home, depending on the procedure and the state. Doctors can conduct virtually the same examination for medication abortions — which are generally available in the first trimester of pregnancy, as approved by the FDA — as they do in office, Shah said.
The health workers ask patients about their medical history, their history with pregnancy, how far along they are in their pregnancy, and whether they have any conditions that could affect prescribing the drug. They give instructions and advice about safely taking abortion pills and undergoing a medication abortion at home (a process that Planned Parenthood describes as similar to an early miscarriage) and ask if the patient would like to start a method of contraception. In states where an ultrasound is required, patients can go into a satellite office and speak to a doctor working in a clinic further away.
Abortion rights organizations have been pushing for increased access to telemedicine in particular over the last decade, as more than 100 abortion clinics have closed down.
Often patients have to travel for hours and stay overnight to get an abortion or other treatment, when, in the case of medical abortion, it could be as easy as speaking with a doctor via your laptop, and getting a prescription delivered to your home. There are already apps that help prescribe and deliver birth control as well. One birth control delivery service, Pill Club, said that in the past week it’s already seen a 30% increase in prescriptions being transferred to it from other pharmacies.
However, over the past few years, telemedicine for abortion has been regulated and even banned in 18 states across the country, according to Guttmacher Institute, a reproductive rights research organization. Legislators and anti-abortion advocates argue that not being in a clinic for the procedure puts people at a greater risk of complications during the procedure.
A further barrier is the FDA’s classification of Mifepristone, one of the pills used in medical abortion, as a medication regulated by the Risk Evaluation Mitigation Strategy. REMS drugs are prohibited from being mailed to patients or prescribed via pharmacy, requiring patients to physically come into a clinic to receive the prescription.
The abortion rights organization Physicians for Reproductive Health and research group Advancing New Standards in Reproductive Health, among other groups, have long pressured the federal government to lift the restrictions on mifepristone, and they have renewed this effort during the virus outbreak when stay-at-home orders are made across the country. So far, the FDA has not budged.
“They’re forcing patients to come out of quarantine just to pick up meds, when they could easily have loved one or somebody pick up the medications for them from a pharmacy that's near their house,” Shah, who is a fellow with Physicians for Reproductive Health, said. “Maybe it will take this crisis to make them see just how unnecessary this regulation is.”
Even while clinics like Planned Parenthood continue serving patients, they could see layoffs and shutdowns in the near future, just like any other organization affected by the downward turn of the economy as a result of the virus.
“Unfortunately, a lot of my patients are low-income people [and] people of color who are ready facing barriers to accessing care,” Shah said.
“And now, with people having to stay home, not able to go to work, not getting paychecks, job insecurity, childcare insecurity — people are really thinking hard about continuing their pregnancy right now. It feels scary for a lot of people,” she said.
The name of Physicians for Reproductive Health was misstated in an earlier version of this post. Meera Shah’s name was also misspelled.