COVID‐19, health care, and abortion exceptionalism in the United States

Abstract

Context: Few qualitative findings have been published that explore and identify the challenges experienced by independent abortion providers during the COVID-19 pandemic in the United States (US). In this paper, we explore these themes while expanding the concept of "abortion exceptionalism" beyond its original legal meaning to address the impact of abortion stigma.Methods: Twenty abortion providers from independent abortion clinics throughout the US South and Midwest participated in semi-structured interviews in June and July 2020. Interviews explored the challenges of providing abortion care in the wake of the COVID-19 pandemic and sought to identify how clinics strategized and amended their clinical practices to continue providing abortion care during this time.Results: All providers we spoke to noted significant challenges to providing abortion care in the early days of COVID-19. In addition to experiencing the same concerns as other health care institutions, abortion clinics also faced additional, unique burdens that can only be attributed to the politics of abortion exceptionalism. Examples of this abortion exceptionalism include abrupt orders to close clinics, the need to rely on traveling physicians, legislature-imposed limits on telemedicine, heightened activities of protesters, and non-evidence-based regulation of medication abortion. Conclusion:Despite major challenges and differential treatment, independent abortion clinics in the US persevered to continue to provide abortion care throughout the COVID-19 pandemic. SETTING THE CONTEXTCOVID-19 has brought significant challenges to virtually all health care services in the United States (US). Patients' needs for in-person clinical services have had to be weighed against the need to protect both patients and health care providers from contracting or spreading the virus. Health care institutions have made numerous changes to their practices to minimize the threat of infection by both patients and staff. Facilities that provide abortion not only experienced these same challenges but also faced additional and unique challenges. In what follows, we outline the impacts of "abortion exceptionalism," that is the idea that abortion is regulated both differently and more stringently than other medical procedures that are comparable to abortion in complexity and safety. [1][2][3][4] This exceptionalism has affected nearly every aspect of abortion care during the pandemic and has placed additional burdens on patients and clinic staff alike.While the concept of "abortion exceptionalism" was originally used by legal theorists to describe regulatory issues relating to abortion, in this paper, we extend the meaning of the concept to also encompass the highly politicized and stigmatized status of abortion in American society. We argue that this status has significantly impacted

Abortion as a Public Health Risk in COVID-19 Antiabortion Legislation

“…Twelve states banned abortion during the first months of the pandemic, ranging in duration from 6 days to 42 days, with most being in effect for approximately 30 days (see Table 2). These restrictions followed the approach of Casey by targeting abortion providers, exacerbating the difficult situation providers faced during the height of COVID (Joffe and Schroeder 2021). Additionally, state legislatures used the term "elective" inaccurately, disregarding clinical definitions that place procedural abortion at an intermediate level of acuity (Farkas et al 2021), instead using the term to stigmatize abortion (Bayefsky et al 2020;Smith et al 2018).…”

“…Abortion providers experienced the same issues as other healthcare providers, including extended wait times before procedures, workforce disruptions, changes to standard work and clinic practices, and financial strain(Fang, Castaño, and Davis 2020;Roberts, Schroeder, and Joffe 2020). Clinics faced additional pressure from US abortion exceptionalism, including abortion bans which forced several clinics to close, regulations on medication abortion, limits on telemedicine, and increased protester presence(Joffe and Schroeder 2021). State legislatures placed additional strains on clinics despite lack of evidence that abortion clinics posed a higher risk for COVID transmission than other healthcare settings.…”

COVID‐19 and abortion in the Ohio River Valley: A case study of Kentucky, Ohio, and West Virginia

“…The hyper vigilance of protesters and politicians on abortion in comparison to other forms of healthcare serves as an example of abortion exceptionalism, [64][65][66] as was observed in other studies of abortion care during the pandemic. 63,67 Implications While this study cannot measure the direct impacts of fewer method options or delays to care on patients seeking abortions in Kentucky, Ohio, and West Virginia, research shows that access to timely abortion care is associated with a range of benefits, including a lower risk of intimate partner violence, 68 better socioeconomic conditions, 69 and better overall health. 70 Additionally, abortions can become more complex 71 and costly 72 later in pregnancy and patients also report a desire for earlier access to abortion care 73 and autonomy in method choice.…”

“…Qualitatively, facility staff expressed both frustration and resilience during this time. Joffe and Schroeder 63 identified similar themes of anxiety and confusion in dealing with threats of, or actual, closures in their interviews of abortion providers in the Southern and Midwestern US. Additionally, the continued presence of protesters, despite the ongoing pandemic, added to staff members' concerns about their patients' safety.…”

Abortion as an Essential Health Service in Latin America During the COVID-19 Pandemic

“…At any rate, this could mean that abortion could become extremely hard to get in at least 26 of the 50 States in the United States, marking the growing conservative radicalization of the country ( 47 ). We already see some of this happening: the pandemic has caused several disruptions to abortion service availability, including clinic closures ( 48 ) driven by unreasonable governmental requirements or bans specifically targeting abortion services (e.g., forbidding the use of telemedicine for home abortions in some States) giving rise to what we now call “the politics of abortion exceptionalism” ( 49 ).…”