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Paying for an Abortion Was Already Hard. The COVID-19 Economic Downturn Has Made It Even Harder.

For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.  

For people seeking abortion care, the COVID-19 pandemic has made an already difficult situation harder.

In recent weeks, millions have lost their job, and parents are struggling to afford necessary childcare as schools across the United States have closed until further notice. People are faced with abortion costs that, for most, were difficult to afford in the first place. To make matters worse, states like Texas and Oklahoma have classified abortion care as “nonessential” in their COVID-19 response.

Organizations that help cover the costs of abortion care are already seeing the grim effects of a record 3.3 million people in the United States filing for unemployment benefits and Republican state officials using the crisis to interrupt abortion access.

Yellowhammer Fund, an abortion fund based in Alabama, has heard from callers who have lost their job as wide swaths of the economy shut down to slow the spread of COVID-19.

“It’s upsetting to see people become more impacted by what’s going on, and one of the things that’s upsetting is not seeing a better response [from our government] because people are hurting,” Candace E.C. O’Brien, associate director of health services for Yellowhammer Fund, told Rewire.News. “We have a low-income community [that’s] being heavily impacted by the virus that don’t have the same protections as [the] middle and upper class. They don’t have the same financial security—it’s impacting their health care and will impact it in the future as the pandemic grows.”

“If people don’t have jobs, they can’t afford to put anything towards the procedure and have to pinch pennies to get by. We have to get people their health care access, and abortion is health care,” O’Brien said.

Because of the increased need Yellowhammer is seeing during the COVID-19 pandemic, the organization has increased the amount of funding they provide callers and implemented a gift card program to provide more support. The gift cards will be mailed to clients and can be used anywhere, because, O’Brien said, limiting people to gas or groceries could increase the barriers they’re experiencing, and not everyone has access to a debit card or state-issued ID.

The Northwest Abortion Access Fund (NWAAF) was already seeing a high number of callers in January, something board member Nilofar Ganjaie said normally would have decreased by now. They’ve had to make changes to accommodate the skyrocketing demand by callers concerned they won’t be able to have an abortion during the pandemic.

People seeking abortion care in Washington state, Oregon, Idaho, and Alaska can call NWAAF’s 24/7 hotline, and  volunteers call back to assist with the cost of abortion and related travel and lodging. But because of concerns about spreading COVID-19, instead of volunteers opening their homes or driving patients to their appointments, NWAAF is reserving hotel rooms and booking transportation through rideshare apps to limit physical contact. Ganjaie pointed out the safety precautions rideshare companies have taken, adding that their organization is screening volunteers and callers for COVID-19 symptoms.

NWAAF has also struggled with providing food assistance during the COVID-19 outbreak. “We provide grocery delivery, and because delivery services are backed up three to five days, we’ve been having volunteers—and even our board of directors—deliver no-contact groceries or takeout to callers. We drop it off to where the person is staying and leave it on their doorstep,” Ganjaie told Rewire.News.

NWAAF has updated its hotline database so that it allows “hotline advocates to indicate if a caller is experiencing any additional barriers or hardship to access[ing] abortion due to the COVID-19 outbreak,” like if they need financial assistance because they’ve lost their job, or if the situation has made it harder to get to the clinic.

“Our purpose for tracking data is to adjust our plan, [because] we want to start collecting this information immediately so we can pivot [as an organization] as needed. We want to do what we can to shift our budget and allocate our money [to people seeking abortions],” Ganjaie said.

The organization also plans to provide funding assistance to people seeking abortion care in states outside the Northwest where Republican officials have suspended abortions.

Sarah Lopez, program coordinator for Fund Texas Choice (FTC), an organization that provides logistical support to Texans needing abortions, told Rewire.News that while people traveling out of state for care usually do so because of gestational limits, FTC has recently heard from people of “varying gestational ages” needing to travel because of canceled appointments. Access in Texas is already severely limited after a sweeping anti-abortion law shut down over half the state’s clinics, leaving some people 300 miles from the nearest provider.

“As of last week we haven’t been able to purchase bus tickets, but we’re still able to book flights, help with gas, and book whichever remaining hotels are open,” Lopez said. “The major effects of the crisis were kicked into full gear this week, as clinics were forced to cancel appointments. I’ve been doing my best to keep folks at ease and prepare them for out-of-state travel by maintaining that if they need to travel even further to reach a clinic, we will still help them get there.”

Lopez said she’s angry the state is using the COVID-19 outbreak as an opportunity to “politicize health care,” but she’s “feeling so much solidarity” with her partner organizations and clinics.

“I know that it feels harder than ever to access abortion care right now, but I want folks to know that they’re not alone and they have a whole community of people rallying behind them to make sure access isn’t pushed entirely out of reach.”

‘Not the Time to Play Politics’: The False Premise Behind Texas’ Anti-Abortion COVID-19 Order

For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.  

Texas’ COVID-19 executive order to suspend most abortions—including them among “nonessential” medical procedures—is supposedly intended to free up necessary hospital beds and personal protective equipment (PPE) for Texas hospitals. It’s a justification that abortion providers have swiftly debunked.

On Sunday, Texas Gov. Greg Abbott (R) issued an executive order calling for “all surgeries that are not medically necessary” to be postponed. Texas Attorney General Ken Paxton specified that the order included abortion clinics in the state, ordering providers to halt any abortion services “not medically necessary to preserve the life or health of the mother.” Health-care providers who fail to comply with the order could face up to $1,000 in penalties or 180 days in jail.

Abortion rights advocates said the arguments for halting legal abortion during the COVID-19 outbreak are being made in bad faith, as reproductive health clinics rarely need the kind of equipment in high demand at hospitals and complications requiring hospital trips for abortion patients are exceedingly rare.

“[It] really just doesn’t make any sense given that … the vast majority … of the abortions in Texas are performed in outpatient clinics,” said Dr. Daniel Grossman, director of the Advancing New Standards in Reproductive Health research program at University of California, San Francisco. “It’s also very, very rare that a patient has a complication that requires treatment in a hospital, much less than 1 percent.”

According to a 2018 report, just 0.01 percent of emergency room visits made by women in the United States are related to abortion.

Abortion procedures also do not require significant amounts of personal protective equipment. “Very little personal protective equipment is used in a first-trimester aspiration abortion that’s performed in an outpatient clinic,” Grossman said. “Maybe you would use a pair of disposable nonsterile gloves for the ultrasound and then another pair of disposable nonsterile gloves when the abortion is actually performed. It’s important that the clinician use a face shield that can be reused throughout the day with multiple patients. But usually, a mask isn’t used. There’s no gown.”

Grossman pointed out that in states, including Texas, that require an ultrasound before an abortion, such restrictions force providers to use more gloves than they would need to otherwise. And that pales in comparison to the amount of personal protective equipment that would be needed throughout a person’s pregnancy, or during delivery, which requires “multiple sterile gloves, gowns, masks. [And] if the patient has a C-section, obviously that’s even more,” Grossman said.

Abortion access is already limited in Texas, where more than half of clinics have closed since the state imposed more stringent restrictions in 2013.

“Anti-abortion politicians in Texas have spent the past decade trying to ban abortion,” Aimee Arrambide, executive director of NARAL Pro-Choice Texas, told Rewire.News. “[But] I’m surprised that they would take advantage of a public health crisis in order to advance their agenda.”

Texas’s decision bans nearly all abortions, but the full extent of its reach is unclear, with experts uncertain if the new restrictions are limited to surgical abortion, or extend to medication abortion.

“Instead of trying to ban abortion for Texans … they could have been doing things like lifting the current restrictions,” Arrambide said. “I think they could have … waived mandatory waiting periods, so it doesn’t require multiple visits. I think they should allow telemedicine for medication abortion and counseling.”

Texas’s decision signals a potentially worrisome trend for pregnant people in states hostile to abortion, as anti-choice governors, state and local lawmakers, and their allies weigh the decision to postpone “nonessential” medical procedures.

“We are starting to get a lot more requests [about teleabortion services],” said Melissa Grant, COO of FemHealth USA, which operates carafem, a network of health-care centers and provides in-person and teleabortion services in Georgia, Illinois, and will soon expand to Maryland. “People [are asking], ‘What does this mean? What can we do, where can I go?’ … The level of anxiety is rising.”

Last week, the American College of Obstetrics and Gynecology issued a statement advising that abortion should not be categorized as an “elective” or “non-urgent procedure.” In Alabama, which, like Texas, has some of the most onerous abortion laws in the country, the Department of Public Health announced Wednesday that the state’s three abortion clinics would remain open and designated as “essential” businesses.

But decisions like the one carried out in Texas can position pregnant people’s bodies, lives, and welfare as the collateral damage to the COVID-19 crisis. That is especially true of low-income, Black, Latinx, and Native women. “Putting [abortion] this much further out of reach is just going to create … an exponential impact on those communities that are already marginalized,” Arrambide said.

“These are unprecedented circumstances and we would hope that elected officials would focus on legitimate public health concerns,” said Dr. Kari White, principal investigator of the Texas Policy Evaluation Project (TxPEP) and associate professor of social work and sociology at the University of Texas at Austin. “Even before this crisis, people seeking abortion in Texas faced numerous barriers to obtaining timely care: state-mandated visits that are medically unnecessary, cost, and long-distance travel for some… If Texas clinics are required to suspend services for the duration of this executive order or longer, it is unclear … how many [patients] will be forced to continue their pregnancies.”

Texas lawmakers will have to come up with some answers, and soon. On Wednesday afternoon, Planned Parenthood, the Center for Reproductive Rights, and the Lawyering Project filed a lawsuit against the state, calling the COVID-19 order unconstitutional and requesting a restraining order.

“Forcing people to remain pregnant during a public health crisis is unbelievably cruel,” Amanda Beatriz Williams, executive director of the Lilith Fund for Reproductive Equity, which provides financial support to women seeking abortion in Texas, said in a statement shortly after the lawsuit was announced. “A pandemic is not the time to play politics with people’s lives.”

The COVID-19 Stimulus Bill Leaves Abortion Providers Out in the Cold (Updated)

UPDATE, March 27, 2020, 1:44 p.m.: The U.S. House of Representatives on Friday passed the stimulus bill. The legislation now heads to President Donald Trump, who is expected to sign it into law.

Planned Parenthood and other health-care organizations that provide abortion care could be denied loans from the $350 billion available for small businesses in the stimulus bill passed Wednesday by the Republican-controlled U.S. Senate.

The $2 trillion stimulus bill, expected to pass the Democratic-majority U.S. House of Representatives on Friday, includes a provision giving the U.S. Small Business Administration (SBA) “broad discretion to exclude Planned Parenthood affiliates and other non-profits serving people with low incomes and deny them benefits under the new small business loan program,” according to Planned Parenthood Action Fund.

The bill also has “a new unnecessary Hyde Amendment provision, a harmful policy that prevents people with low incomes from accessing safe and legal abortion coverage, to a state stabilization fund for providing coronavirus relief,” according to Planned Parenthood. The anti-abortion provisions come two weeks after the Trump administration held up coronavirus funding because it didn’t include anti-abortion language.

“It has become shamefully clear that not even a global pandemic will stop the Trump administration or Republican Congressional leaders from attacking access to reproductive care,” Alexis McGill Johnson, acting president of Planned Parenthood Action Fund, said in a statement. “Our leaders should be working to support the nation’s full network of safety-net health care providers during these uncertain times. Instead, the Senate bill targets Planned Parenthood and expands the harmful and discriminatory Hyde amendment, putting up even more barriers to care for women, people with low incomes, and communities of color.”

Under the Senate bill, the SBA will have the power to determine which companies and organizations receive loans. The SBA is headed by Jovita Carranza, who briefly served as U.S. treasurer under Trump and was the SBA deputy administrator in the George W. Bush administration. Carranza also served in the administration of former Illinois Gov. Bruce Rauner (R), who in 2017 signed a landmark pro-choice bill.

An earlier version of the bill blocked nonprofits that receive Medicaid funding from being eligible, such as health centers, home and community-based disability services providers, rape crisis centers, and more, but that provision has been removed, the Washington Post reported.

“According to a senior Republican aide, drafters in both parties agreed that the original language, while targeted toward Planned Parenthood, could also implicate numerous other nonprofits whose patients receive Medicaid. That led to an agreement to remove the language,” the Post reported.

Kelsey Ryland, director of federal strategies for the reproductive justice group All* Above All, called Senate lawmakers “ruthless” for inserting anti-abortion language into the stimulus bill.

“They are exploiting an emergency relief bill to further expand the Hyde Amendment in funds designed to help state, local, and tribal governments respond to this pandemic,” Ryland said in a statement. “Our communities across the country are doing everything we can to keep ourselves and our families safe, and our elected officials should be doing the same—not blocking health care for communities that already face significant barriers. Once again we’re seeing how far Trump and anti-abortion politicians will go to push their political agenda.”

Meanwhile, some governors are using their COVID-19 emergency orders to stop access to legal abortion—a policy challenged in court by Planned Parenthood and others on Wednesday.

Planned Parenthood pulled out of the Title X family planning program after the Trump administration instituted its domestic “gag rule” preventing Title X recipients from talking to patients about abortion care and forcing clinics to physically separate abortion services from the rest of their services.

Texas Race Shows Democratic Party’s Unwavering Loyalty to Incumbents—Even If They’re Anti-Choice

Abortion rights advocates in Texas are not only disheartened that a progressive challenger fell short of unseating one of the last anti-choice congressional Democrats, but that Democratic Party leaders also offered unwavering support for the incumbent.

It was a clear message to advocates that incumbency trumps reproductive rights in the Democratic Party.

The Democratic establishment backed Rep. Henry Cuellar (D-TX) in his primary race against immigration and human rights lawyer Jessica Cisneros, who lost by fewer than 3,000 votes on Super Tuesday earlier this month. Cuellar received party support even though he has voted in line with President Donald Trump almost half the time. The Democratic Congressional Campaign Committee (DCCC) announced last year that it would blacklist any vendors who helped insurgent campaigns take on incumbent House Democrats, no matter their stance on major issues. Cuellar’s race in Texas’ 28th Congressional District proved the party’s loyalty to incumbents.

“I completely support him,” DCCC Chair Cheri Bustos (D-IL) said of Cuellar in September, the Texas Tribune reported. “He has very good relationships with the vast majority of his colleagues—who are supportive of him—and I think he’ll be fine.”

House Speaker Nancy Pelosi (D-CA) endorsed Cuellar—one of the few congressional Democrats still taking campaign contributions from the private prison industry—and traveled to his campaign headquarters in Laredo ten days before the primary.

“We want this to be not only a victory, but a resounding victory for Henry Cuellar,” Pelosi said, according to Tribune.

Reproductive rights advocates saw the establishment’s support for Cuellar as a betrayal. Cuellar voted for a 20-week abortion ban in 2017, and in 2019 co-sponsored the “Born-Alive Abortion Survivors Protection,” legislation based on the anti-choice myth that doctors routinely commit infanticide after so-called failed abortions. When Republicans and the few anti-choice Democrats petitioned to force a House vote on the latter bill, Cuellar told Roll Call that he wasn’t on board because he didn’t want to change legislative procedures.

Cisneros, on the other hand, told Rewire.News last year that abortion access is “super important” to her and that she would be “on the side of people that know that that choice is important.” Rather than letting the Democratic primary play out and then backing whoever the nominee happened to be in the general election, national Democratic leaders swiftly endorsed an anti-choice incumbent over a pro-choice candidate in a state with some of the country’s most severe abortion restrictions.

“The Democratic establishment needs to ask itself why it’s constantly willing to compromise on abortion rights and further harm communities that are most impacted by restrictions,” Delma Catalina Limones, communications manager for NARAL Pro-Choice Texas, told Rewire.News. “We see time and time again that lawmakers who are willing to compromise on abortion rights … are also willing to compromise LGBT and immigrant rights. That’s not bipartisanship—that’s cowardice that has gotten us nowhere.”

Texas has long been an abortion rights battleground, with the state’s Republican-controlled legislature passing onerous and medically unnecessary restrictions over the past decade. The number of abortion clinics in the state has dropped from more than 40 in 2013 to 22 since 2019; there are no abortion clinics in the 28th District. In 2017, more than 52,000 abortions were performed throughout Texas, according to Texas Health and Human Service’s data. But only a small percentage of those were in the southern part of the state, home to the 28th District. Whole Woman’s Health clinic in McAllen, one of the only abortion providers in South Texas, performs about 1,500 abortions each year, according to Kandice Miller, Texas communications manager for Whole Woman’s Health Alliance.

In her concession speech, Cisneros said her campaign fought an uphill battle, that “the establishment machine and corporate money on the other side fought back for the incumbent this time.” “They saw us coming,” she said. “They saw the hope that was starting to brew here in South Texas.”

Cisneros did not touch on abortion access in her speech. But Becca Rose, communications associate for the Justice Democrats political action committee that helped elect Rep. Alexandria Ocasio-Cortez (D-NY) in 2018 and backed Cisneros’ 2020 campaign, told Rewire.News there’s “no excuse for prioritizing an anti-choice incumbent over a progressive challenger who believes in the party’s core principles and fights for what’s best for her community.”

While Cisneros has not said whether she plans to challenge Cuellar again in 2022, she said she would “keep fighting.” Cisneros’ campaign did not return Rewire.News’ request for comment.

“This fight was an opportunity to prove that a brown girl from the border with her whole community behind her could take on the machine and bring hope to South Texas,” Cisneros said in her concession speech. “We accomplished that.”

Although Cisneros was ultimately unsuccessful in ousting Cuellar, challenging anti-choice Democrats gives abortion advocates “the opportunity to have a conversation about our values as a party and hold leaders accountable,” Limones said.

The race in Texas’ 28th District showed activists how far Democratic leaders are from adopting an abortion litmus test.

“There are a number of issues in which progressive groups and activists are working tirelessly to challenge the Democratic establishment to stand up against corporate PACs and lobbyists and do what’s right,” Rose said. “Apparently abortion access is now an issue we need to add to that list.”

Here’s How You Can Help Sex Workers During the COVID-19 Outbreak

For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.  

As the number of COVID-19 infections in the United States grows rapidly, nightclubs and bars have shut down, public health officials have ordered people to “socially distance,” the stock market has tanked, and sex workers have begun to see negative impacts of the pandemic.

“I haven’t gotten any customers, so I’ve been cutting down on food,” Maya Moreno, a sex worker based in Brooklyn, New York, told Rewire.News. “A few people canceled because of flights, but I’m also not getting the amount of people reaching out like I used to.”

Moreno is shifting her focus to her OnlyFans account, a paid subscription content service, amid the COVID-19 outbreak.

Sex workers run a higher risk of virus transmission, as many jobs—like stripping, escorting, and massage work— require in-person gatherings and physical intimacy. The public health crisis has also meant lost incomes and a decimation of their industry. Strip clubs closed. Massage parlors closed. Online, sex workers across the country have shared updates about cancellations and declines in business. Those with access are moving online to subscription services like OnlyFans and camming, or shifting to other industries altogether.

Sex workers are usually self employed or independent contractors, and thus not eligible for unemployment benefits when out of a job. And there is no knowing how long it will take for the industry to bounce back, given the forecasted economic recession.

Here are a few ways you can help sex workers right now.

Donate money and supplies

Sex workers and advocates have set up emergency relief fundraisers in cities like New York, Detroit, Portland, and Las Vegas. Other sex workers’ rights organizations in specific localities, as well as online, are raising funds too.

  • Lysistrata: online sex worker mutual care collective
  • Red Canary Song: advocate group for Asian and migrant sex workers in New York City
  • SWOP Behind Bars: nonprofit providing community support for incarcerated sex workers
  • Green Light Project: Seattle-based harm reduction outreach group for street-based sex workers
  • Bay Area Workers Support: Bay Area-based sex worker resource organization
  • Coyote RI: Rhode Island-based sex worker advocacy grassroots organization

More comprehensive lists of emergency relief fundraisers can be found here and here, including international efforts.

Some groups, like Coyote RI and SWOP Brooklyn, are seeking donations of supplies. SWOP Behind Bars accepts book donations for incarcerated sex workers and those who will be released soon.

Support decriminalization and fight FOSTA-SESTA

Sex work advocates across the country are pushing for the decriminalization of sex work.

One way to support the sex worker community is by opposing legislation that hurts their livelihoods and safety, like FOSTA-SESTA. The bill package, which consists of the U.S. Senate’s Stop Enabling Sex Traffickers Act (SESTA) and the U.S. House of Representatives’ counterpart, Fight Online Sex Trafficking Act (FOSTA), has been responsible for the removal of content pertaining to sex work from websites like Craigslist, Tumblr, Reddit, and others. Screening platforms for sex workers like VerifyHim limited their offerings. Sex workers have reported being de-platformed from their social media accounts and payment processors as a result.

The realities of FOSTA-SESTA are that sex workers are pushed onto the streets, where they are more vulnerable to trafficking, violence, and sexually transmitted infections. One free way to support sex workers is to learn about, rally against, and reach out to lawmakers about legislation that harms the community.

Other legislation like “walking while trans” anti-prostitution loitering laws disproportionately target transgender women of color.

Pay tribute to providers and subscribe

Instead of streaming free porn, which was likely taken from its creators, try to be an ethical porn consumer and pay for subscriptions to providers’ channels. When possible, send money directly through payment processors like Venmo or Cash App. Often, independent providers like dominatrixes will provide wish lists and accept tributes from their clients or anyone who wants to contribute.

Share resources

Donating old devices or sharing your technological wherewithal can be helpful for sex workers trying to transition to digital work. Sex workers have been sharing tips and providing open resources for making money online.

Demand the release of incarcerated people

As a highly criminalized community, sex workers are disproportionately likely to enter into the criminal justice system and be incarcerated. As COVID-19 spreads, people incarcerated in jails, prisons, and ICE detention centers are at serious risk of infection. Abolitionist activists across the country have called on Congress and local officials to #FreeThemAll.

Abortion Providers Are Acting as Travel Agents. That’s Wrong.

We will not find out for a few months how the recently argued U.S. Supreme Court case, June Medical v. Russo, will be decided. But lurking behind the Court’s first abortion case since President Donald Trump appointed two anti-abortion justices is an underappreciated aspect of abortion care in the United States: the extent to which abortion providers serve as de facto travel agents for patients.

If the Supreme Court rules against abortion rights in this case, an already challenging situation will become much worse.  But even before the Court rules, the COVID-19 crisis is already complicating abortion care and putting more pressure on providers to troubleshoot travel issues.

At issue before the Supreme Court is whether a Louisiana law requiring abortion doctors to get medically unnecessary hospital admitting privileges is constitutional. If the Court allows the law to go into effect, the ruling will leave Louisiana with just one abortion facility. Under the rule, people in Louisiana seeking abortion care will have to depend on health-care professionals and pro-choice allies to help them navigate the complexities of long-distance travel to assure access to care.

We know this because abortion travel is already a reality for many patients in the United States. For our recently released book on barriers to abortion care, providers told us stories of helping patients navigate the difficulty of abortion travel. For many people today, the difference between getting an abortion and forced childbirth comes down to long-distance travel.

If, as many fear, the Supreme Court continues to chip away at abortion rights, these challenges will grow, and the time providers spend arranging travel will only increase. The spread of COVID-19, of course, will only further complicate the efforts to get patients to clinics safely and efficiently, as anti-choice state officials target abortion access as part of their COVID-19 response and clinic escort services are curtailed to slow the spread of the virus.

The problem arises for some patients because many have to rely on other people to drive them, either because of a lack of their own car or because some clinics use sedation, and therefore patients are not allowed to drive themselves home. Poignantly, several providers told us of patients who were driven to the clinic by a male partner and then were abandoned. In these cases, clinics either pay for transportation or staff would drive patients home.

This is beyond a medical staff’s normal responsibilities, but as one New England clinic director told us, even she periodically does this. “You do what you’ve got to do,” the director said.

We heard stories of old, barely functioning cars breaking down on the long drive to the clinic, forcing the clinic to scramble for a solution.

One provider told us of a panicked patient’s harrowing experience. “She was driving to see us with her boyfriend, and the car broke down,” the provider said. “She called us and said she was going to be late, and then called some friends who were able to meet her and provide another car. When she got to our clinic, she said to us, ‘I felt like, oh my God, I’m going to have a child because my car broke down!’”

With clinics few and far between—six states have only one clinic—it’s common for bus rides to take a half-day or longer. Many providers told us of patients, sometimes with their children and other family members in tow, sleeping in cars in the clinic parking lot after a long drive because they could not afford a motel. Even worse, a provider in the Midwest told us about a young woman who was home for the summer in a remote area of the state when she found out she was pregnant: The woman had no help because her boyfriend was in New York and her parents were unsupportive. So, as the provider told us, “she rode 15-plus hours from the northern part of the state on a bus down to our clinic the night before her abortion. When she came to us the next morning, she was covered in mosquito bites because she had spent the night in the bus station. Outside the bus station, actually.”

Even when patients are able to initially present at a clinic, some find out they have to travel to yet another facility because the clinic can’t treat them if they are too far in pregnancy or have special health issues.

One of the most extraordinary travel stories we heard was of a woman in a Southern state who was unable to be seen locally and was driven, over a three-day odyssey, by a volunteer in her mid-60s to a clinic in Washington, D.C., and then to a third clinic in New York, where she finally received care. But the challenge didn’t end there, as the 12-hour ride home was the trickiest part. The volunteer told us, “It was a hair-raising ride with storms, torrential downpours, and high-wind advisories. We made it to her home at one minute past midnight on Christmas Eve, so it was technically one minute into Christmas Day.”

The volunteer had promised to get the patient back home for the holiday, so she was relieved. “I kept my promise to her.”

Research backs up the stories providers and patients tell about the restrictive reality of abortion care in the United States. An estimated one-fifth of people in the United States seeking an abortion travel more than 50 miles to get an abortion. Scholars have identified “abortion deserts,” the 27 cities in the country, spread out among 15 states mostly in the South and Midwest, that are more than 100 miles from an abortion clinic.

These stories and statistics paint a rarely captured picture of abortion access in this country. Many people are familiar with the obstacle that the cost of abortion creates, especially given the federal ban on Medicaid covering abortion care. What is less commonly understood is the way poverty creates travel difficulties—just getting to an abortion facility adds costs and logistical challenges for patients. And of course the lost wages many will experience as a result of COVID-19 shutdowns will only exacerbate this poverty.

Jumping in to alleviate some of these burdens is an unheralded army of abortion providers and volunteers stepping up to help conquer the travel challenges facing abortion patients. These travel agents disburse gas cards, arrange volunteer rides, coordinate bus rides, pay for flights, and reserve hotel rooms. One such volunteer told us of a somewhat clandestine network in the South of relay drivers: “I’ve got people in place along the interstate that can say, ‘OK, I can drive her this far. Someone else can pick her up here.”

How COVID-19 will affect flight travel, presumably making it harder for patients to access the specialized care only available in a few states, not to mention the ability of traveling doctors to reach clinics, remains to be seen.

Those who care about abortion rights need to be prepared for this coming reality and work to support providers as they handle the even-greater flood of need that is likely to come. In an ideal world, trained medical professionals should be focused on delivering health care, not acting as travel agents.

David S. Cohen is a professor of law at Drexel University and Carole Joffe is a professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco. They are the authors of Obstacle Course: The Everyday Struggle to Get an Abortion in America.

‘Jane Against the World’: Writing a Young Adult Nonfiction on Abortion for Teens

Journalist and author Karen Blumenthal’s recently released book, Jane Against the World: Roe v. Wade and the History of Reproductive Rights, tells the history of abortion in the United States targeted to a very specific group of people—young people.

Blumenthal has written other nonfiction books for this audience, like a biography of Hillary Clinton and books about Title IX, Prohibition, and the stock market crash. The books have a straightforward tone and approach, born from Blumenthal’s long career as a business journalist, writing and reporting on complicated issues. Her next challenge was to tackle a young adult novel on reproductive rights.

The research for Jane Against the World took about two years, Blumenthal said. “The more I researched it, the more I realized you can’t separate birth control and abortion, and you can’t separate … this whole area of reproductive rights,” she told Rewire.News. And because the book is for young adults, you “really have a responsibility to be thorough,” Blumenthal added. She accomplishes this not only narratively and visually but also through the “Pregnant Pause” segments, supplementary information throughout the book that offers deeper context on topics like “Where do babies come from?” and “A short history of birth control.”

If you’re a parent or caretaker of a teenager or young adult, Jane Against the World is an ideal book to help start (or continue) a conversation on reproductive rights and abortion. Rewire.News spoke with Blumenthal about the research that went into her book, writing for young people, and more. The interview has been lightly edited for length and clarity.

Rewire.News: What did you learn, and what surprised you in the research of this book?

Karen Blumenthal: It was very surprising to read about this group of clergy who in 1967 decided that women need access to safe abortions even if they’re illegal and that they’re going to help provide access to women who really want that option. Thousands of clergy ended up being involved in it, and they were incredibly influential and helpful to women all across the country. I was really taken by this group, Jane. They start as a referral service and then they realize that they can perform them, and they’re actually these ordinary women performing abortions. We know [about] midwives, we know that people can deliver babies, so it makes sense, but still it was fabulous [to learn].

The thing that was most shocking of all is it cuts to so many of the significant issues—issues around sterilization—these doctors think they’re doing the right thing, sterilizing women of color across the country without their permission, without their consent. [It] highlighted everything about women’s authority over their bodies, about the differences in the way white women and women of color were treated. It brought all that into focus in a way that other examples are not quite as shocking and clear.

Rewire.News: How has the book been received? Who’s reading it, and what are you hearing from them?

KB: I’m going to be honest and say that I was terrified about doing this book. Before I even agreed to do it, I talked to a lot of people, because I was afraid that there wouldn’t be interest, especially at that level, that schools would have problems with it. And then the worst part would not be that it would be banned but then it would be ignored.

A lot of librarians have told me they really need this book in their high school libraries in their teen sections. I have met librarians who call themselves conservative—they make a point of saying that—but say that on this issue they feel like men have been telling women what to do for too long.

Rewire.News: What do you think is missing in the conversation around abortion when it comes to young people? 

KB: Ten to 15 years ago, health was required [in schools]. Apparently health classes are no longer required. So, it occurred to me as I was doing this that there would be kids who might never be introduced to contraception, to forms of birth control. They might get biology, but they wouldn’t get explanations of how certain things work. And boy, that’s really important when you’re young, right?

I went through a real effort to include in [the book] definitions, explanations. And I made a definite decision not to use language that I thought was partisan.

Rewire.News: I think a lot of it has to do with what’s being taught and not taught in schools, and books like these being available. I love the book’s “pregnant pauses,” the illustrations are well done, and the cover is beautiful, which seem important for books for young people.

KB: It’s such a great job [the cover]. I also think it’s for young women in their 20s and 30s, and I would love for people to also see it as a book for adults who don’t want 500 pages or something. That’s the hope. And despite the virus, it’s still going to be the only thing out there when we come up for air. So, people who are interested will find it. Hopefully it’ll be available in the library.

Anti-Abortion Groups Ask Trump’s HHS to Use COVID-19 Outbreak to Stop Abortion

For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.  

Officials from anti-abortion organizations asked the Trump administration on Tuesday to take steps to halt abortion access as part of the federal government’s response to the COVID-19 crisis.

Anti-abortion groups, led by Trump ally and Susan B. Anthony List President Marjorie Dannenfelser, wrote in a letter to U.S. Health and Human Services (HHS) Secretary Alex Azar that clinics continuing to provide abortion care during the COVID-19 outbreak are “compounding one crisis with another.”

The letter claimed that abortion providers will divert much-needed personal protective equipment from the COVID-19 response, and that potential complications from abortion care will increase demand on emergency rooms—a suggestion that falsely depicts abortion as risky. (Experts agree that the complication rate for legal abortion care is very low.)

Alexis McGill Johnson, acting president and CEO of Planned Parenthood Federation of America, said in a statement that the COVID-19 crisis is “not the time for politicians or groups to advance their own agenda by taking advantage of a worldwide pandemic.”

“Delays or additional barriers to care can make it more difficult or even impossible for some patients to access safe, legal abortion,” McGill Johnson said. “While we continue to provide critical care during this pandemic and work with our partner health care providers, we must still ensure that patients can access the services they need.”

The letter included a list of suggestions for how the Trump administration could use the COVID-19 outbreak to cut off access to abortion care, including making sure “telemedicine abortion is not expanded during the crisis” and ensuring “emergency response funds are not diverted” to clinics that provide abortion care. Earlier this month, the administration stalled a COVID-19 funding bill because it didn’t contain anti-choice “Hyde language.”

As HHS secretary, Azar has proven hostile to reproductive health care, and anti-choice congressional lawmakers have praised Azar’s policies. Last April, he restructured HHS so the Title X family planning program would be under the direction of an anti-choice activist. HHS did not respond to a Rewire.News request for comment.

Jennie Wetter, director of public policy at the Population Institute, which promotes comprehensive family planning services, said abortion rights foes are capitalizing on emergency measures needed to address the COVID-19 outbreak.

“It is unacceptable that anti-choice groups are using a pandemic as a pretext for attacking the constitutional right to abortion,” Wetter told Rewire.News. “Abortion is basic health care and time sensitive health care. People who want an abortion need to be able to access it without delay. We will continue to fight to ensure that anyone who wants an abortion is able to access the care they need.”

Governors and other state officials have taken varying approaches to abortion services in emergency orders that delay “nonessential” or “elective” medical procedures in order to to conserve resources for the expected wave of COVID-19 patients in the United States. Texas Gov. Greg Abbott (R) is the only governor so far to explicitly target abortion in his COVID-19 order—an Abbott spokesperson confirmed to the Associated Press that the state’s order against nonessential health services would include abortion in most cases.

Indian Health Services Is Ill-Prepared for the Coronavirus Crisis. Indigenous People Will Suffer.

For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.  

Most Native Americans rely on Indian Health Services (IHS), an agency within the U.S. Department of Health and Human Services (HHS), for their health-care needs. Since it was established in 1955, IHS has been crucial to Native American health care, yet it continues to suffer from several structural deficits, such as maintaining medical providers, operating from safe facilities, and funding—the agency’s most severe and life-impacting deficit—as it is chronically underfunded by billions of dollars each year.

If IHS can barely keep up with broken bones and preventive care, what makes our people across the country think IHS can handle the outbreak of COVID-19?

Native Americans across the United States who are the health-care recipients of IHS often do not have consistent, quality health care that build trust and satisfaction as a patient-provider should have. The agency’s contribution to this long-standing problem is often based on the lack of consistent providers and providers who are not culturally aware of their patients’ communities. IHS has been a source for newly graduated medical students who are looking for ways to pay off their student debt, which spirals into negative outcomes in care because providers’ stay and commitment to serving Native Americans is based on a debt service. Many medical providers come from the armed services and are routinely in their uniform while providing care.

It must be understood that there is no standardization of health care within IHS at any given facility. Tribes have taken it upon themselves to open their own clinics. Despite its shortcomings, IHS is still a lifeline for Indigenous people who may not be able to get care elsewhere due to factors like limited public transportation and access to the internet.

In the age of technology, the ideal use of telehealth services could be effectively promoted for our communities to take advantage of, but the infrastructure needs, including broadband, are only wishful thinking.

IHS patients who do have access to technology and can visit the IHS website and receive the most basic information on the outbreak. According to the website, 40 people across the agency’s jurisdiction have tested positive for COVID-19 as of Saturday, but there are likely many more cases given the pending test results. The website does not provide information in a culturally literate and responsive manner that explains ways to stay indoors, or contacts for Indigenous people, who on the West Coast were among the first to contract the virus, to reach out to with questions about accessing IHS under social distancing. This is a glaring example of the very little regard the federal government gives to the original inhabitants of this continent.

One of the primary functions at Indigenous Women Rising (IWR) is to be strong advocates for reproductive health, including abortion care. IHS is included in the Hyde Amendment, forbidding abortion care unless the health of the pregnant person is at stake, which we know is a ridiculous premise and means Indigenous people have this additional barrier to accessing abortion.

There is also no standardization to how providers respond to pregnancy-related care, from carrying the pregnancy to term, adoption, or abortion. Many IHS hospitals have varying administrative structures, too. Here are some stories about inadequate access at IHS that our staff has shared:

Rachael Lorenzo (Mescalero Apache, Laguna Pueblo, Xicanx)

“The IHS I grew up with, located in Acoma Pueblo, New Mexico, called ‘ACL,’ or Acoma-Canoncito-Laguna, does not have a consistently open ER, had a rotating dentist, and no OB/GYN to help deliver a pregnancy if needed. In some cases, people from Acoma Pueblo, Laguna Pueblo, Canoncito (part of Navajo Nation), Cubero, Seboyeta, and San Fidel (the last three are Spanish land grants) may need to travel about 30 miles west to Grants, New Mexico, or about 50 miles east to Albuquerque to get to an ER that’s equipped to handle emergencies, specialty care, and births.

“This scenario is not unique to the community I grew up in. These realities are concerning to me because IHS has proven ineffective to meeting as many needs as exist in the communities they serve. I have also been denied the removal of long-acting reversible contraception (LARC) and a change of method, so there is also a degree of coercion when it comes to our reproductive autonomy and a lack of trust that we know how best to care for our bodies.”

Nicole Martin (Laguna Pueblo, Diné, Zuni Pueblo)

“At Indigenous Women Rising, I work on sex education development. My focus is on centering our ancestral teachings and stories regarding sexuality and creating a space where we can discuss and access reproductive care without shame or stigma. Recently, I scheduled an appointment for an STI and HIV/AIDS screening, and treatment for a yeast infection. When I called, I was told to come into their open clinic, which began at 8 a.m., and if I was fortunate to secure one of the 12 available spaces, I could only be seen for the yeast infection or the testing. I did back-to-back morning trips so I could be seen for both, otherwise I would have to make an appointment with my primary care physician, which was scheduled a month out.

“Here we are, a month later, my results came back from my tests, and they were negative. However, my primary care physician has been deployed, as most physicians within IHS are military members. I applaud IHS for their call to action to provide safe health care to their patients during this time, but I have yet again been rescheduled a month out—this time to replace the implant birth control in my arm. As a caretaker, community organizer, oldest of three, I have to be adaptable with my schedule, and this means choosing to put my reproductive health on the back burner from time to time.

“I am not alone in having been rescheduled a month out for birth control or basic health-care needs. I often take to social media to ‘rant’ about my access to Indian Health Services. I get a lot of feedback with the same consensus. As the sex ed lead in the organization, the impact I see from COVID-19 is my relatives and friends also deciding the importance of their basic or overall health, to be rescheduled or not to be.”

Malia Luarkie (Laguna Pueblo, Zuni Pueblo, Maidu)

“Unfortunately, many people in the surrounding areas know they can’t always depend on IHS. If they do, it could be months before they see results, like Nicole. I grew up with both Rachael and Nicole. In my family, we rarely ever went to ACL (an IHS provider). If we did, it was because we absolutely had too. In some cases, it was to pick up a prescription or maybe visit someone who worked there. In the past, when family members were seen, the physicians could do very little. They did what they could, but at some point, we were going to be referred out. There were situations when we would have to visit several times and we’d have a new doctor each time or for follow-up. This made appointments and follow-ups a hassle, having to re-explain each visit was very uncomfortable especially if visits were because of an urgent matter.

“As the birth and breastfeeding lead at IWR, it’s extremely disheartening when I hear and see pregnant people not being able to get the care they need at an IHS facility, especially if they have to travel far distances to receive a short checkup. Just like any other community, we love being with family and spending time with other relatives, but in times like these it’s extremely crucial that we take care of ourselves and each other. With COVID-19 circulating, pregnant people, elders, and others who depend on care from IHS are all at risk. These facilities don’t have the extensive care if an outbreak does happen in the surrounding areas.”

As the only Indigenous-led and Indigenous-centered abortion fund in the country, we haven’t heard from callers about their concerns about COVID-19—we are getting texts and calls about applying for funding for an abortion. And we continue to get invoices from clinics to pay our pledges to them for the patients who qualified for our funding. We are still collaborating with our sibling funds on how to continue to support each other, our callers, the clinics, and the support providers who are putting their lives at risk.

Abortion care should not be separated from the rest of health care, and the threat of abortion clinics closing during this time could have a dangerous impact on Indigenous people who are seeking abortion care. We know clinics are at risk politically, whether from their state government, Congress, or both, during this time, too. The American College of Obstetricians and Gynecologists and other groups have recommended that clinics stay open, and have cited the dangerous consequences that could come from delays in accessing abortion care.

At IWR, we are guided by the traditional values we were raised with and that culturally inform how we, as individuals and as an organization, are responding to this pandemic. We understand how dangerous capitalism is to our people, especially when it comes to land ownership and access to natural resources, including water, and we view reproductive health care as one part of our holistic well-being. We will continue to consider the mental, emotional, physical, physiological, and spiritual well-being of our collective Indigenous communities.