As the coronavirus pandemic continues, officials in many parts of the United States have put restrictions in place to protect populations and frontline workers, including prohibiting people from leaving their houses, engaging in non-essential travel, or having non-essential medical procedures. In some states, abortion has been categorized as “non-essential” and restricted indefinitely, leaving patients scrambling to access the time-sensitive procedure. On March 18, the American College of Obstetricians and Gynecologists and the American Board of Obstetrics & Gynecology, along with several other medical associations, put out a joint statement calling abortion care “essential” during the pandemic, and urging authorities not to restrict it.
Nicole Quinones, 25, is the patient services coordinator at CHOICES Memphis Center for Reproductive Health, an independent health care clinic and abortion provider in Memphis, Tennessee. She spoke with Elite Daily’s News Editor Lilli Petersen about what it’s been like providing abortion care during this pandemic, what’s at stake for patients, and what the hardest part of the coronavirus crisis has been for her.
Like many other people, I wasn’t too concerned with coronavirus at first. But when it started to make its way into the U.S., the situation started to get really scary, really quick. States began advising residents to stay at home, and only essential services were allowed to stay open. Texas deemed abortion to be not essential on March 22. That's when we at CHOICES prepared ourselves — as an abortion clinic in the South, where "TRAP laws" limit abortion care, we know these kinds of restrictions usually have a cascading effect. We knew that what started in Texas could be a possibility in Tennessee as well. Sure enough, Tennessee’s first order halting non-essential procedures, including abortion, was announced on March 23.
The hardest thing about providing care during this pandemic has been having to tell somebody, 'I can't do anything for you.’
What Tennessee essentially said was that providers could not perform procedural abortions. We could only do medication abortions, meaning providing patients with the abortion pill. Because medication abortions only work up to 10 or 11 weeks from a patient's last period, not everybody's going to fall into that category, and not everybody wants to have a medication abortion, anyway. Having to tell patients we can’t help them because of this executive order has been really hard.
As a data analyst, translator, and patient educator for the clinic, I meet with patients seeking abortion care to help them schedule appointments, get any financial assistance that they need, and answer questions they may have. My role means I can really feel the anxiety my patients have during this crisis. Many are worried, and they’re calling the clinic to ask if we’re open. Are we going to have to cancel their appointment? What happens if some new restriction goes into place and then we have to cancel their appointment? Where will they go? Those situations are emotionally difficult, especially because you don't have a good answer.
After Tennessee's executive order was announced, I had to call one Spanish-speaking patient and let her know we would no longer be able to help her. We put her in contact with the closest clinic possible, in Little Rock, Arkansas — which meant she would have to travel across state lines and put her health at risk by traveling during the pandemic. I tried the best I could to help her navigate the landscape, but there's only so much I can do. I thought about her a lot, about whether or not she was going to make it to her appointment, and about all the things that could go wrong. Luckily enough, this patient was able to get to the appointment. The day after her abortion procedure was scheduled, Arkansas’ executive order abortion ban went into place. She missed it by very little. She was really lucky.
When you turn somebody away, you know exactly how much more difficult it’s going to make their situation.
Unfortunately, her story isn't an isolated incident. Seven other states have tried to put effective abortion bans into place during the pandemic — Alabama, Arkansas, Iowa, Louisiana, Ohio, Texas, and West Virginia — so far, and more have discussed it. In some of these states, the bans have been blocked and reinstated several times. A federal judge ruled on April 18 that abortions could continue in Tennessee during the pandemic. At CHOICES, we've seen patients traveling to try to get to us from other states, particularly after Texas' ban — which went back and forth, before effectively lifting on April 22 — went into place. I had a patient from Texas who drove 11 hours to come to our clinic, paid for two nights at a hotel, and because of our new coronavirus policies, she was here all by herself. We’ve had patients from Texas, and Tennessee, and many other states who we've had to turn away because they were too far along in their pregnancies.
The hardest thing about providing care during this pandemic has been having to tell somebody, "I can't do anything for you." Working in an environment where one of your main goals is to help people, having your hands tied in a time when people need help is really, really difficult. There’s so much emotion that comes with having to say no, because you know how time sensitive abortion care is and how much more expensive it becomes the longer a patient has to wait. When you turn somebody away, you know exactly how much more difficult it’s going to make their situation.
Denying someone an abortion is a never-ending cycle with terrible consequences. A multi-year study from Advancing New Standards of Reproductive Health (ANSIRH), which will be published in full in 2020, looked at the health outcomes of patients who tried to have an abortion and were denied, for whatever reason. Those patients had worse health outcomes than people who had an abortion — they were more likely to be in poverty, more likely to stay in abusive relationships, and even more likely to experience serious pregnancy complications. In my office, I've met with patients who have poured their hearts out to me about their difficult life circumstances. No situation is the same, of course, but my patients all know how difficult the decision they're making is, and they know they're making it because it's the right decision for them.
Even during a pandemic, abortion care is essential. Abortion care is health care. A person's reproductive health needs don't stop because of a pandemic, and those needs still have to be addressed. Our health care system and its structures still need to provide for our patients, even during uncertain times.
This interview has been edited for length and clarity.
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