Abortions without clinics: Amid COVID-19 crisis, let women self-manage abortion

With many clinics closed during the pandemic, women who self-managing their abortions should not face legal risk

Published April 13, 2020 6:00AM (EDT)

 (Getty Images/istockphoto)
(Getty Images/istockphoto)

The pandemic has brought into sharper focus the inequities and outright gaps in people's access to health care of all kinds, including abortion care. It has also exposed the shameless extremes to which anti-abortion politicians will go to exploit a crisis to promote their own harmful religious and political agendas to the detriment of vulnerable communities. In their most thinly veiled attempt to date, abortion opponents are trying to keep women from having abortions in the midst of a public health crisis by threatening providers with jail time and attempting to ban abortion care by declaring it "non-essential." The Fifth Circuit has even allowed Texas to implement a near-total ban on abortion services during this pandemic, leaving patients confused about their options.

Indeed, these latest attacks on abortion signal an even more dire situation for those who've long been the hardest hit by anti-abortion politicians' wrathful lawmaking: women of color, youth, undocumented people, LGBTQ folks, and other marginalized communities. Unless lawmakers and judges act with reason and compassion, these groups will face even higher obstacles, longer delays and more dehumanizing threats to their lives and liberty just for trying to have abortions in the age of COVID-19. If politicians truly cared about public safety and wanted to flatten the curve, they would follow guidance from the American College of Obstetricians and Gynecologists and other reproductive health experts: Abortion should be treated as essential health care, telemedicine options should be expanded, and the criminalization of self-managed abortion should end.

Clinics must remain open, and abortion providers must be allowed to care for their patients without threats of fines and jail time. That said, there are many reasons why people may not be able to reach clinics, or may not want to travel to clinics, in light of the health crisis and community responses. We are concerned that the opportunism and callousness of anti-choice officials will extend to the targeting and terrorizing of people who choose ending their own pregnancies at home. Those who need to self-manage their abortions, and the loved ones who support them, must be able to take care of themselves right now without fear of being policed and prosecuted

In Texas, the Fifth Circuit's decision means that people living in almost every county in the state will be more than 100 miles away from the nearest clinic and some people seeking abortion care will even have to travel up to 800 miles in total, at a time when travel is already a danger and a challenge. Across the country, many people cannot reach clinics right now because they don't have reliable transportation due to their age, loss of income or family situation. Others must stay home to care for children in light of school closures or provide aid to quarantined loved ones. While we practice social distancing, self-isolation, and quarantines to maintain public health and flatten the curve, people must be allowed to safely end pregnancies at home with support and without fear of arrest. Anyone who needs it must be able to get abortion pills via telemedicine or through the mail so they can avoid potential exposure on public transportation and in public spaces, and to ensure our medical facilities and providers can continue to focus on allocating resources as needed.

The last thing people need in the midst of this health crisis is to worry about being arrested for taking care of themselves and trying to stay safe. But we are deeply concerned about the potential for increased policing of those who end their own pregnancies at home with pills when they cannot or choose not to access abortion care in clinics. Likewise we worry about those who support others in self-managing their care at home, especially as politicians single out abortion providers for scrutiny and punishment. It is imperative that lawmakers, police and prosecutors recognize that targeting people for self-managed abortion is both wrong as a matter of law and dangerous as a matter of public health. The vast majority of states either explicitly prohibit or do not authorize criminal charges for people based on a self-managed abortion. Furthermore, court decisions and other authoritative interpretations of law have recognized that criminalizing people for having abortions violates constitutional protections. 

If someone who has self-managed an abortion wishes to seek medical care, they should be able to do so with peace of mind, knowing that they care they receive will be confidential and will not ensnare them in the criminal legal system. Health care providers are not required to report patients they believe may have self-managed to law enforcement — in fact, if they do, they're likely breaking the law and violating their patients' privacy rights. 

This era is a time to lift unnecessary restrictions, not enact more; to support and herald our health care providers, not threaten them with jail time; to facilitate self-directed care, including self-managed abortion, that allows people to stay safe and limit the spread, not shame them for being resourceful or add to their woes with the threat of arrest. People continue to need abortions during the pandemic, and they can get them while slowing the spread of the coronavirus — but only if lawmakers and law enforcement employ logic, compassion and common sense.


By Jill E. Adams

Jill E. Adams, J.D., is executive director of If/When/How: Lawyering for Reproductive Justice

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Abortion Commentary Coronavirus Covid-19 Reproductive Rights