Providers and advocates say the pandemic highlights the need to end bans on telemedicine and requirements like the mandatory waiting period.
Since she became the medical director of her Dallas-Fort Worth abortion clinic in 2013, Robin Wallace has been trying to recruit more physicians to meet the growing demand. That year, the Texas Legislature passed the sweeping House Bill 2, which shuttered dozens of clinics across the state. State restrictions also make it difficult to find providers who live in Texas. So the clinic has long relied on traveling doctors, piecing together the schedules of one Texas-based physician and seven who fly in from around the country to provide abortions for 150 or so patients each week. That patchwork has dissolved in recent weeks as coronavirus spreads, sending doctors into quarantine and limiting travel.
Right now, just one of the clinic’s remote doctors is able to travel. One of the providers is stuck in California under a shelter-in-place order. Another is quarantined at home after a coworker tested positive for the virus, and yet another is quarantined after a patient tested positive. Wallace, a family physician who left Texas last year and travels back to the clinic for one week each month, says she can’t leave her family while her kids are out of school. For the next three weeks, patient visits that would normally be covered by an additional four doctors will fall to two: the local provider, who at over 60 years old is high-risk for COVID-19, and Wallace’s co-medical director, who flew in last weekend to “hunker down” in the area until early April.
“It’s an incredible burden on the two of them,” Wallace says. “And should either of them need to go into quarantine, or become symptomatic, then we’re really facing having to close the doors.”
Reproductive health advocates here and around the country warn that the coronavirus could dramatically increase the hurdles to abortion access that pregnant people in states like Texas already face. With limited in-state providers, many clinics rely on out-of-state doctors, and travel restrictions impact the availability of services. And, advocates say, state regulations around abortion—like mandated waiting periods and restrictions on telemedicine—put patients and providers in more danger of contracting the virus by forcing multiple clinic visits.
For abortion clinics that have traveling doctors, “disruptions in their travel schedule will make access to care more difficult than it already is,” says Kari White, a researcher at the Texas Policy Evaluation Project at the University of Texas at Austin. “Even before the onset of the pandemic, 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,” she says. “Economic uncertainty and unanticipated child care needs brought on by this crisis will add to the challenges people face.”
Already, some Texans have to travel more than 300 miles one-way for an abortion, after HB 2 rules forced half the clinics in the state to close before being struck down by the U.S. Supreme Court in 2016. There’s currently just one abortion clinic south of San Antonio, in the Rio Grande Valley. There are none in the entire western half of Texas, between San Antonio and El Paso.
Amy Hagstrom Miller, CEO of Whole Woman’s Health, which has abortion clinics in Austin, Fort Worth, and McAllen, says her group has been able to keep all its doors open for now, albeit with “some pretty significant changes.” Those include new precautions like screening patients on the phone, limiting people in the buildings, and shifting schedules for traveling physicians whom the clinics rely on. At the McAllen clinic, the only one for hundreds of miles, Whole Woman’s Health spends about $65,000 per year on physician travel alone, Hagstrom Miller says. In light of the coronavirus outbreak, one out-of-state doctor decided to stay in Texas for an extended time, to provide services at the Austin and McAllen clinics.
The pandemic highlights the burdens imposed by state abortion regulations, Hagstrom Miller says, such as the requirement that patients have an ultrasound at least 24 hours before the abortion by the same doctor who will do the procedure. That “puts patients at double risk with double exposure, with absolutely no medical benefit,” she says.
The solution, in addition to eliminating the mandatory waiting period, would be to immediately expand medication abortion in Texas from 10 to 11 weeks of pregnancy, and make it available via telemedicine so patients don’t need to travel to the clinic, says Ghazaleh Moayedi, a Texas OB-GYN and board member of Physicians for Reproductive Health. Moayedi is particularly concerned about contracting COVID-19—she says she is the only abortion provider living in her community who offers abortions up to the state limit. The others fly in. She says some older physicians have already stopped traveling to Texas. And even possible exposure to coronavirus can keep doctors home without adequate testing. Already, Moayedi knows a Texas abortion provider who is in self-quarantine for two weeks with symptoms, who hasn’t been able to be tested.
Governor Greg Abbott this week agreed to waive some other telemedicine requirements in light of the outbreak. His office didn’t respond to a request for comment on calls to loosen these restrictions on abortions.
As hospitals around the country determine which medical procedures can be delayed to prepare for patients with COVID-19, national obstetrics, gynecology, and family planning groups this week urged that abortion not be sidelined. Access is especially urgent, providers say, given how little we know about the risks of being pregnant or giving birth in the midst of this crisis. “During a pandemic with an infection where we have no data long-term on what the maternal and fetal outcomes are going to be, it’s more important than ever that people be able to control the timing of their pregnancies,” Wallace says.
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