Dear Decaturish – Abortion in the time of a global pandemicBetsy Collins
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I have been reading in the news that several states have placed a moratorium on abortion as an unnecessary surgery that could be postponed.
I’m here to tell you this is hardly the case.
Patients are already be having difficulty accessing contraception. People are losing insurance coverage, have limited funds to pay for care or prescriptions, and are having difficulty getting appointments with providers who are focusing exclusively on emergency services at this time. This is increasing the risk of pregnancy at a hectic and uncertain time.
When abortion is illegal or not accessible, people still get abortions- albeit unsafe ones. According to the Guttmacher Institute in their report Abortion Worldwide in 2017: Uneven Progress and Unequal Access, abortion rates in countries where the practice is illegal are almost identical to rates where it is legal (37 per 1000 women vs. 34 per 1000 women). The takeaway point: making it illegal or impossible to get an abortion will not prevent abortion.
Abortion was legalized in the United States because of the horrific consequences of illegal abortions such as infection, hemorrhage, and death, as well as the fact that continuing a pregnancy to term is more dangerous to a person’s life than abortion in the first trimester of pregnancy (Roe v. Wade, 410 U.S. 113 (1973)). This has not changed over the years. Maternal mortality in the United States is one of the highest compared with other developed nations and our rates are worsening, from 7.2 deaths per 100,000 births in 1987 to 16.9 deaths per 100,000 births in 2016 according to the Centers for Disease Control’s Pregnancy Mortality Surveillance System. Minority women in the US disproportionately bear the burden of death related to pregnancy with mortality rates three times higher than white women.
Abortion in the first trimester of pregnancy, a time when the vast majority of Americans approve of it (Gallup, Trimesters Still Key to U.S. Abortion Views, 2018), is also the safest time to have an abortion. According to the Guttmacher Institute, the risk of serious complications requiring hospitalization from abortion in the first trimester is less than 0.5%.
Numerous abortion roadblocks are already in place, including mandatory wait times, un-necessary ultrasounds or visits with providers, having to travel to the nearest clinic many hours away (or many states away), financial barriers, and more. Adding actual physical roadblocks like lockdowns and labeling abortions unnecessary procedures only make abortions significantly less accessible which we know does not make them more rare, just more unsafe.
If a patient is able to meet with an abortion provider before 11 weeks, they are also eligible for a medication abortion which could prevent them from needing surgery at all. Medication abortions are also incredibly safe. The patient takes two medications and the pregnancy ends at home, similar to a miscarriage. Follow up can often be accomplished over the phone if the patient is progressing normally, reducing the need to leave home.
If a patient chooses a surgical abortion, the procedure also falls under guidelines for procedures that can be accomplished safely during this pandemic. Most surgical abortions are performed at outpatient surgical centers. Intubation- a risky procedure during the COVID pandemic, is rarely used for abortions. Anesthesia is typically injected into the cervix, taken by mouth, or given intravenously, all low risk. Patients are not expected to need hospitalization afterwards. Minimal personal protective equipment is required. The patient goes home the same day. The farther outside of the first trimester that an abortion occurs, the riskier it is, the harder it is to obtain, the more it costs, and the more stigmatizing it is.
In all, we know that people will seek out abortion no matter what laws say or what road-bocks are in place. The American College of Obstetrics and Gynecology and several other Gynecologic professional societies affirm abortion procedures as essential, time-sensitive, patient care. We have seen recent examples of desperate patients driving hours across state lines to have consultations, ordering un-prescribed medications online, or taking other substances with the hope that they will miscarry. Furthermore, people who don’t want to be pregnant will be forced to stay pregnant and cope with potential complications of pregnancy. Keeping abortion safe means keeping it readily available-ideally within the first trimester. It will save lives, prevent unnecessary hospitalizations, and mean that we can focus on the patients who absolutely need to be in our care at this critical time.
– Betsy Collins MD MPH
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