Shoshana Aronowitz is a National Clinician Scholar Program Fellow at the University of Pennsylvania and family nurse practitioner. Charlotte Scott is a family nurse practitioner. Shawana Moore is the program director of the Women’s Health-Gender Related nurse practitioner program at Jefferson University, a women’s health nurse practitioner, and on the Board of Directors of NPWH. All provide primary and reproductive healthcare in Philadelphia.
With at least 50% of US citizens on ‘stay at home’ orders, many of us have experienced one of the impacts of these policies: decreased access to non-emergency healthcare. While out-patient clinics are generally considered life sustaining and are allowed to remain open, many have limited their hours or have completely ceased in-person visits. This is due in part to fewer scheduled appointments as patients are socially distancing and staying in, and because clinics are protecting the health of their staff as the supply of personal protective equipment (PPE) runs dangerously low. Clinics must now determine which services are deemed “essential” and will continue to be offered and which are “non-essential” and can be put on hold. Especially controversial–at all times and especially now–are reproductive and sexual healthcare services.
Limits on Already Limited Access
Many areas of the country are already severely lacking in reproductive healthcare, and COVID-19 related ‘stay at home’ orders threaten to limit this access further. Within the past few months, the Attorney Generals of both Texas and Ohio have announced that abortions are “non-essential” services and must be halted immediately. Orders like these threaten the health and safety of people who may become pregnant in the next few months, as well as those who are already pregnant and are awaiting scheduled procedures. The medical community is in agreement: abortion is an essential component of comprehensive healthcare. We do not know how long ‘stay at home’ orders will last and restricting access to abortion during this time will mean that many people will be too far along in their pregnancies to receive the procedures when clinics are allowed to reopen.
Unplanned and Unwanted Pregnancies Could Spike
As reproductive healthcare providers, we are worried about what will happen to our patients if they lose access to these services. Increased time spent at home during COVID-19 lockdowns may lead to a “pregnancy boom.” While many people will be excited about these pregnancies, others will be unplanned or unwanted, especially if access to contraception is reduced due to clinic closures. Financial hardship caused by lost jobs and wages could make the prospect of an unplanned pregnancy especially stressful for many families. Additionally, increased isolation may make some individuals especially vulnerable to sexual coercion and violence during this time. Many individuals in sexually coercive or abusive relationships rely on discreet birth control options like injectable Depo-Provera or intrauterine devices (IUDs), which may be harder to access as clinics close.
How Reproductive Healthcare Can Continue
‘Stay at home’ orders do not need to mean that access to reproductive health services will be totally lost; much of this care can be provided over the phone. Providers can easily refill birth control prescriptions and emergency contraception (the morning-after pill) electronically. Even medication abortions–which involve the prescription of two medications to induce abortion safely at home–can be provided by telehealth and clinics providing this service have 24 hour on-call providers available to answer questions or direct patients to in-person care in the case of emergencies. Access to these services must be expanded to serve all who need them.
Nurse Practitioners Are a Valuable Resource
Some states, such as Vermont, Washington, Oregon and Maine (to name a few) allow nurse practitioners and physician assistants to provide medication abortions. These provisions help increase access to reproductive healthcare by ensuring that more clinicians are available to serve patients. During a time when fears about healthcare professional shortages abound, allowing for expanded scope of practice for nurse practitioners and physician assistants can reduce some of the stress on an already taxed system. New York, Wisconsin and West Virginia are among the few states that have temporarily suspended all practice agreement requirements for nurse practitioners during COVID-19. Other states (Pennsylvania, Louisiana, Missouri, to name a few) have temporarily waived selected practice agreements requirements during this time.
This is Essential Healthcare
The proliferation of telehealth services can help ensure that reproductive healthcare remains accessible–but not all care can be provided over the phone. Surgical abortions require in-person visits and must not be deemed “elective” procedures. Medication abortion is not the right choice for all patients, and policies limiting access to in-clinic procedures put these individuals in danger. We call on state policy makers to consider the essential nature of reproductive healthcare services and not to limit their provision during these uncertain and scary times. We call on healthcare providers offering telehealth to make sure that patients who need contraception have access. For everyone else wanting to help: donations to the Women’s Medical Fund assist people with financial hardships afford the reproductive healthcare they need.