Accessing reproductive healthcare in a pandemic

COVID-19 has upended reproductive care access, particularly for those needing to cross a border.

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Living in a pandemic has upended most of what we used to call “normal life.” Countries are in lockdown, economic activities are paused, and social life is now through computer screens. Through it all, politicians, decision-makers and health specialists have made a distinction between what is considered “essential” and what is deemed “non-essential” or “elective.” However, what we consider to be one or the other is rooted in ideology and not without impacts. Such is the case with accessing reproductive healthcare in the United States. 



Ideology, Necessity, and Reproductive Health


Accessing reproductive healthcare in the United States has been a matter of geographical position for years. Prior to Roe v. Wade, the landmark US Supreme Court decision in 1973, states had varying laws. While in some a woman could choose to terminate a pregnancy, in others, the choice was nonexistent. Through its decision, the Supreme Court aimed at securing the right to choose for all women on U.S. soil. However, the Court segmented the pregnancy into three trimesters – each with specific limits on state power – allowing states to outlaw abortion during the third trimester.


While subsequent Court decisions (Webster v. Reproductive Health Services, 1989; Casey v. Planned Parenthood, 1992) bid farewell to the trimester division, they maintain – and even enlarged – states’ abilities to curb or protect access to abortion within their territorial limits. Since then, states slowly but surely enacted laws in line with their ideological affiliations: from a right for all, abortion has become a right wherein its effectiveness depends on where one stands. 


This situation is problematic in general. But COVID-19 has shed light on the underlying ideological divide that prompts restrictions in red states and protections in blue states when it comes to reproductive care access. As states realized the scope of risks associated with the pandemic, they mandated that all non-necessary surgical interventions be put on hold in order to free beds and healthcare workers, and save much-needed medical equipment. While for pro-choice individuals, politicians, and decision-makers, abortion access is deemed a necessary intervention, a group of conservative states explicitly banned all abortions on their territory, counting them as non-necessary. 


This raises the question of what states consider to be essential and necessary versus what is non-essential and unnecessary. In conservative states, where local policy agendas aimed at curbing access altogether, terminating a pregnancy is never considered necessary – unless a mother’s life is in danger, and even then some will say it is still a sin. However, abortion is not elective in the sense that it can’t be pushed back indefinitely – there is a time constraint that must be taken into consideration. 


In the last 50 years since Roe v. Wade, interior borders have been created between states that protect abortion access or curb it. In a pandemic, these policy barriers are even more critical. Barriers to access will push – and have been pushing – women to seek care outside their state of residency because, as stated, the time constraint is real and matters. Forcing women to travel long distances, while increasing the probabilities of being in contact with the virus (not at the clinic, but rather at gas stations and other necessary stops) while most roadside amenities are closed only adds to their vulnerability.  



Cross-border Care 


While these impacts are critical for women living in the United States, they are not limited solely to those with a U.S. address. Reproductive health clinics in states bordering Mexico and Canada are used to serving women from the other side of the border. At the U.S.-Mexico border, clinics serve women coming from Mexico, where only three Mexican states – Mexico DF and two southern states – allow women to terminate a pregnancy within the first 12 weeks. At the Canada-U.S. border, specialized hospitals allow women needing to terminate a pregnancy for medical reasons to receive care that is currently unavailable in their province of residence.


Furthermore, some women decide to travel at their own expense to access care either due to proximity to clinics on the other side of the border, or because they are too far along to access it in their province of residence – as some border states allow termination during the second trimester. However, on March 18, 2020, Canadian Prime Minister Justin Trudeau and U.S. President Donald Trump announced that the countries' shared border would be close to non-essential travel as of midnight on March 21. And on March 20, the same announcement was made by Trump and Mexican President Andrés Manuel López Obrador regarding the U.S.-Mexico border. Those announcements left women stranded: what definition of “essential travel” is applied to them? 


Currently, patients seeking healthcare on the border between Canada and the United States are deemed to be engaging in “essential” travel. Women are encouraged to bring a letter from a doctor stating they are traveling for medical reasons, but, as highlighted by the Abortion Rights Coalition of Canada, they may not be granted access to the United States. At the U.S.-Mexico border, the situation is even more complicated as many women were hesitant to disclose the reason for their travels, even prior to the current pandemic, due to a difficult cultural acceptance of abortion. 




The risks associated with the current pandemic are not to be taken lightly. However, some reproductive healthcare is time-sensitive and can’t be considered elective as other surgical interventions may. From the border zones to the interior borders between states, how state and federal governments respond to the COVID-19 pandemic significantly impacted the options available for pregnant Americans, Canadians, and Mexicans seeking care.



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Health Care, Immigration, Women, Reproductive Health, US Foreign Policy, Pandemic, COVID-19, Medicine, Women's Rights, Feminism