In a previous Special Feature, we covered the role of biological sex differences in the spread of the new coronavirus. Here, we look at how the pandemic is affecting women’s sexual and reproductive health in the United States and across the world.
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The coronavirus pandemic has affected people differently based on their sex and gender. And, as we explained in our previous feature, gender has played an important part in the primary and secondary impacts of the current health emergency.
Although our previous article used sex-disaggregated data to focus on the primary effects of the virus, such as viral transmission and mortality rates, this feature will examine some of the secondary effects that this crisis is having on women — with a special focus on sexual and reproductive health.
From a primary impact point of view, men seem to be much more likely to have a severe form of COVID-19 or die from the disease.
However, on a societal level, the pandemic has had a range of serious consequences for cis and trans women everywhere — including the higher risks they face as a result of their traditional roles as carers, the rise in domestic violence, and their lack of decision making power in their own sexual and reproductive health.
Many have argued that there has been a power imbalance in the COVID-19 response, and that the insufficient number of female leaders places women at a disadvantage.
For instance, the initial U.S. coronavirus task force consisted entirely of men until two women joined in February 2020. In addition to these imbalances, the existing power dynamics on a political level have resulted in decisions that may jeopardize women’s reproductive health.
For example, government officials in the states of Texas, Ohio, Alabama, and Oklahoma have tried to ban most abortions — that is, those that are not required to preserve the life or health of the mother — on the basis that they do not consider them urgent or medically necessary during this pandemic.
They allegedly made this decision to preserve hospital beds and other medical resources and facilities that are necessary during the pandemic.
Although federal judges have tried to block these attempts, further efforts to appeal them have resulted in a decision to ban the procedure in Texas.
The U.S. appeal court ruled in favor of the state on April 20, 2020, banning all nonessential abortions, including those done by ingesting a pill, which account for a third of all abortions. This is despite abortion providers’ protestations that medical abortions are not surgical procedures that require the use of medical facilities, resources, or protective equipment.
However, a new order that took effect on April 22, 2020, has allowed abortion facilities in Texas to resume both medical and surgical abortions in return for preserving a certain number of beds for COVID-19 patients.
Texas is not the only state where abortions were in danger of receiving a ban because they were not deemed “essential healthcare.” In fact, officials in many states are continuing to contest a woman’s right to have an abortion.
In Utah, Indiana, Ohio, West Virginia, Kentucky, Tennessee, Alabama, and Louisiana, officials are currently contesting a woman’s right to an abortion. Abortions are already restricted in Alaska, Arkansas, and Mississippi.
In an interview, Dr. Erin King — who works as an obstetrician-gynecologist in Missouri — explains why abortions are essential healthcare.
She said, “It’s important to remember that people [seeking] abortion care need that care when they need it.”
“They know their bodies best, their social situations best, their lives best. And if it is not the right time for them to be pregnant, that pregnancy is not waiting for the end of a pandemic. Although abortion is safe pretty much all of the time, the earlier you are in your pregnancy it’s an even safer procedure.”
– Dr. Erin King
When asked about the argument that abortions are not medically necessary during a pandemic because they are considered “elective,” Dr. King said: “Abortion in general is medically necessary, and for patients seeking abortion, they can’t wait. Their pregnancy is continuing to grow regardless of what’s happening outside their bodies.”
Furthermore: “There are patients with medical conditions that will worsen if they don’t access abortion care as quickly as possible. There are patients with fetuses that have multiple anomalies, and they may end up actually being past a gestational age where they can access abortion care if they wait.”
Dr. King is certainly not the only healthcare professional who thinks that abortions are essential healthcare.
The American College of Obstetricians and Gynecologists, in collaboration with other institutions, have recently released a statement on abortion access during the COVID-19 outbreak.
“Some health systems, at the guidance of the CDC [Centers for Disease Control and Prevention], are implementing plans to cancel elective and nonurgent procedures to expand hospitals’ capacity to provide critical care,” they say.
“To the extent that hospital systems or ambulatory surgical facilities are categorizing procedures that can be delayed during the COVID-19 pandemic, abortion should not be categorized as such a procedure.”
“Abortion is an essential component of comprehensive healthcare. It is also a time-sensitive service for which a delay of several weeks, or in some cases days, may increase the risks or potentially make it completely inaccessible. The consequences of being unable to obtain an abortion profoundly impact a person’s life, health, and well-being.”
Restricting access to abortions has already had immediate consequences on women’s physical and emotional well-being. Many now have to travel long distances to seek the care they need.
For example, a report from the Guttmacher Institute estimated that the average driving distance to an abortion clinic for a woman in Texas could have increased by almost 2,000% had legal abortion care centers shut down.
Although there are have been no studies on the impact that such measures might have on the mental health of those refused abortions during COVID-19, there are studies that suggest that unintended pregnancies in general are associated with poor mental health outcomes.
In fact, experts have found significant increases in depression both in the short term and in the longer term, nearly 20 years later, in women who had unintended pregnancies.
It is worth noting that emerging studies show that women