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This week, Texas clarified an abortion ban under the guise that it's not an essential health care service and stopping abortions will help free up the demand for personal protective equipment (PPE) like gloves, masks, and gowns. But this is a baseless argument. I'll explain:
First, of course abortion is essential health care—it's a time bound procedure that cannot be delayed, particularly in states with medically unnecessary restrictions like state-mandated waiting periods, ultrasound requirements, and gestational limits.
Now, let's talk about PPE!
Now, let's talk about PPE!
Texas AG Ken Paxton warned physicians to stop providing abortions because the “COVID-19 pandemic has increased demands for hospital beds and has created a shortage of personal protective equipment needed to protect health care professionals and stop transmission of the virus.”
It is true that the pandemic is increasing the demand for hospital beds, and most hospitals have canceled non-essential surgeries. But very few abortions in Texas are performed in hospitals.
Let's look at the data!
Let's look at the data!
According to the state’s official statistics, in 2017, among 52,103 abortions performed for Texas residents, only 87 abortions were performed at a hospital. https://hhs.texas.gov/about-hhs/records-statistics/data-statistics/itop-statistics
Some have argued that abortions should be stopped to avoid the need for patients to go to a hospital with complications after an abortion. But complications after abortion are very rare.
Again, let's look at the data!
Again, let's look at the data!
A study from California found that less than 1% of abortion patients went to an ER for a complaint related to an abortion, and only 0.2% had a complication requiring treatment at a hospital. https://www.ncbi.nlm.nih.gov/pubmed/25560122
In another national study, only 0.01% of all emergency department visits among women aged 15-49 were related to a recent abortion. These data make it clear that canceling abortion procedures will not free up hospital beds or ER space. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000974/
To the contrary, banning abortion makes it more likely that people will self-manage an abortion. While many may use safe and effective medications, some may use unsafe methods. Patients will go to the ER with complications or to know if the method worked. https://www.nejm.org/doi/full/10.1056/NEJMra1908412
What about the argument about banning abortion saves personal protective equipment (PPE) like gloves, masks, and gowns? It’s important to recognize that if a pregnant person continues their pregnancy, they end up using a lot more gloves, gowns, and masks than with abortion.
Patients have a couple of pelvic exams and ultrasounds during prenatal care, all of which require gloves, and then use multiple sterile gloves and other PPE during delivery—even more with a c-section.
Here’s what a first-trimester abortion in a clinic requires in terms of PPE: 2 pairs of gloves (1 for the ultrasound and 1 for the procedure) and a reusable face shield. A gown and mask are not usually required.
That’s it.
That’s it.
You can’t tell me that cancelling abortions is going to free up enough PPE for hospitals considering the scale they're requesting.
If this were really about preventing COVID-19 and saving PPE—not about banning abortion—government agencies would encourage the use of telemedicine to provide the abortion pill. Telemedicine can be used safely and effectively to provide the abortion pill. https://www.ncbi.nlm.nih.gov/pubmed/28885427
Medication abortion can be safely provided without requiring most patients to have an ultrasound or blood tests. @RCObsGyn just issued guidelines for abortion during the pandemic, basing the assessment on patient history. Ultrasound is used when necessary. https://www.rcog.org.uk/globalassets/documents/guidelines/2020-03-21-abortion-guidance.pdf
During the pandemic, it would be possible to provide medication abortion through 11 weeks of pregnancy without an in-person visit & by mailing pills to a patient. This would reduce the patient & clinician’s risk of acquiring the virus, and not a single piece of PPE would be used.
But unfortunately about 18 states, including Texas, have banned the use of telemedicine to provide abortion care—despite the evidence of its safety and effectiveness and that it improves access to care early in pregnancy. https://www.guttmacher.org/gpr/2019/05/improving-access-abortion-telehealth
In addition, the FDA requires that mifepristone used for abortion be dispensed in a doctor’s office, clinic or hospital. It may not be mailed to a patient or dispensed on prescription from a pharmacy. This restriction is not based on medical evidence. https://www.nejm.org/doi/full/10.1056/NEJMsb1612526
Recently, @ACOG & 7 medical organizations wrote “Abortion is an essential component of comprehensive health care. 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.”
Abortion is an essential health care service. https://www.acog.org/news/news-releases/2020/03/joint-statement-on-abortion-access-during-the-covid-19-outbreak
Using a pandemic, and the need for personal protective equipment, to ban abortion is not a legitimate argument—as the data prove.
This is just another attempt to circumvent the law and make abortion inaccessible for all, particularly during a global public health crisis.
This is just another attempt to circumvent the law and make abortion inaccessible for all, particularly during a global public health crisis.
