Blog by Neha R. Pidatala
During the current COVID-19 pandemic, many states in the US have ordered or supported the cessation of both medical and surgical abortion, while few have directed only the surgical abortion to halt. Some states have threatened jail times and massive fines if the laws are not upheld. Ohio singled out abortion clinics even as gun stores and marijuana dispensaries were deemed essential and allowed to remain open. Texas ordered the most restrictive abortion policy in the nation. Under the current circumstances, delaying procedures may increase the associated pregnancy risks with each passing week and since most states impose upper limits of gestational age at which abortion can be performed, this will mean that many women will be unable to obtain an abortion at all.
I understand their argument for conserving PPE (Personal Protective Equipment) and limiting resources for COVID-19 patients, but an increase in domestic and sexual abuse due to shelter in place, travel restrictions and the economic and financial hardships during a pandemic only compound the need for safe and legal abortion care. Such challenging times call for expanded access to abortion care; denying care and penalizing women will only lead to the uptake of unsafe abortion practices, endangering their lives with complications that might require emergent interventions which consume the rationed PPE.
Given the potential effects on women if states suspend abortion care throughout the pandemic, the president of the AMA (American Medical Association) issued a statement on March 20, 2020, in support of continued access to abortion and explaining that physicians, not politicians should decide which procedures should be delayed. Planned Parenthood is also conducting more assessments over the telehealth platform so that eligible patients can pick up the medications at their center. ACOG (American College of Obstetricians and Gynecologists) and other reproductive professional organizations issued an unequivocal statement on March 18, 2020, that they do not support COVID-19 responses that cancel or delay the abortion procedures.
The draconian orders of halting abortion care services have immediate effects on patients like me. Unfortunately, I experienced both the medical treatment by pills and surgical treatment with Dilation and Curettage (D&C). In the first few weeks of my much-desired pregnancy, I intermittently had brown discharge which progressed to spotting, frantically leading me to “Dr.Google.” It reassured me that many women experience such symptoms and go on to have healthy pregnancies. I wish Dr. Google were right; my bleeding progressed and this time I called my obstetrician’s office, which was attended by a receptionist who robotically took my details and assured me that a triage nurse will call back.
I waited an hour, indulging in some mindless banter to calm my nerves. At the end of almost two hours, the triage nurse called back and surprisingly she was no different from the receptionist, using the same unempathetic tone asking structured questions to document my history in the electronic records. With tears streaming down my cheeks, I gave her a thorough history, expressed my fear of losing my unborn, and begged her to help me give my child “every” possible opportunity to be welcomed into this world. Alas, all I could hear from her end was the “click-click “of her typing. After finishing the documentation, she informed me that my doctor was on leave and on that Friday afternoon, the best we could do is some blood work to confirm my pregnancy. “What time can you come? She asked. “I am rushing out of the door and will be there in 15 minutes”, I replied.
After the technician called me in to draw blood, I had an encounter with the same triage nurse, who informed me that they can’t order an ultrasound to confirm my condition until they have the blood test results, per the protocol to be reimbursed by insurance. Fatefully, it was a Friday evening with Monday being a long weekend, leaving me with no access to ultrasound management until Tuesday at the doctor’s office. Hearing this, I started crying and discussed my fears, begging for any necessary intervention, should the bleeding be caused by any treatable condition. She addressed my concern by encouraging me to use the closest Emergency services in the event of any profuse bleeding or intense pain. I took the bumpy cab ride back home and as every speed bump rocked my pelvis and aggravated my bleeding my hands trembled, my heartbeat galloped, and my skin flushed. I could now feel the clots pass and I mourned my loss and helplessness. It was February 14th, Valentine’s Day and our marriage anniversary.
I kept up my Tuesday’s appointment to follow up on ultrasound management and was diagnosed with incomplete abortion, which required further treatment. This was my experience before the pandemic; I can only imagine the devastation visited upon women in similar situations during COVID-19 times. Studies suggest that about 15% of women who experience pregnancy loss have depression and anxiety, which can last anywhere from one to five years, while PTSD (Post Traumatic Stress Disorder) affects one in six women who suffer a miscarriage I share my experience because I am among the 20-30% of the women in the United States who suffer a miscarriage due to chromosomal abnormalities; I am also among the one-quarter of American women who use abortion services under the age of 45 and it is imperative that we receive timely care irrespective of the pandemic.
The lack of social support due to social distancing and economic and financial hardship adds up to our loneliness and guilt. Abortion care is essential care. The medical profession’s response to COVID 19 pandemic must include continuing to meet urgent healthcare needs, including the need for time-sensitive abortion.
Dr. Neha Pidatala is a medical doctor in New York City. Her interests include patient advocacy, health policy, and research. She can be reached at @DrNehaReddy on Twitter.