COVID-19 and access to abortion
The compounding nature of COVID-19: How the global pandemic exposes longstanding barriers to women’s optimal reproductive health and further restricts access to abortion
Autumn Pierce
I’m pretty familiar with the link between natural disasters and gendered violence. As part of my IMPH I took a unit of study called Health Issues & Humanitarian Emergencies specifically so I could examine the staggering increase in intimate partner violence following Hurricane Katrina in the United States (the numbers I heard on TV in 2005 have always stuck with me).
I have also seen Women’s Health East’s sister organisations present on their Gender & Disaster (GAD) Pod initiative in several different forums. The initiative addresses the research gap in Australia relating to the gendered impacts of disaster and the link between disaster and violence against women, with a specific focus on transforming emergency management practices as they relate to bush fires. Their work however is directly applicable to many emergency situations, including global pandemics, as the current coronavirus context is also one of anxiety, uncertainty, stress, fear and lack of control – factors we know to increase the likelihood and severity of violence.
The growing evidence is still limited, but Australia expected a spike in violence as COVID-19 spread and lockdowns were imposed. Local police stations in China, the epicentre of coronavirus, saw reports of domestic violence almost triple in February during isolation. Unsurprisingly, in March the Australian Government reported Google searches about domestic violence had almost doubled in the wake of coronavirus, and demand for family violence services has surged around the nation (reflecting worldwide patterns). Keep in mind these numbers represent only the women who are able to reach out – we can assume there are many deterred by the risk of being overheard on the phone or forcibly stopped from leaving home. Refuges, overstretched at the best of times, are scrambling because they’re not equipped to act as quarantine facilities or to respond to emergencies of this scale.
The thought of women being trapped in isolation with their abusers, of a perpetrator weaponising COVID-19 to terrorise his victim, of a crisis situation being used to justify relegating women to subordinate roles, is alarming. But leadership’s acknowledgement of and response to the issue has been encouraging. The federal government has pledged $150 million on top of what state governments have committed to domestic and family violence services.
It is equally important however, to recognise the widespread reverberations of coronavirus that are beyond, but exacerbated by, family violence and crisis responses. An increase in family violence, which includes sexual violence and reproductive coercion, goes on to increase other risks, such as poorer sexual and reproductive health outcomes for women. A state of emergency instils in government the power to override rights to liberty, freedom of association and freedom of movement, which may help contain COVID-19, but disproportionately disadvantages women and has serious implications for access to essential sexual and reproductive health (SRH) services, including contraception, emergency contraception and abortion.
Growing up in America, my knowledge of SRH rights is defined by Roe v Wade, the landmark decision handed down by the US Supreme Court in 1973 affirming the right to abortion in the first 12 weeks of pregnancy. The decision is just as polarising now as it was then. Roe v Wade won a hard-fought battle for abortion rights, but almost four decades later the war wages on. The security Roe v Wade intended to bring about has never been realised. The attacks on abortion access have been constant and unrelenting, and last year saw an unprecedented wave of the most restrictive anti-abortion laws in decades, many blatantly unconstitutional by design. The 1973 Supreme Court decision has been challenged over and over – in Supreme Court no less – and while there has not yet been a reversal, the very fact that the Supreme Court hears the cases validates the attacks and sends a clear message to women that their ‘right’ is no guarantee. Weaponised language such as ‘partial-term abortion’ and ‘heartbeat bill’ shape the narrative around the abortion debate, and provide the moral justification for efforts to undermine, dismantle, control and ultimately reverse women’s right to bodily autonomy.
(I could write a whole other article just on the language wars of the abortion debate. At Trump’s first re-election campaign rally this year in Toledo, Ohio, he told supporters: ‘Virtually every top Democrat also now supports late-term abortion, ripping babies straight from the mother’s womb right up until the moment of birth.’ At the 2019 State of the Union address, when asked to comment on a law passed in New York that removed some restrictions on later abortions, Trump replied: ‘These are living, feeling, beautiful babies who will never get the chance to share their love and their dreams with the world.’ Trump and other politicians use illustrative rhetoric like this often, despite the misleading and inaccurate nature of the claims. Partial- or late-term abortion is not a medical term – it is a political construct. It overstates the frequency and misrepresents the circumstances of later abortions, while also ignoring how systems and structures disproportionately hinder women based on race, socioeconomic status, education, state of residence, and rural or metro location. In reality, 11% of abortions are performed after the first trimester and slightly more than 1% of abortions in the US are performed at 21 weeks or later.
Heartbeat bills ban abortion at six weeks, before most women know they are pregnant, conveniently overlooking the fact that at six weeks a heart has yet to form. The detected rhythm is electrical activity coming from a 4-millimetre-wide growth called the foetal pole. The first heartbeat bill was introduced in 2011. In 2019 four states actually passed heartbeat bills with the state of Alabama passing a near total ban on abortions. Not one state has yet managed to enact heartbeat legislation long-term, but peddling the illusion of a child in need of protection has damaging effects for women exercising their reproductive rights.)
The Australian anti-choice movement is tiny compared to the US, but their views ‘have an outsized place in the abortion debate because of their vocal political and religious allies.’ Protest groups that target local abortion clinics here in Australia such as Helpers of God’s Precious Infants and 40 Days for Life, are chapters of US organisations. After South Australian Greens MP Tammy Franks introduced a decriminalisation bill in SA’s Legislative Council in 2018, anti-choice activists from the US, including the chair of 40 Days for Life, brought their lobbying efforts directly to Adelaide. They met with several MPs to discuss ways they might assist in the fight against a bill to fully decriminalise abortion in the state.
Without an overriding federal decision, abortion in Australia is dictated by state and territory governments, all of which have different rules and regulations. In Victoria, abortion is legal to 24 weeks, and post-24 weeks with the approval of two doctors. In Western Australia abortion is very restricted after 20 weeks, and in the Northern Territory it is only legal to 14 weeks with one doctor’s approval, and at 14-23 weeks with an additional doctor’s approval. It is not legal after 23 weeks unless it is performed to save a pregnant person’s life. South Australia is the only state to not offer medical abortion via Telehealth, meaning South Australia patients can only access abortion care if they leave their house. That being said, to access abortion telemedicine even where it is available you must live within two hours of a medical facility and be less than nine weeks pregnant.
Although more subtle, attempts to wind back women’s reproductive health rights at a structural level are launched in Australia the same way they are in America. For example, the Exposure Draft of the Religious Discrimination Bill was introduced in August 2019 and, on its surface, is designed to have positive implications for society by improving protections against religious discrimination for all people in Australia. In practice however, this bill provides the legal framework to advance the anti-choice movement. For example, the bill would sanction anti-choice activists’ intimidation of women outside of health clinics that provide abortion services, in states where legislated safe access zones have not yet been established.
The bill would also extend existing protections for health practitioners who conscientiously object to the provision of abortion. This is problematic because objections and non-compliance with current laws and policies are already high, which limits women’s access to reproductive health services. This has more severe consequences for some women over others, for instance women living in rural and regional areas. Rates of conscientious objection are particularly high in some rural and regional areas. A 2017 survey of GPs and Practice Nurses in the Grampians Pyrenees and Wimmera regions in western Victoria showed 38% of GPs ‘sometimes’ or ‘always’ referred women to a colleague because they held a conscientious objection, with the proportion increasing to 62% for GPs trained overseas. Non-compliance with these provisions is also widespread. A study conducted in 2015 involving interviews with abortion experts found that doctors had: directly contravened the law by not referring; attempted to make a woman feel guilty; attempted to delay women’s access; or claimed an objection for reasons other than conscience. This information and more can be found in Women’s Health Victoria’s submission on the Religious Discrimination Bill Second Exposure Draft, endorsed by the women’s health sector, which further outlines how the bill will delay women’s access to abortion and lead to unwanted pregnancies, more complex abortions, financial loss and negative mental health impacts for women.
Access to abortion in already inequitable in Australia and the Religious Discrimination Bill would only exacerbate this disparity. In the US, the same patterns emerge. Between 2011 and 2017, 4% of abortion clinics closed in America. This may seem insignificant, but the reality is that clinics are closing in large numbers in the south and Midwest and opening on the coasts, leading to expensive logistical nightmares for many women. A 2014 analysis revealed women who live at least 50 miles away from an abortion facility were more likely than those who lived less than 25 miles away to seek a second-trimester abortion. In addition, 25% of women who lived in states that require an in-person counselling visit before an abortion procedure obtained an abortion within seven weeks after their last menstrual period, compared with 40% of women who lived in states without waiting periods. The current intrastate travel restrictions in Australia present a similar barrier, further limiting women’s options during a time critical situation. The travel bans restrict women’s freedom of movement and the isolation periods impact on doctors’ readiness to fly interstate to perform later gestation abortions (there are a very limited number of specialised doctors who can provide these types of terminations).
It is important to understand the influence America has had on our conversations about abortion in Australia because it without a doubt shapes our interpretation of what is and isn’t an ‘essential’ service – a distinction in the COVID-19 context that has significant implications. As part of the COVID-19 response, DHHS has developed guidelines about the provision of medical procedures based on whether they are deemed essential or elective. (More information on COVID-19 and IVF services). Non-essential services have been temporarily suspended, and whether or not abortion has been temporarily classified as essential given the circumstances depends on not just the state or territory but on the particular medical board, hospital and even doctor.
Marie Stopes has recently updated their Situational Report: Sexual and Reproductive Health Rights in Australia A request for collaboration and action to maintain contraceptive and abortion care throughout the SARS-COV-2/COVID-19 pandemic. The report implores the Morrison Government to make contraceptive and abortion care a priority. Among other calls to action, Marie Stopes recommends:
- All Governments, health and hospital services, and health clinics to consider abortion an essential service with Category 1 classification
- Medical abortion via telehealth to be provided for people living in South Australia
- The provision of medical abortion to be increased to 70 days/10 weeks gestation, supported by the Pharmaceutical Benefits Scheme (PBS)
- Women and pregnant people who attempt unsafe abortion during the pandemic will not be criminalised
- Safe Access Zones to be established in South Australia and Western Australia
These measures aim to maintain sexual and reproductive health rights in Australia by acknowledging the compounding nature of global pandemics on an already precarious situation and advocating for appropriate allowances. Against the backdrop of inequitable sexual and reproductive health rights and within the context of increased unplanned pregnancy and reproductive coercion, as well as increased barriers to accessing safe and affordable abortions, we cannot consider regression an option.