All health care providers have faced significant challenges during the COVID-19 pandemic. The need for in-person services had to be weighed against the need to protect patients and staff from the virus. Facilities that provide abortion experienced unique burdens on top of these challenges. Carole Joffe and Rosalyn Schroeder of ANSIRH talked to abortion providers across the US to explore how stigma and excessive regulation of abortion impacted them during the pandemic. Several themes emerged:

Clinic closures. Clinics faced uncertainty and even chaos in 12 states whose governors ordered them to shut down early in the pandemic, arguing that abortion is not an “essential service.” Legal challenges overturned those bans and allowed closed clinics to reopen, but closures were the greatest cause of stress. Vague orders about what procedures are “elective” caused confusion and anxiety.

"We have been on the edge of our seats to find out if the government will shut us down…the anxiety is a torment."

Staffing issues and traveling doctors. Keeping up staffing levels was challenging, as staff faced childcare issues, became sick, were exposed to COVID or were too afraid to come to work. Clinics also grappled with a chronic physician shortage that predated the pandemic. Due to stigma around abortion, many clinics rely on doctors who fly in from out of town. Travel restrictions made it difficult for physicians to get to the clinics and provide care.

"I have one doctor – and if she gets sick, I'm toast."

No support people in the clinic. Changes to limit exposure to the virus meant that clinics had to suspend their practice of encouraging people to bring a support person like a partner or a parent. Clinic staff felt that could no longer touch patients except when absolutely necessary. The lack of support could be even more consequential due to perceptions of abortion as a stigmatized and controversial act.

"So we don't have someone holding the patient's hand anymore. That's the sad part, there always used to be a patient-support person sitting by the patient's head, talking with her throughout the whole thing."

Protesters and COVID-19. Many clinics rely on volunteers to shield patients from anti-abortion protesters. Early in the pandemic, clinics told escorts to stay home to protect their health. That left protesters with more opportunities to harass patients. They were often unmasked and ignoring safety protocols.

"We had to tell our escorts to stay home. Our protesters are out of control. They don't social distance. They harass our patients in the parking lot and our patients come in in tears."

Despite these challenges, there were bright spots. Clinics were heartened by community support, including people sending food and personal protective equipment. The pandemic also prompted clinics to innovate new, more efficient ways to provide abortion care by eliminating unnecessary medical tests and increasing the use of telemedicine.