The USA has just passed the grim milestone of 4 million COVID-19 cases in a single month (November). With the holidays approaching, experts warn that gatherings of family and friends will accelerate the spread. Trump politics and rhetoric are not helpful.
Moreover, the virus has secondary effects on reproductive health, which Trump’s administration has also exacerbated. The pandemic is affecting reproductive choices, with many people preferring to delay pregnancy and/or have fewer children. This makes reproductive health services all the more important, but they are less accessible because of Trump’s policies.
Restrictions on access to reproductive health services are particularly harmful in the midst of a pandemic, but that is exactly what the outgoing government and its allies in the state houses have done. To help restore them, the government could facilitate Biden’s access to reproductive telemedicine.
In the United States, the fertility rate (the number of children a person will have during their lifetime) has been declining for decades. In fact, before the pandemic, the US fertility rate was the lowest it has been since 1985. COVID-19 has accelerated this trend. The birth of a child can be expensive and medically risky for many Americans, and the pandemic has heightened these concerns.
The social and financial situation of American women is an important factor. The United States is the only developed country that does not guarantee paid family leave for new parents and does not provide universal childcare or pre-K, putting pressure on working parents. School closures during the pandemic disproportionately affect women, who account for the lion’s share of childcare, so that mothers will be twice as likely as fathers to leave their jobs in 2020. These job losses have long-term implications for women’s financial stability and consequently long-term effects on their reproductive choices.
At the beginning of the pandemic, many conservative politicians used the crisis to intensify attacks on reproductive health and rights. Under pressure from anti-choice advocates, state officials included procedural breaks in their bans on unnecessary operations. Pro-choice groups defended themselves in court. As the grip of the virus loosened over the summer, the restrictions on elective medical procedures were also relaxed. But when the number of cases rises again and the lack of intensive care beds in some hospitals reappears, conservatives will no doubt use the virus again as a pretext for restricting access to abortion.
The pandemic affects people disproportionately according to class, race, ethnicity and sexuality. This includes its impact on sexual and reproductive health. As a result of COVID-19, blacks and Hispanics, gays and low-income people tend to want fewer children or delay the birth of children compared to their white, heterosexual and higher-income counterparts. They are also more likely to be concerned about whether they can provide or receive contraception during the pandemic. The policies of trump and GOP-dominated countries reduce reproductive health services, which has a disproportionate impact on colored, gay and low-income people.
To reduce these inequalities and restore the availability of comprehensive reproductive health services for all, telemedicine could help. Since the beginning of the pandemic, online health clinics have reported an increase in patient requests for birth control and an increased demand for emergency contraception. Telemedicine can also offer significant benefits for those who want to have a medical abortion (e.g. mifepristone, known as the “abortion pill”). It eliminates the risk of spreading COVID-19 and lowers the hurdles of having to travel long distances to an abortion clinic, as well as the associated costs.
But anti-choice politicians are trying to prevent the online provision of these services. Despite their track record of safety and effectiveness, GOP senators are pushing the FDA to ban mifepristone. The Trump administration even called on the Supreme Court to reinstate the FDA’s requirement for personalized dispensing of the drug, something that reproductive health advocates say should be waived during the pandemic.
The new Biden administration can and should expand access to reproductive telemedicine. During the pandemic and in its aftermath, we have a duty to meet reproductive health needs and respect reproductive rights. Without effective access to reproductive services, we cannot exercise these rights. It will take time to rebuild the physical capacity of reproductive health clinics, which was lost in the Trump years. In the meantime, telemedicine could enable Americans to exercise their rights online.
Vina Smith-Ramakrishnan is a Werner Fornos Fellow of the Population Institute, a Washington, D.C. based non-profit organization dedicated to reproductive health and rights.
The views expressed in this article are the author’s own.