These are unprecedented times. The amazing and courageous primary care clinicians we work with are on the front lines, often in very difficult positions, but they are still working to ensure that patients have access to reproductive health care. Because of the current crisis, primary care settings are trying to figure out how best to provide people with reproductive health care in ways that minimize possible exposure to the virus.
In order to support their work, RHAP has created a new section on our website with a collection of COVID-19 Reproductive Health Care Resources. On this page, you’ll find newly created or adapted resources to support clinicians to provide reproductive health care via telehealth. We’ve also included guidance and resources from our partners and allies that will help inform clinicians of evolving practices and suggestions for continuing reproductive health services during this time. If you have a resource or would like to see a resource created to support the work you are doing to provide remote reproductive health care via telehealth, please reach out to our Program Manager, Jordan@reproductiveaccess.org.
Mifepristone with misoprostol is the safest, most effective way to manage abortion and early pregnancy loss (EPL) with medications. However, regulations on mifepristone make it difficult for primary care clinicians to provide this basic, evidence-based care. Currently, the US Food and Drug Administration regulates mifepristone under a Risk Evaluation and Mitigation Strategy (REMS), which means it’s classified as a “dangerous drug” – despite its history of safe and effective use. It prevents clinicians from prescribing mifepristone, but rather requires them to stock and dispense the pill directly to patients in-office.
Last fall, we surveyed primary care clinicians around the US to tell us about their experiences and stories trying to provide mifepristone, and the effects on their patients.
Here’s what we learned:
- Primary care clinicians want to provide medication abortion and/or EPL care in their primary care practices, but 63.2% did not have mifepristone available in their clinics.
- If mifepristone could be prescribed like other medications, 77.6% and 91.7% of respondents would prescribe it for medication abortion and EPL management, respectively. This could potentially increase the availability of medication abortion and EPL care providers.
- Clinicians across the country commonly shared two main REMS-related obstacles to providing mifepristone: navigating the many logistics and “bureaucratic hurdles” involved in fulfilling REMS requirements and resistance from their organizations’ administrative leaders to stock the medicine.
When mifepristone is inaccessible in primary care, patients are harmed. Their continuity of care is disrupted, they experience unnecessary and invasive procedures, they must manage multiple appointments and delays in care, and they receive less effective EPL care.
“Patients have come to me wanting medical management of miscarriage or a medical abortion, and I have had to turn them away and send them to other practices…stigmatizing their experience and sending the message that their management of their pregnancy and fertility is not part of primary care – which is outrageous.”
Today, this pandemic is exacerbating these challenges in accessing abortion and EPL care. The REMS rules require patients to come in-person to health care facilities to obtain mifepristone – sometimes multiple times over the course of several days – putting themselves and their families at increased risk of exposure. It has never been more clear that mifepristone must be available by prescription for medication abortion and EPL care. Stay tuned for a full publication on our research this year.
The COVID-19 pandemic is highlighting inequities that have long existed in our country’s health care system.
Many states and the federal government have laws and policies that create barriers to accessing reproductive health care, especially abortion care. Denying health care coverage for abortion, banning telemedicine for abortion, preventing prescription access to medication abortion, mandated ultrasounds, forced waiting periods, and parental consent laws are just a few examples of the medically unnecessary restrictions placed on abortion care. Due to the ongoing pandemic, many states are now placing bans on “non-essential” health care procedures in order to prioritize combatting the pandemic. Anti-abortion politicians and organizations are capitalizing on this moment of crisis to further restrict access to abortion by deeming abortion services to be “non-essential,” effectively attempting to shut down abortion access in their states entirely.
The primary care clinicians that we work with are feeling the impact of the pandemic acutely. They are on the front lines caring for sick patients, often dealing with shortages of proper Personal Protective Equipment. Many primary care clinics in areas struggling to manage the pandemic are asking healthy patients seeking birth control and other reproductive health care services not to come in and to access services via the phone or internet. Yet, current laws and policies prevent these very services from being provided virtually.
Now more than ever, it is important that we stay true to our mission and values. Evidence-based, patient-centered reproductive health care must be accessible to everyone, in a way that takes into account the reality of people’s lives in this moment. We need, in this time of crisis, to prioritize:
- Over the counter access to contraception
- Prescription access to medication abortion
- Access to telemedicine for all reproductive health care, including abortion
- Legal protections for people who self-manage abortions
- Insurance coverage of all services, including abortion care
RHAP is committed to working to ensure that reproductive health care, including abortion care, is protected in this time of crisis and beyond.
Last month, the Supreme Court heard June Medical v. Russo, a case challenging Louisiana’s admitting privileges law. However, this is not the only reproductive rights case that SCOTUS will be hearing this year. In Pennsylvania v. Trump and Little Sisters v. Pennsylvania (these cases have been consolidated), the Court will hear a case that will determine whether employers and schools can deny insurance coverage of birth control to employees and students on religious grounds.
Thanks to the Affordable Care Act of 2010’s birth control benefit, employers and universities were mandated to offer birth control coverage for their employees and students. In 2018, the Trump administration finalized rules that undermine the ACA’s birth control benefit, effectively allowing for institutions to discriminate under the guise of religious objection. These rules were challenged in courts across the country, and a case brought forth by Pennsylvania and New Jersey prompted the 3rd Circuit Court of Appeals to issue a nationwide injunction blocking these rules.
We know that the outcome of this case will critically impact access to birth control for millions of people across the country, especially people who already have less access to comprehensive, affordable reproductive health care services. It would also set a very dangerous precedent for allowing religion to be used as a means to discriminate and take away rights from certain populations. The Reproductive Health Access Project has signed onto an amicus brief urging SCOTUS to strike down these rules. While this case was originally scheduled to be heard in late April, the Court has decided to postpone oral arguments this month due to the COVID-19 pandemic. Sometime in the first two weeks of May, they will be heard by telephone conference. We will keep our supporters updated as the time comes.
Building and fostering spaces for community is the core of RHAP’s organizing. Right now, during this time of social distancing, our largest platform for organizing is on social media. Beyond a lone tweet or hashtag, social media platforms have enabled us to amplify calls to action, further connect with primary care clinicians and allied organizations, debunk myths around reproductive health care and abortion, highlight the tireless work of our clinicians, share clinical resources, and shape the narrative to demonstrate how reproductive health and primary care are linked and need to be connected even more during this crisis. You can help us with this!
We believe everyone should be able to receive reproductive health care—including abortion, contraception, and miscarriage care—safely, easily, affordably, with dignity, and without judgment. We believe full-spectrum, patient-centered care belongs in primary care. We believe abortion access should never be a bargaining chip in political games. We believe in evidence-based care, not junk science. Narratives are power and we are committed to uplifting content and resources that reflect our values as an organization dedicated to making reproductive health care accessible to everyone. Join us and play an important role in building our movement.
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