Coronavirus Created an Obstacle Course for Safe Abortions

BRUSSELS — When a 19-year-old woman from southern Poland decided to end her pregnancy at 18 weeks, she knew the only way to get an abortion was to rush to a neighboring European country.

Abortion is illegal in most circumstances in Poland, and so for years, many women have traveled within Europe to seek the procedure.

But it was April, and across the continent, borders were closing fast because of the coronavirus pandemic. So she and a friend loaded up their Renault with instant noodles and candy for a 14-hour race to Utrecht, in the Netherlands. They made it just in time for her to have the procedure and return home, her friend said.

From the world’s richest nations to some of its poorest, the pandemic has unleashed suffering, bringing governments and health care systems to their knees. For many women in Europe seeking abortions, the virus added another obstacle in an already complicated and time-sensitive course.

Closing borders made it harder for women in countries with strict abortion regulations, like Poland, to seek the procedure elsewhere.

And governments in Germany, Austria, Romania, Croatia and Slovakia, trying to tackle the health care demands of the pandemic, did not label abortions as essential, time-sensitive procedures.

Under normal circumstances women in these countries can get an abortion during the first half of a pregnancy. But not including abortions on the essential procedures list meant that hospitals and clinics were free to turn women away. And some did although they have now reopened or will this month.

But for a time, the continent had “a combination of factors coinciding: Hospital care is restricted, doctors are shutting down services, states are not classifying abortions as an essential service,” said Leah Hoctor, the Europe director of the Center for Reproductive Rights, an advocacy group

She added that governments failed to understand that women who need an abortion need to have it in a timely manner.

The pandemic also unexpectedly cracked open a window in a small number of places in Europe.

France, Ireland and England, Scotland and Wales in Britain, all loosened restrictions and permitted at-home abortions with medication administered by prescription and the guidance of a medical professional over the phone or online.

Before the pandemic, medical abortions in these countries were permitted only after an in-person consultation with a doctor, and the medication had to be taken in a clinic, not at home.

Authorities in Britain said allowing at-home medical abortions with remote guidance was a temporary measure. But Ms. Hoctor said she hoped the countries that permitted the procedure would not go back to restricting it.

At-home abortions “represent women-centered, evidence-based policy changes,” Ms. Hoctor said. “The fact that these laws and policies were changed quickly in order to respond to the pandemic demonstrates that it is possible to modernize European countries’ abortion laws.”

From the outset of the coronavirus outbreak, advocacy groups and the United Nations warned that women’s access to reproductive services could be imperiled.

In April, the U.N.’s sexual and reproductive health agency estimated that there could be seven million unintended pregnancies around the world — potentially increasing the demand for abortions — if lockdowns continued for six months and there were disruptions to reproductive services.

“As a corollary, unsafe abortions will increase,” Natalia Kanem, executive director of the agency, said in April.

Earlier this month, the World Health Organization reiterated the need for governments to maintain access to safe reproductive services.

“Even a 10 percent reduction in these services could result in an estimated 15 million unintended pregnancies, 3.3 million unsafe abortions and 29,000 additional maternal deaths during the next 12 months,” the organization stated in a recent report.

Ms. Hoctor said that as the coronavirus swept Europe, demand for abortions rose. Although hard numbers are scarce, there are anecdotal reports that more women were worried about raising a family in the midst of the economic destruction caused by the measures to combat the virus.

In many European Union countries, abortions are legal and relatively accessible. Still, restrictions exist in some parts of the region, so women have historically used the continent’s open borders to choose providers and legal frameworks that suit them most, a largely unseen byproduct of mobility within Europe.

Advocacy groups and doctors say it’s impossible to know how many women have been affected by closing borders, given that records of abortions and who has them are not public.

Germany offers a case study on how the virus affected abortion services in Europe.

In a policy decision that was replicated in many parts of Europe, the German federal government did not list abortions — which are legal in the country — as essential medical services during the pandemic.

Instead it was up to state health authorities and individual providers to determine how to handle requests, and, according to the German Hospital Federation, “depended on whether clinics were extremely involved in corona care.”

In at least four German states, a few clinics and hospitals stopped offering abortions for some time — saying that in some cases they were focusing exclusively on virus cases, and in others because they shut down entirely.

In Niederbayern, a district in the state of Bavaria, the only doctor who performed abortions was older than 70, and in an at-risk category himself. He stopped going to work, making access to the service harder in the already underserved rural area.

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In Munich, 8 of the 20 abortion providers in the city suspended their services during the lockdown, and larger providers had to pick up the slack.

In Merseburg, in Germany’s Saxony-Anhalt state, abortions were suspended as of March 16 in at least one hospital, which said its aim was to minimize new Covid-19 infections and to prepare personnel and other resources for the pandemic. Services are set to resume on Monday.

Kristina Hänel, a doctor and an activist in Hesse, said that although individual women had problems, “overall the system did not break down.”

“We had to make politicians aware of some of the hurdles,” she added.

One hurdle for each woman was getting a certificate saying she had seen a consultant to discuss her decision, as German law requires.

These consultations — which German activists consider an obstacle to abortions — have been made available online or by phone because of the pandemic.

Another obstacle was that, before getting an abortion, a woman needed to physically visit her insurance company to get a voucher to cover the costs. That was impossible during the lockdown as insurance offices were shut.

Finally, the authorities figured out a way for women to get this voucher through the mail.

But, Ms. Hoctor said, both those solutions posed problems for girls and women trying to keep their pregnancies private, for example, teenagers living with their parents, or those sharing a living space with someone during the lockdown.

In Europe, the pandemic’s interruption of abortion procedures seemed largely the byproduct of a hurried and frantic response to a public-health crisis. Across the Atlantic, where the debate over abortion is more highly politicized, disruptions to services were more deliberate.

Anti-abortion governors in Oklahoma, Texas, Ohio, Iowa and Alabama listed abortions as “nonessential” procedures, arguing that performing them would threaten supplies of medical resources and protective equipment in the midst of the pandemic.

The medical community pushed back, setting off a flurry of lawsuits to keep services running.

But some women ended up racing across state lines to avoid the new limitations. One traveled from Arkansas to Oklahoma to Kansas before she could terminate her pregnancy.

“I firmly believe that this is a coordinated movement among the anti-abortion folks,” said Julie Burkhart, founder and chief executive of Trust Women, which operates a clinic in Oklahoma City and another in Wichita, Kan. She noted that even before the pandemic, states that deemed abortion nonessential were debating legislation to curb access.

Her clinics, she said, saw a surge in the number of women seeking abortions, many of them coming in from other states. “We saw, in one week, over 250 patients,” she said, compared with the usual number of 40 patients per week per clinic.

Dr. Kanem, of the U.N. agency, said the problems in the United States arose because of the polarized debate over abortion, while in Europe they were caused by governments’ failure to make women’s health needs a priority. Each cause, she said, “leads to terrible outcomes.”

She added, “Women and girls should not be shoved to the end of the line.”

Matina Stevis-Gridneff and Monika Pronczuk reported from Brussels, and Alisha Haridasani Gupta from New York. Christopher Schuetze contributed reporting from Berlin.

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