How One Local Abortion Clinic Weathered COVID-19 and Why It Matters

by Megan Burbank

As businesses closed, travel was canceled, and Washingtonians stayed home under Gov. Jay Inslee's "Stay Home, Stay Healthy" order early 2020, Cedar River Clinics, the independently operated network of abortion clinics in Renton, Seattle, and Tacoma were experiencing a boom.

"We had patients traveling to us," said Mercedes Sanchez, director of Development, Communications, and Community Education and Outreach for the clinics. "People were willing to travel to an epicenter of the pandemic to get care."

It's not unusual for patients to cross state lines for abortions. Just last month, patients from Texas began traveling to the Northwest for care in the wake of SB 8. The law bans all abortion procedures in Texas before most people know they're pregnant and deputizes private citizens to sue anyone seeking or facilitating abortion care.

Even before SB 8, Washington was a sanctuary state for patients living in abortion-hostile areas. But as abortion restrictions grow across the country, Washington is likely to become even more of an outlier — and to be burdened with providing care other states won't.

Traveling for care is costly, and carries additional risk in a pandemic. But ironically, the way some local governments chose to handle COVID-19 made these trips necessary: As states enacted shelter-in-place and stay-home orders, they included provisions about what types of health care qualified as essential, and guidance around abortion became politicized, with states like Alaska, Iowa, and Texas grouping it among treatments to be delayed or canceled, despite the fact that abortions, by their very nature, are time-sensitive procedures.

This wasn't the case in Washington, where Gov. Inslee's proclamation limiting nonurgent medical procedures included an exemption for "the full suite of family planning services and procedures," allowing abortion providers to continue operating under the stay-home order. According to the Guttmacher Institute, executive orders in 12 other states also specified that abortion procedures could continue.

But Alaska's public health guidance instructed providers to delay abortions "unless the life or physical health of the mother is endangered by continuation of the pregnancy during the period of postponement." And it was among 11 states that used the administrative flexibility brought on by the pandemic to disrupt access to care.

These limitations have since been lifted or blocked by court orders, but while they were in effect, Sanchez said patients who had lost access to abortion care in their home states turned to clinics in states like Washington, even if that meant traveling to the site of a COVID-19 outbreak when public health guidance encouraged doing the opposite.

This wasn't the only impact the pandemic had on patients seeking abortion care. The Northwest Abortion Access Fund (NWAAF), which helps people pay for abortions throughout the Pacific Northwest, began collecting data on the calls they got during COVID-19. More than 67% of the callers NWAAF heard from reported that they had been impacted in some way by the pandemic.

NWAAF board member Dusty Ginner said she'd spoken to callers who reported that they or a partner had lost a job or health insurance benefits due to COVID. "It is very clear that COVID really impacted our callers' ability to receive care," she said.

At Cedar River, Sanchez agreed. "An unplanned pregnancy during a pandemic is extremely difficult," she said. During the pandemic, the clinics had heard from patients who already had abortions scheduled, asking if any cancellations meant they could expedite their procedures. "There was a greater sense of urgency," she said.

This was also true for the clinics themselves, which faced significant financial challenges even before the pandemic hit. Cedar River was one of many family planning sites impacted by the Trump administration's domestic gag rule, which blocks Title X family planning funding from clinics that provide abortion care or referrals.

The Biden administration is currently working to restore the funding gutted under the gag rule, but it's already had a major impact on family planning providers. "We actually lost over 50% of our family planning funding," said Sanchez.

Despite the compounded threats of financial challenges and the COVID-19 outbreak, Cedar River never closed entirely. Instead, they cut down in-person appointments during the pandemic and operated with fewer people in the clinic. They also expedited a planned launch of a telemedicine service and offered medication abortion remotely.

Due to a new FDA policy, abortion providers now have expanded capacity to prescribe medication abortion — abortion induced by two medicines, mifepristone and misoprostol, rather than surgery. Doctors can send the drugs to patients directly through the mail, a possibility previously limited by a strict regulation on mifepristone.

Cedar River Clinics took advantage of this new opportunity and responded to challenges rural community members were having accessing abortion care by transforming a shuttered clinic in Yakima into a telemedicine satellite site. There, patients could have telemedicine consultations with Cedar River's doctors in Renton and, when appropriate, receive direct mail prescriptions for medication abortion.

It's unclear how long that option will be available, but the need isn't likely to wane. The Supreme Court has now twice allowed the Texas law to proceed and will soon take up a challenge to Mississippi's 15-week abortion ban. Meanwhile, several states are already planning to replicate Texas' controversial six-week ban, making access to abortion increasingly precarious.

Sanchez is used to hearing horror stories from her colleagues in abortion-hostile states. "We feel very lucky to live in a more progressive state that supports reproductive rights," she said, "but there are still challenges."

Editor's Note: This article has undergone minor post-publication edits for clarity.

Featured Image: Photo by Gayatri Malhotra on Unsplash.