State responses to the novel coronavirus in early 2020 – limiting medical access to those patients requiring “essential services” – had the effect of reducing visits to abortion clinics, likely resulting in fewer abortions being performed during that time frame, according to a study by a team led by University of Kansas researchers (KU Press Release 11/9/20). *
Visits to clinics fell 32% in 2020 across the board, we’re told. They fell an additional 23% in states that specifically enacted a ban on elective procedures during the pandemic.
The abortion industry and its political allies have tried to argue that abortion is an essential service, that abortion is such a critical health need, in such demand, that medical personnel, equipment, and equipment that is used during the performance of an abortion cannot be spared to try to save lives during the pandemic.
The data in this study appears to show that this is not the case. When these services are not pushed or not readily available, many women will choose to carry and bear their babies, making clear that women do not consider abortion to be an “essential medical service.’
Background: Clinic Closures and COVID–19
It may seem like ages ago, but if one remembers back during the start of the pandemic, there was a great concern that coronavirus cases could overwhelm the medical system. This led experts to argue that medical personnel and equipment ought to be reserved and deployed only where there was clear medical necessity. This reduced medical traffic across the board, leading many people to forego or delay scheduled surgeries or treatments.
The policies affected abortion, as it did other procedures, as part of the general reduced utilization of medical services that were not Covid-19-related. But some states went further, specifying that abortion was generally an elective procedure that did not qualify as an “essential medical service.”
When and where those qualifications were in effect (they were challenged in the courts), the industry maintained they had the potential to effectively shut down provision of abortion services.
It wasn’t clear how anxious staff were to reopen during the height of the pandemic. Several Planned Parenthood clinics temporarily closed on their own, while others operated on a limited basis. They would tell patients to reschedule “non-essential appointments” or use telemedicine, sometimes referring their abortion patients elsewhere.
Even so, their management and leaders of their movement were livid, arguing that abortion was still an “essential medical service.” They further contended that delaying these abortions would make them more expensive, more dangerous, or might even result in some women foregoing abortion altogether and giving birth to their children (!).
As noted, they went to court to challenge governors whose orders effectively closed their clinics. Allies in sympathetic statehouses agreed that abortion was an essential service, officially allowing abortion clinics (those that wanted to) to stay open in those states, while they were closed in others.
The abortion industry went further. They exploited fears about the pandemic to argue that protections surrounding chemical (or “medication”) abortions must be relaxed. Specifically, they said women should be allowed to skip visits to the clinic and simply do screening, instruction, and checkups by telemedicine and have the pills sent to them by mail, a long-sought goal.
Study finds reduced visits
Most people sensed that medical visits not related to COVID were down. People avoided settings where they might be exposed and sought to relax the burden on overtaxed healthcare workers. However, this study is the first one known to have demonstrated the connection to abortion clinics.
To ascertain the nature and depth of this decline, University of Kansas researchers obtained anonymous cell phone location information for the period February to May of 2020 and compared it to phone location data from a similar period in 2019. They specifically looked for occasions where that cellphone was identified as being at the same site as a known abortion clinic address. (No particular individual was identified by the cell phone location data taken from over 18 million cellular devices.)
The data told researchers nothing about the particular services the cell phone user accessed at the clinic. There was no information on visits by those without cell phones.
But unless there was a sudden unexplained drop in cell phone usage and ownership by those visiting abortion clinics from one year to the next, or an odd surge or trough {?} in clinic visits among those without cell phones, the data should give a fairly accurate sense of the difference in abortion clinic traffic between those four months in 2019 and the same four months in 2020.
Researchers got abortion clinic addresses from Planned Parenthood, NARAL, and Abortion Clinics on-line. Wherever there were several businesses either at or so near the same address as the clinic that the intent of the phone user was indeterminable, that data was excluded. In the end, this left researchers with data on visits to 317 abortion clinics in 42 states and the District of Columbia.
When comparing data from the two years, they found there was a clear drop in traffic to these sites from 2019 to 2020. Overall, there was a 32% drop in foot traffic at identified abortion clinics by cell phone users who had their location data turned on from 2019 to 2020 in all the states that the study measured, whether there were official restrictions on elective procedures or not.
In those states where there were those official restrictions–where governors told citizens not dealing with COVID or some medical necessity not to tie up healthcare workers or hospital facilities with non-essential care–there was an additional 23% decline in abortion clinic traffic by those cell phone users.
The drop in abortion clinic traffic was substantial where elective procedures in general were banned. However, there was no measurable additional difference when a state specified that abortion was one of those banned, non-essential, elective medical services. We’ll explain why momentarily.
For the country as a whole, what this means in practical terms, is that for every 100 such women visiting an abortion clinic in the U.S. in 2019, there were only 68 doing so during a similar time frame in 2020 when the pandemic first began raging.
But in states where governors banned elective procedures in general, for every 100 women visiting abortion clinics in 2019, there were just 45 in 2020.
Of course, the location data of an anonymous cell phone does not tell us what service that a woman sought (many of those clinics offer birth control, pap smears, STD testing in addition to abortion); what their reason was for visiting (in theory, it could have been a person delivering office supplies), or even the sex of the person visiting. But it would include any women with cell phones visiting the clinic for abortion in either year.
Authors of the study felt comfortable speculating on the impact of the decline in visits on the annual incidence of abortion in the U.S. Previous trends reported by the Guttmacher Institute led researchers to expect a decrease of 1.3% in abortions each year since 2017, when Guttmacher reported 862,370 abortions.
If those trends remained constant–and there was no virus–the study authors expected that about 829,000 abortions would eventually have been recorded for 2020.
Considering just the dip in abortion clinic traffic their study found earlier this year and extrapolating from just those first four months of the pandemic, they would revise that estimate down to 750,000 abortions for 2020, an enormous drop from the most recent official number.
Even if the authors may be overly optimistic about abortion trends in general and their estimates may depend too heavily on the endurance of a temporary downturn, some real and significant drop does appear likely from the data they have gathered.
Remaining questions
There are limitations with any data set. For example, we can’t know for sure that women did not simply delay their abortions or turn to chemical self abortions with pills bought on-line.
However, it appears unlikely that women simply waited and came back to the clinics weeks later. Charts included in the study show an obvious drop in clinic traffic occurring about the time the bans on elective procedures went into effect and then some increase as the restrictions eased, but not to levels seen before the pandemic.
Whether traffic picked up once the study was completed is something we won’t know until there is additional data. There certainly wasn’t a sudden spike in women visiting the clinics to make up for visits missed during the time of restrictions.
However, all of this did give abortion clinics the opportunity to promote chemical abortions with pills, particularly in states where Gynuity was “testing” its TelAbortion program, shipping mifepristone and misoprostol directly to the customer after a video consultation.
All but one (Hawaii) of the thirteen states *participating in Gynuity’s “trials” had clinics being tracked in the University of Kansas study.
Those clinics would have been able to facilitate chemical abortions to patients in those states without the patients (and their cell phones) ever having to visit the clinics. Since the study did not measure abortions, but only patient traffic, those patients would have been missed by the study.
The researchers mention the at-home chemical abortion protocol but do not appear to account for it in their analysis.
It is worth noting that, in the middle of the pandemic during the period covered by this study, 21 state Attorneys General sent a letter to the FDA on March 30, 2020, asking the agency to relax its restrictions on the prescription of chemical abortions so that women could get the pills without visiting the clinic.
Though the FDA did not accede to that request, the Gynuity “trials” continued. On July 13, 2020, a federal judge in Maryland issued an order directing the FDA to suspend its rule requiring in person visits during the pandemic. The FDA appealed the ruling and a final resolution awaits, but the abortion industry’s long-term plan has been exposed: at-home abortions.
Conclusion
It is hard to ascertain what the ultimate, long term impact of this pandemic will be on abortion demand in the United States. It seems clear, however, that utilization of abortion, like that of non-corona medical care in general, was reduced during the height of the pandemic, and that it may drop again as COVID resurges.
As noted above, some women may have waited and gotten abortions later while some may have turned to chemical abortions via on-line pills and virtual consultations. However, the numbers seem to indicate that many women, whether choosing to stay home to avoid the virus or just deciding that medical personnel were more needed elsewhere, likely came to terms with their pregnancy and decided to carry and birth their babies. In a season of fear and death, those were the fortunate ones.
The finding of the study–that abortion-specific inclusions to the elective procedure bans did not appear to have further reduced numbers–may not necessarily be so much an indication that these were ineffective .
Rather, it may be a sign that pregnant women already saw abortion as an elective procedure, not a necessity, and one that they and their unborn children could well live without.
*Martin Andersen, Sylvia Bryan, David Slusky, IZA Discussion Paper No. 13832, “COVID-19 Surgical Abortion Restriction Did Not Reduce Visits to Abortion Clinics” IZA Insitute of Labor Economics, October 2020. Martin Andersen is from the University of North Carolina at Greensboro, while Sylvia Bryan and David Slusky are from the University of Kansas. Paper available at https://covid-19.iza.org/publications/dp13832/ .
* The states currently listed as participating in Gynuity’s trial are Colorado, Georgia, Hawaii, Illinois, Iowa, Maine, Maryland, Minnesota, Montana, New Mexico, New York, Oregon, Washington state, and the District of Columbia.
Chelsea Garcia is a political writer with a special interest in international relations and social issues. Events surrounding the war in Ukraine and the war in Israel are a major focus for political journalists. But as a former local reporter, she is also interested in national politics.
Chelsea Garcia studied media, communication and political science in Texas, USA, and learned the journalistic trade during an internship at a daily newspaper. In addition to her political writing, she is pursuing a master's degree in multimedia and writing at Texas.
