The Fight to Protect Abortion Access Amid the Pandemic

As the public health crisis continues, providers confront anti-abortion protesters and politicians exploiting the outbreak to undermine reproductive health.

Mandatory Credit: Photo by Rogelio V Solis/AP/Shutterstock (10593690c)David Lane, right, an anti-abortion activist pleads with a driver and the patient to drive away and hold off having an abortion, to women as they are directed by clinic escort Scotta Brady to the parking lot of the Women's Health Organization clinic, in Jackson, Miss. The clinic is Mississippi's only state licensed abortion facility. Gov. Tate Reeves told reporters at a press conference on the coronavirus Tuesday that he considers abortion an elective and unnecessary procedureVirus Outbreak Mississippi, Jackson, United States - 25 Mar 2020
Clinic escort Scotta Brady, left, directs a patient to the parking lot of the Jackson Women’s Health Organization in Mississippi on March 25, 2020, while David Lane, right, an anti-abortion activist, protests. Photo: Rogelio V Solis/AP/Shutterstock

It wasn’t much past 8 a.m. on a Saturday morning in late April, and anti-choice protesters outside the Jackson Women’s Health Organization, the only abortion clinic in Mississippi, were already cantankerous: There were three men with bullhorns, including one on top of a ladder; a 1,200-watt speaker pointing toward the clinic’s front door; and another protester blowing a shofar. “Welcome to the circus,” said Kim Gibson, a clinic escort who works to keep the mayhem away from patients.

Even as the coronavirus pandemic has gripped the nation (new cases are still on the rise in Mississippi), protesters disregarded Jackson’s stay-at-home order and have consistently failed to wear masks or keep appropriate social distance — not only from one another, but also from patients, whose cars they readily approach in an effort to “counsel” them and hand out anti-abortion propaganda.

In the best of times, the scene outside the Jackson clinic is chaotic. Protesters regularly crowd the fence line of the Pink House, as it is known because of its vibrant pink façade. During the Covid-19 crisis, the activity has amped up. On a single day in late March, nearly 100 protesters descended on the clinic. A majority of the protesters don’t live in Jackson, and some have even traveled from out of state, including a family with eight kids who drove from North Carolina. “Abortion tourism,” Gibson calls it.

On May 1, two weeks before Jackson’s stay-at-home order expired and just before Gov. Tate Reeves officially announced the state would reopen restaurants and parks, armed protesters — including many who regularly protest at the Pink House — rallied at the Capitol in support of their right to assemble without face masks or social distancing. They’ve brought that same stridency, albeit without the firearms, to the Pink House.

Protesters have deliberately tried to bump into people outside the clinic and have refused to move from the sidewalk to allow escorts and patients to pass by. The cops have been called, but even when the city’s lockdown was in full effect, they did nothing to abate the madness. That’s not unusual in Jackson, where the police routinely fail to enforce city ordinances that should constrain the protesters’ activities. In April, while responding to Gibson’s call about a protester chasing the escorts and shoving his Bible in their faces, one officer told her that at the clinic, “we’re an island on our own,” she said. “I mean, literally, he said it.”

Gibson and Derenda Hancock, both veteran clinic escorts with a group known as the Pinkhouse Defenders, say the protesters have been buoyed by hope that the outbreak would close the clinic. “Since this has started, they are more aggressive because they think they have their teeth in something that will get it closed down,” Gibson said. “They’re just railing on the fact that it’s still open.”

Anti-abortion politicians across a large swath of the country seized on the public health crisis in order to push for clinic closures, while simultaneously backing less stringent restrictions on things like religious gatherings and gun shop operations. And both politicians and activists have cheered the protesters, decrying the rare instances in which they’ve been arrested for defying crisis-related health orders. After one such incident in Charlotte, North Carolina, Sen. Ted Cruz took to Twitter, writing, “NC Dem Gov has wrongly deemed elective abortion ‘essential,’ allowing abortion drs & staff to gather in larger groups. IF providing abortions is essential, then peacefully giving pregnant women counseling on alternatives to abortion is ALSO ‘essential.’”

The ongoing politicization of abortion amid the outbreak has emboldened protesters, created whiplash for patients and providers, and again highlighted the sensitive nature of a reproductive health care system operating under burdensome, and unnecessary, regulations.

It has also drawn into stark relief the hypocrisy of protesters who would defy health and safety measures in an effort to chastise women seeking health care. As the writer Danielle Campoamor posted on social media in mid-April, “The Venn diagram of people protesting shelter in place orders because they don’t like ‘the government telling them what to do’ and people who think the government should tell pregnant people who want abortions what to do with their bodies is one giant fucking circle.”

A pro-life activist and a volunteer who escorts patients into the Jackson Women's Health Organization, the last abortion clinic in Mississippi, waits for patients to arrive April 5, 2018 in Jackson, Mississippi. - Women have been able to legally seek an abortion throughout the United States since 1973's landmark Supreme Court decision Roe v. Wade. But the right to reproductive choice remain tenuous as debate over the issue continues to rage, especially in conservative states like Mississippi which have introduced myriad measures restricting access to services -- creating for many women an effective ban. Mississippi is among seven US states with just one place where women can seek an abortion. (Photo by Brendan Smialowski / AFP) / With AFP Story by Eleonore SENS: Facing legal threats, Mississippi's last abortion clinic stands defiant        (Photo credit should read BRENDAN SMIALOWSKI/AFP via Getty Images)

A anti-abortion activist and a clinic escort wait for patients to arrive at the Jackson Women’s Health Organization, the only abortion clinic in Mississippi, on April 5, 2018.

Photo: Brendan Smialowski/AFP via Getty Images

Thrown Into Chaos

In addition to dealing with protesters, Gibson and Hancock have also helped the clinic manage strict new protocols designed to keep staff and patients safe. They’ve devised a whiteboard and number-card system to control the flow of traffic in and out of the parking lot and the clinic. People wait in their cars for their number to be called, and only patients are allowed inside. “We’re the ones who are really having to balance how many people are in the clinic at a time,” said Hancock. “We’re spacing everything.”

This is the way abortion services have been managed in clinics across the country, which adopted Centers for Disease Control and Prevention guidance in the earliest days of the pandemic. Routine gynecological exams were postponed while other appointments were pushed to telemedicine. Scheduling for abortion patients was retooled to maximize social distancing. “It is essential health care,” Julie Burkhart, president and CEO of Trust Women, which operates clinics in Kansas and Oklahoma, told me back in late March. “They need it immediately; they need it as soon as they can get in for an appointment. Pregnancy does not stop in the time of a disaster or this pandemic that we’re moving through.”

“The governor and attorney general’s ban put Texas patients in heart-breaking situations — it was politics at its worst.”

That view has not been accepted by elected officials in a number of states, some of whom were urged early on by anti-choice advocates to deem abortion nonessential. Nowhere was that message more warmly received than in Texas, where Attorney General Ken Paxton threatened providers with jail time if they did not heed an executive order to curtail nonessential medical procedures. While the order made clear that whether a procedure was essential should be determined by medical professionals, Paxton mounted an aggressive legal crusade to close clinics, arguing to the federal courts that the state’s police powers were vast amid a pandemic and that everyone had to make sacrifices and fall in line.

But that was a ruse. Gov. Greg Abbott said his pandemic order meant clinics must close, but he encouraged religious congregations to gather and labeled gun shops “essential” businesses. And Paxton, while chest-thumping about the state’s broad police powers, wrote a letter to officials in Gunnison County, Colorado, saying that their order barring nonresidents during the pandemic would deprive Texans of access to their vacation homes. “The banishment of nonresident Texas homeowners is entirely unconstitutional and unacceptable,” he said. As it turns out, Paxton’s protestation would benefit a contingent of nine political supporters who own property in Colorado and together have contributed nearly $2 million in campaign donations to Paxton and his wife, Angela, who is a state senator.

Still, Paxton’s pronouncement in late March sent Texas’s reproductive health care system into chaos. Hundreds of appointments had to be canceled as thousands of calls flooded the state’s clinics. Over a three-day period, Planned Parenthood of Greater Texas, which has clinics in Austin, Dallas, and Fort Worth, had to cancel 261 appointments and fielded nearly 600 calls from patients looking for services. “Patients were scared and frantic for options,” Sarah Wheat, the organization’s chief external affairs officer, wrote in an email. “Some patients traveled out of state, which put them in jeopardy during the ‘shelter in place’ orders. Others didn’t have this option due to financial, child care, transportation, time off work, documentation status, and other barriers. The governor and attorney general’s ban put Texas patients in heart-breaking situations — it was politics at its worst.”

A similar scene played out in states across a large section of the country: Ohio, Oklahoma, Iowa, Arkansas, Alabama, Tennessee, Louisiana, West Virginia, and Mississippi all took a shot at shutting down abortion clinics amid the pandemic. In nine states, including Texas, those efforts ended in legal action, with providers suing in state or federal court to stop the closures. (Although Mississippi Gov. Tate Reeves said the Pink House should close, state officials ultimately did not force the issue.)

“All the plans I had to get back to work, my hopes for my kids’ lives, I felt like it was all about to go down the drain.”

In all but two states, those legal challenges ultimately kept clinics open, though not without a significant amount of whiplash, which has resonated across the country’s beleaguered reproductive health care system. In Texas, each time Paxton lost his case in district court, he ran to the notoriously conservative 5th U.S. Circuit Court of Appeals for immediate (and unprecedented) intervention. As a result, the ban was repeatedly lifted and then enforced until the governor’s executive order on nonessential medical care was eased. Arkansas was also successful in shutting down all procedural abortion care — even for those women who would be past the state’s 20-week gestational limit by the time the order was lifted — thanks to a favorable ruling by the 8th Circuit.

Shuttering operations in a number of states, even if only briefly, sent women scrambling in search of care. Although Paxton and other public officials claimed that shutting down clinics was an effort to contain the spread of the virus, their actions forced many women to travel long distances, often across state lines. “I completely panicked,” one woman from Tennessee told the American Civil Liberties Union after finding out that she was 14 weeks pregnant and Gov. Bill Lee was shuttering abortion services. She’s a single mother of three kids under two. She’d had her tubes tied last year precisely because she didn’t want to have another child, but she got pregnant anyway. The woman was faced with having to drive to Atlanta for care — which would be nearly impossible with three kids in tow. What if they were exposed to the virus? Who would watch them during the procedure? “All the plans I had to get back to work, my hopes for my kids’ lives, I felt like it was all about to go down the drain,” she said. “I am a strong woman who has overcome a lot of adversity in my life, but this was too much.”

Kathaleen Pittman, the administrator of the Hope Medical Group for Women in Shreveport, La., poses for a portrait in the clinic’s recovery room on Feb. 20, 2020. The clinic is one of three in the state that provides abortions to women, and it is challenging a state law that requires doctors who perform abortions to have admitting privileges at a nearby hospital. The Supreme Court is hearing the case on March 4. (CREDIT: Rebecca Santana)

Julie Burkhart, president and CEO of Trust Women, is pictured during an interview at the Oklahoma state Capitol on April 10, 2017.

Photo: Sue Ogrocki/AP

“It Just Feels Unrelenting”

In late March, Hancock and Gibson started seeing more out-of-state tags at the Pink House in Mississippi; in Oklahoma, Burkhart, who operates the Trust Women clinic, was struggling to accommodate as many people as possible amid the new protocols. Then, on March 27, Oklahoma Gov. Kevin Stitt announced that abortion services there would be banned. Burkhart said the state didn’t bother to tell her; she found out from the media. Women were waiting at the clinic, and Burkhart had to break the news that they would not be seen. Outside, a protester was using a microphone to yell at them. In all, 164 appointments were canceled.

In the days that followed, Burkhart’s staff came in to work the phones in an attempt to reschedule patients elsewhere: to Arkansas (which hadn’t yet banned care) and Wichita, Kansas, where Burkhart’s other clinic is located. “We were already seeing like a threefold or so increase of our patient load” in Oklahoma City, Burkhart told me on April 1, because of the “fiasco” in Texas. “So now everybody has been pushed up to Kansas.”

As multiple states tried to ban abortion, the Wichita clinic became something of a beacon. In 2019 the Kansas Supreme Court concluded that the state’s constitution guaranteed the right to abortion, and Gov. Laura Kelly signaled early on in the crisis that she would not tolerate any attempts to ban reproductive care.

Pressure on the clinic increased exponentially; in a single week, Burkhart said, the clinic saw more than 250 patients. That pressure continued even after the original restrictions on “nonessential” medical procedures eased, because officials in Arkansas and Oklahoma began requiring every woman seeking a procedural abortion to first test negative for Covid-19, which created a new logistical wrinkle for providers like Burkhart.

“We’re being lumped in with, like, plastic surgery.”

First, there was the matter of actually procuring testing kits — no small feat, considering widespread testing for asymptomatic individuals has remained largely unavailable. And then there was the matter of getting test results turned around quickly.

Testing was required before all “elective” procedures in both Oklahoma and Arkansas, so in a way, the mandate was just another attempt to deem abortion nonessential. “We’re being lumped in with, like, plastic surgery,” Burkhart said. But the advantage many other providers had was their affiliation with hospitals and other facilities with lab access. “So, they have access to the type of testing that we don’t have access to as a standalone clinic.”

In addition to a 20-week gestational ban, both Arkansas and Oklahoma have waiting times connected to abortion access; Oklahoma requires a 72-hour “reflection” period between a woman’s first appointment and the second, when she can actually receive care. Burkhart was already testing her employees amid the crisis, so she knew it would take roughly three to five days to get the results. Working with that lag time made scheduling abortion appointments even trickier.

“This mandate places another obstacle in front of women trying to access abortion care” and punishes patients, Burkhart wrote in a May email. After the testing requirement took effect, she had to reschedule patients whose test results didn’t come back in time; some who were earlier along in their pregnancies opted for medication abortion, which is available up through 10 weeks of pregnancy; others had to make the journey over state lines — including to Burkhart’s Kansas clinic — to avoid additional obstacles to service.

Burkhart and her staff were exhausted, she told me. “It just feels unrelenting.”

On June 12, the testing requirement for Oklahoma was lifted. How quickly things will level out, Burkhart said, remains to be seen.

Rhetoric and Threats

As the public health crisis dominated headlines, lawmakers in some states nonetheless continued apace in their broader efforts to erode reproductive rights. In Kansas, conservative lawmakers dismayed by their high court’s 2019 abortion ruling held hostage a bipartisan proposal to expand Medicaid coverage to roughly 130,000 uninsured residents unless their colleagues would agree to a constitutional amendment denying women abortion rights. In Oklahoma, lawmakers pushed through a bill that allows “parents or grandparents” to sue an abortion provider for “wrongful death.”

And in Kentucky, Gov. Andy Beshear vetoed a bill that would have extended to the state’s attorney general the ability to enforce health and safety codes, including the power to inspect abortion clinics — a brazen attempt to give law enforcement officials the power to directly oversee and meddle in clinic operations, which have long been monitored solely by public health authorities.

Kathaleen Pittman, the administrator of the Hope Medical Group for Women in Shreveport, La., poses for a portrait in the clinic’s recovery room on Feb. 20, 2020. The clinic is one of three in the state that provides abortions to women, and it is challenging a state law that requires doctors who perform abortions to have admitting privileges at a nearby hospital. The Supreme Court is hearing the case on March 4. (CREDIT: Rebecca Santana)

Kathaleen Pittman, administrator of the Hope Medical Group for Women in Shreveport, La., poses for a portrait in the clinic’s recovery room on Feb. 20, 2020.

Photo: Rebecca Santana/AP

Indeed, in early April, it was two members of the Louisiana attorney general’s office — and not the Louisiana Department of Health — who descended on the Hope Medical Group for Women in Shreveport for an unannounced inspection, Kathaleen Pittman, the clinic’s longtime administrator, told reporters during a press call. They wanted to see how the clinic was managing social distancing, check its stock of PPE, and review various other Covid-19 protocols. They also demanded to see confidential patient records. “It was very disconcerting. We’re accustomed to unannounced visits from LDH, but never the attorney general’s office,” Pittman said, which “normally has no bearing as far as the inspection and the running of the clinics.”

“We are constantly, constantly bombarded with calls from women who are trying desperately to get in.”

The visit came amid the clinic’s struggle to accommodate patients from a growing list of states where public officials were using the pandemic as a pretext to close clinics. The AG’s office in Louisiana was unsuccessful in its bid to do the same. “We are constantly, constantly bombarded with calls from women who are trying desperately to get in,” Pittman said.

And then there was the harassment from anti-abortion activists. They were calling the clinic too. “One moment we’re trying to comfort a woman over the phone. The next moment we’re trying to get away from a phone call or to record the phone number of a harasser,” she said. “It has really begun to take its toll.”

Those in the reproductive rights movement know that threats are an unfortunate part of the landscape that at times, often related to the amplification of anti-abortion rhetoric by politicians, have ended in waves of deadly violence. “Anybody who has been in this field for very long knows someone who has been killed,” the Very Rev. Katherine Ragsdale, president and CEO of the National Abortion Federation, told me. Indeed, Burkhart’s Wichita clinic is in the same building that housed a clinic run by her friend and mentor Dr. George Tiller, who was assassinated in 2009 by an anti-abortion zealot. Burkhart has been the subject of sustained harassment, including by protesters who have picketed outside her home and put her face on “Wanted”-style flyers.

The NAF tracks violence and threats against abortion providers, which have ticked alarmingly upward since the 2016 election of Donald Trump. Amid the pandemic, Ragsdale says, the “deceptive, demonizing, dehumanizing rhetoric is on steroids,” with people like Texas AG Paxton twisting the purpose of public health orders into political rallying cries. By claiming abortion is nonessential — a medical determination he is unqualified to make — Paxton has essentially dog-whistled anti-abortion activists into action. “They’re emboldened,” Ragsdale says. “Saying that abortion isn’t essential health care, and at the same time, saying that these folks are exempt from social distancing and stay-at-home orders that everyone else is subject to because they’re expressing religious opinion.”

“He watched them gather 50 strong, no masks, no nothing. He watched them put up a ladder to look through the front door.”

Back in late April, a regular protester at the Pink House, Coleman Boyd, started ginning up support for Saturday morning “church” outside the clinic. The first gathering drew some 80 protesters. When Coleman posted plans for a second protest on Facebook, Gibson had had enough. She penned an email on May 4 to local officials in the police department and mayor’s office, as well as the city council president and city attorney. She sent a link to a nearly hourlong video of Boyd’s first rally outside the clinic — where protesters screamed at patients and blocked the roadway — and asked why the city wasn’t enforcing its buffer-zone ordinance meant to tame the aggressive actions.

“It is a dangerous situation outside of a medical facility,” Gibson wrote. “Patients and their companions are terrorized by these people. The neighborhood suffers their noise and harassment as well. As a volunteer and a concerned citizen of Jackson, I would appreciate your assistance. These people are congregating outside of a medical facility during a pandemic, endangering others.”

None of the city officials responded to her email, but a cop did show up outside the clinic that Saturday. He just sat in his car, watching. “He watched them gather 50 strong, no masks, no nothing,” Gibson told me. “He watched them put up a ladder to look through the front door.”

As exhausting as it has been, Gibson and Hancock remain determined to help women navigate the pandemic and the protesters. With everything that has been going on, the Pink House’s patients have “taken it totally in stride,” Hancock said. While there’s “nothing really good” about the current situation, there is something “pretty cool” that has happened: Patients have also been emboldened. Gibson agrees. “It’s kind of galvanized them,” she said. “It’s not taken for granted so much, because it’s been made plain to them how tenuous it all is,” she added. “How meaningful it all is … and how it can all be gone real damn quick.”

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