I am a medical assistant at an abortion clinic in Texas. It can be an emotionally wrought experience under normal circumstances, but during this pandemic it has only intensified. As Texans, our patients are up against their own unique set of obstacles to obtaining care. When the lockdown first went into effect in March, our governor banned elective procedures. He included abortion under that order.
Those early days of the pandemic are linked in my memory with the difficult conversations I had with countless patients. As I called to cancel their appointments, I could not offer any comfort by telling them the date in which we would be able to provide abortion services again. I gave patients information for clinics in New Mexico, and while some people were grateful for that despite the long journey to obtain their essential medical care, just as many patients told me there was no way they could afford to travel that far. As a staff dedicated to reproductive justice, this unnecessary barrier to care tore me and my coworkers apart. The only thing we could do was compile a list of patients to call back when the ban was lifted and wait as we battled it out in the courts.
After nearly four weeks, the ban was finally lifted and we started calling patients to get them rescheduled. Some of these patients were so early when they got their ultrasound at the abortion consultation, a legal requirement in Texas, that they were eligible for the abortion pill. By the time we were able to schedule again, some of these same patients were already in their second trimester. Not only would these patients be required to have a surgical procedure at this point, but now that procedure would require extra medications and have the potential for added complications given the gestational age.
As I called patients to offer appointment times, I was expecting, perhaps naively, that each patient would be relieved and grateful to be seen–but this was not always the case. I had a variety of emotional conversations. Some patients who had been anxious about the uncertainty of obtaining an abortion in Texas ended up going to clinics in surrounding states. Other patients were in fact relieved that we could see them, but that relief was tinged with anxiety that access could be taken away again given the uncertainty of the pandemic. Then there were others who told me they simply no longer needed services as they were now planning on continuing with the pregnancy.
At first, I couldn’t quite understand why so many patients were opting to continue with the pregnancy after they had already had terminations on our schedules. In my mind, I don’t see the difference between choosing to terminate at 10 weeks versus 14 weeks when the decision comes down to whether or not you’re prepared to raise a child. However, not everyone thinks this way, which I learned while working through this ban.
Everyone has different moral boundaries, and some people feel comfortable with a termination at an earlier gestational age, but feel wrong doing it later, just the way some of our patients decide after their initial consultation that abortion is not the right option for them. While access was eventually restored, for some patients, it was too late for them to have the abortion they felt comfortable with. I still think of those patients and I hope they are doing well, even if life is not how they planned it.
For now, it seems we have stable access again, so we have been adjusting to the new normal of abortion care in the COVID era. This means separating patients as much as possible, both spatially and temporally. We have a staff person up front designated for screening patients for symptoms, which means we have one fewer person working in the back. All of these changes that we have made mean that we have less capacity to see patients.
At the same time, staff are being pushed to meet the demand for abortion consultations, even as we are short-staffed. There is so much pressure to work faster, to work longer hours and to see more patients in one day, yet we are being met with novel challenges along the way. Patients who would have otherwise continued with their pregnancies are choosing to terminate because they and their partner have lost their jobs and can no longer afford to raise a child. Because of this, I think these patients feel more shame and sadness about their decision, even when they are confident it is the right choice for them. Here in Texas, there are few social programs that we can refer patients to in order to help with these difficult decisions.
I have these kinds of conversations every day now, and they weigh on me and my coworkers. Even though we are all close to burnout, the therapeutic debriefs we have together at the end of the day keep us going, at least for a little while longer. While we know the way we are working is unsustainable, we are trying to go for as long as we can to see the patients that need us for their essential healthcare.