By Tara Haelle, April 1, 2020

On the same day that an appeals court allowed Texas state Governor Greg Abbott’s ban on all abortion procedures to remain during COVID-19 emergency measures, the Texas governor declared church services an “essential service” that may continue during the pandemic.

The state banned all surgical abortions, and then medication abortions, last week, but a federal district court blocked the ban on Monday in response to a lawsuit filed on behalf of Texas abortion providers by Planned Parenthood, The Center for Reproductive Rights and the Lawyering Project.

Then on Tuesday, March 31, an appeals court reversed the district court decision, allowing the abortion ban to remain in place until the case made its way through the courts. Similar lawsuits are pending in other states as Alabama, Iowa, Ohio and Oklahoma attempt to ban abortions as well.

Meanwhile, Abbott issued a disaster proclamation Tuesday that limits residents’ social gatherings and in-person contact only to “essential services,” which includes all services deemed essential by the federal government—plus “religious services conducted in churches, congregations, and houses of worship.”

In short: Texas women cannot get abortions, a medical procedure deemed essential by physicians that involves contact with only 2-3 other people, but they can go to church, a setting which has already been linked to multiple “super-spreading” COVID-19 events.

Both the free exercise of religion and a woman’s right to terminate a pregnancy are constitutionally guaranteed rights. The Texas governor, however, appears willing to accommodate only some rights—at considerable risk to public health—while not accommodating others involving far less risk. Further, since women seeking abortions must travel out of state, the ban encourages greater risk-taking travel in the midst of a pandemic, and women who attempt unsafe abortions on their own may end up in the hospital anyway, experts say.

Texas Banned All Abortions

The original executive order regarding healthcare services issued by Abbott on March 22 did not mention abortion at all. It required postponement of “all surgeries and procedures that are not immediately medically necessary to correct a serious medical condition of, or to preserve the life of, a patient who without immediate performance of the surgery or procedure would be at risk for serious adverse medical consequences or death, as determined by the patient’s physician.” The order’s intent is to preserve the supply of personal protective equipment (PPE) and hospital capacity to manage the COVID-19 crisis.

However, Texas Attorney General Ken Paxton, who has a well-established history of opposing abortion, issued a statement the next day that interpreted the order as including “any type of abortion that is not medically necessary to preserve the life or health of the mother.”

Texas abortion providers then ceased all surgical abortions but continued providing medical abortions, the two-drug regimen of mifepristone and misoprostol that doesn’t require any surgery—until Friday afternoon when providers received notice that medical abortions must be suspended as well.

Abortion Services Are Essential, Doctors Say

Despite Abbott’s order to leave the determination of “essential” up to patients’ doctors, AG Paxton’s interpretation to exclude abortion as an essential service directly challenges the clinical opinion of the American College of Obstetricians and Gynecologists (ACOG).

“Abortion is an essential component of comprehensive health care,” the medical organization said in a March 18 statement cosigned by seven other medical organizations. They note that delaying abortion weeks or even days can “increase the risks or potentially make it completely inaccessible,” and that the “consequences of being unable to obtain an abortion profoundly impact a person's life, health, and well-being.”

Prohibiting all abortions also increases the risk of potential complications from people attempting to terminate pregnancies on their own, argued Daniel Grossman, MD, and Lisa Harris, MD, PhD, in a recent commentary. An estimated 800,000 illegal abortions occurred annually before abortion was made legal nationwide in 1973, they note. “As access to legal abortion increased after Roe v. Wade, morbidity and mortality from illegal abortion declined by a factor of nearly eight.”

Further, pregnancy carries greater health risks to the mother than abortion, particularly in Texas, which ranks sixth in the nation in maternal deaths. Maternal deaths have nearly doubled over the past 10 years.

“Texas already has a bad enough maternal mortality problem. They do not need to make it worse,” said Rebecca Tong, director of development at Trust Women. “They have lots of things they could be working on, so to waste everyone’s time on this when there’s a real public health emergency going on is a slap in the face to everyone.”

Abortions Use Less PPE Than Pregnancy and Birth

Outlawing abortion during the pandemic under the guise of preserving PPE and hospital capacity is “not a legitimate argument,” according to Daniel Grossman, MD, professor of obstetrics and gynecology at the University of California San Francisco. He points out that a first-trimester abortion requires only two pairs of gloves and a face shield, but “a lot more gloves, gowns, and masks” are used for pelvic exams, ultrasounds and delivery if a woman continues her pregnancy.

Medical abortions require only a single pair of gloves—to conduct the ultrasound that Texas law requires before women receive an abortion. Telemedicine could provide a way to access medical abortion, except that Texas is among 17 states that have banned its use for abortion, according to the Guttmacher Institute.

Meanwhile, only 87 of the 52,103 abortions performed in Texas in 2017 were in a hospital, according to Texas Heath and Human Services, so abortions don’t take away needed hospital beds, Grossman said. Complication rates from surgical abortions are under 1%: one California study Grossman coauthored found only 0.2% of abortion complications required treatment at a hospital. Another national study found “only 0.01% of all emergency department visits among women aged 15-49 were related to a recent abortion,” Grossman writes.

He called Texas’s abortion ban an attempt to “circumvent the law” to eliminate everyone’s access to the essential service in the midst of an existing public health crisis.

Texas has a long history of attempts to restrict abortion access, from cutting funding to providers to towns’ establishing “sanctuary cities for the unborn” to the case with Whole Women’s Health that went to the Supreme Court. Legislators who attempt to preserve Texans’ constitutional right to abortion often have faced threats to their personal safety.

As the Texas Tribune reports, women such as Heather Artrip, a single mother with two sons who lost her job due to the coronavirus pandemic, now cannot get an abortion despite the serious risks a pregnancy poses to her health. She is unable to look for a job because her medical condition means her “uterus could fall out,” she told the Texas Tribune. “I'd have to be bedridden for the majority of my pregnancy,” she told them.

According to NPR station KUT in Austin, Planned Parenthood of Greater Texas canceled 261 abortions last week—and took 583 calls from patients seeking appointments during the same time. The center is one of multiple abortion clinics in the state.

“We know that anti-choice forces throughout the country are trying to score political points and restrict women’s access to this essential healthcare at a time when that healthcare is more essential than ever,” said Reverend Katherine Ragsdale, president and CEO of the National Abortion Federation. “If your life circumstances, your financial and job stability, and all those things that don’t allow you to feel comfortable bearing and raising a child were true before, how in the world can you ask someone in the midst of a pandemic to carry a fetus to term?”

Religious services have already caused multiple COVID-19 clusters

While abortion services pose little risk to women or those in the clinic, religious services pose far greater risk of community transmission of COVID-19.

Abbott’s order to limit residents’ interactions outside the household only to essential services advises remote services, but “if religious services cannot be conducted from home or through remote services, they should be conducted consistent with the Guidelines from the President and the CDC by practicing good hygiene, environmental cleanliness, and sanitation, and by implementing social distancing to prevent the spread of COVID-19,” the governor’s order states.

The order overrules local ordinances, such as Houston’s, that had already banned services, though many churches say they will remain closed. The order does not elaborate on how religious services can be safely conducted, but experts in infectious disease question that possibility.

“Religious services hold the same risks as any other gathering of people,” said Ian Mackay, PhD, an associate professor of virology at The University of Queensland in Brisbane, Australia. “Therefore they should not go ahead in the midst of a pandemic when physical distancing measures are essential to reduce the risk of hospitalization and death due to COVID-19.”

The coronavirus disease is spread primarily through droplets, especially from coughs and sneezes, explained Lea Merone, MD, a public health doctor in Cairns, Australia.

“In a confined place like a church, studies have shown these droplets can linger in the air or on surfaces and either be breathed in by someone else, or someone touches an ‘infected’ surface and then their face, so they catch the virus,” Dr. Merone said. “It is understandable that people will want to go to church at these times if they are religious, but the risks of being close and confined to others who may have the virus will not be small. Church populations additionally tend to be older and more vulnerable to the potentially serious or life-threatening effects of the virus.”

Several gatherings at churches or similar services have already been the source of large-scale COVID-19 transmission. A choir rehearsal in a Presbyterian church in Washington state led to 45 infections among the 56 attendees, and two have died. A funeral in Georgia led to 24 deaths and more than 600 cases in a county of just 90,000 people. Ten people tested positive after attending a church service in Glenview, Illinois. Similar disease clusters have occurred in other countries, such as South Korea, as well.

https://www.forbes.com/sites/tarahaelle/...y/#29f529ae8ab3