In response to the COVID-19 pandemic, federal and state officials have issued several orders and non-mandatory guidelines to help curb the number of people in hospitals, ambulatory surgical centers, and private practices offering inpatient surgeries, to preserve both bed space and personal protective equipment (PPE) for the expected influx of hospital patients needing immediate care.
On the Federal government’s side, the Surgeon General, Dr. Jerome Adams, has let the public know what guidelines they are asking healthcare providers to follow.
“Elective procedures are those that are often scheduled days to weeks in advance and often could be postponed without causing great harm… I am calling on all hospital systems to heed federal recommendations and cancel or delay nonessential elective procedures in a way that minimizes potential harm to patients.”
The Surgeon General also referred to guidelines the American College of Surgeons released (linked below)
The Centers for Medicare and Medicaid Services (CMS) released a document for all healthcare systems which details a tiered approach for determining whether a medical or surgical procedure should be delayed or not. The federal government has issued these guidelines as non-mandatory, giving the local and state governments the final say in what to enforce.
“A tiered framework is provided to inform health systems as they consider resources and how best to provide surgical services and procedures to those whose condition requires emergent or urgent attention to save a life, preserve organ function, and avoid further harms from underlying condition or disease… in analyzing the risk and benefit of any planned procedure, not only must the clinical situation be evaluated, but resource conservation must also be considered.”
The Centers for Disease Control and Prevention (CDC) have also put out guidelines for healthcare providers, which include rescheduling non-urgent outpatient visits and elective surgeries.
Then you have national organizations such as the American Medical Association (AMA) who have released guidelines to help private practices know how to handle non-essential, elective procedures and surgeries, stating:
Delay all elective ambulatory provider visits
Reschedule elective and non-urgent admissions
Delay inpatient and outpatient elective surgical and procedural cases
The American College of Surgeons directs healthcare professionals to the CDC and CMS guidelines for tiered care and safety considerations. The American Academy of Ophthalmology came out with their own specific guidelines for healthcare providers and also refer to the guidelines presented by the CDC and American College of Surgeons. The Ambulatory Surgery Center Association also put out their recommendation for ASCs which include postponing planned surgeries and only doing elective urgent surgeries, among other recommendations.
Many states have stepped up and taken these non-mandatory federal and professional guidelines into consideration when issuing their own orders from the governor’s office or the state health department, as seen in the table below. However, some states have not mandated any stop to any types of surgery or medical procedure, or have only recommended limitations and/or following of the CDC guidelines. In states where the orders have been made, all manner of elective and/or non-essential surgeries are being postponed, even cancer treatments.
Medical professionals and healthcare facilities are facing very hard choices right now. By postponing elective and/or non-essential surgeries and medical procedures, they are forgoing the very services which would make them any profit, while potentially having increased costs.
“...many providers, particularly hospitals and health systems, face increased costs associated with the COVID-19 pandemic, including locating and purchasing additional—and often more expensive—supplies and equipment, higher staffing levels, additional paid sick leave and paid time off for employees, enhanced training on telehealth, and setting up additional separate testing sites for COVID-19, among other extraordinary expenses.”
Insurance rates for systems like Medicare could also be affected. In California and other states where there is no state order yet concerning elective or non-essential medical procedures, some hospitals are already voluntarily canceling, postponing, or rescheduling elective surgeries.
The single notable exceptions to compliance with state orders is abortion clinics. Even in Ohio, where the Attorney General sent out letters to three separate abortion clinics, the clinics are continuing to operate. Why?
The most obvious reason, despite abortion provider’s claims to the contrary, is money. If abortion clinics stop providing abortions, they will lose revenue, the same problem many hospitals and private practitioners are facing right now. If they stop performing lucrative elective procedures, they lose money, and that may mean facing permanent closure.
But abortion providers are couching that obvious reason to keep performing abortions in terms of healthcare and women’s rights. Even the American College of Obstreticians and Gynecologists (ACOG) and other OBGYN groups are stepping into politics and stating abortion should not be delayed:
“While most abortion care is delivered in outpatient settings, in some cases care may be delivered in hospital-based settings or surgical facilities. To the extent that hospital systems or ambulatory surgical facilities are categorizing procedures that can be delayed during the COVID-19 pandemic, abortion should not be categorized as such a procedure. Abortion is an essential component of comprehensive health care. It is also a time-sensitive service for which a delay of several weeks, or in some cases days, may increase the risks or potentially make it completely inaccessible. The consequences of being unable to obtain an abortion profoundly impact a person’s life, health, and well-being.”
A chief medical officer of Planned Parenthood located in NYC, Meera Shah, asserts,
“Our doors will stay open because sexual and reproductive health care is extremely important, and we have to ensure access to it... Pregnancy-related care, especially abortion care, is essential and life-affirming, especially now when there is so much insecurity around jobs and food and paychecks and childcare.”
In defense of abortion, Katha Pollitt for The Atlantic writes,
“Abortion is crucial to women’s ability to have decent lives: to have children when they are ready and able to take care of them, to get an education, to avoid bad marriages and escape abusive partners, to work and support themselves, and to fulfill the many demands society makes on women, such as caring for the children they already have….Moreover, abortions can’t be postponed indefinitely. The longer a patient has to wait, the more likely she is to need a more complex—and more expensive—procedure.”
In Texas, the CEO of Whole Women’s Health, and abortion provider, is even claiming that stopping abortions will create “a health crisis on top of a health crisis.” In Montana, an abortion provider states they will continue to do abortions, even though they also admit they do not have appropriate PPE to deal with COVID-19 contact precautions.
“We are committed to continuing to provide abortion care in this difficult time. We consider abortion, contraception, STI screening, and cervical cancer screening essential services...we do not have the right personal protective equipment for COVID-19 contact precautions.” [emphasis added]
And in Ohio, abortion providers claim they can abide by the state’s order to stop elective and non-essential surgeries and still provide surgical abortions, because abortions are essential.
All this uproar hinges on whether abortions are elective or emergent, essential or non-essential. The Federal and state governments are often using both terms, elective and non-essential, together in state orders from the governor or health department. These two sets of terms have different meanings, though there is overlap. “Elective” merely means a surgery, procedure, or service which is scheduled in advance. However, an elective procedure can be either essential (chemotherapy) or non-essential (a dental cleaning). An emergent procedure is one which must be done as soon as possible to preserve the patient’s life (appendix bursting, myocardial infarction). While “elective” covers a broad variety of procedures, the terms elective and emergent are pretty cut-and-dry.
“Essential” merely indicates the procedure is time-sensitive, and not getting the procedure within a certain time frame will negatively impact the patient’s physical life or health in a severe manner, resulting in death, loss of bodily function, etc. Chemotherapy may be considered essential, while orthodontic services like tightening braces would be non-essential. However, these terms are a little more vague, and different states and different healthcare providers have a little more leeway in defining what the time limit is in their definition of essential services i.e., (30 days, 3 months), or the severity of the harm (i.e., risk of loss of life, risk of loss of major bodily functions).
Induced abortion is absolutely elective. There can be no denying this fact. Abortions are scheduled in advance, so they are necessarily medically elective, not emergent. Furthermore, the “danger” presented to the woman is that if she is not able to obtain an abortion, she will give birth to a little baby. Getting an abortion, pandemic or not, is killing an innocent human being. When our society labels the killing of our most vulnerable members an “essential medical procedure,” the depravity of our culture is on full display.
Because of the mixing of terms in the state orders, abortion providers can claim their services are “essential” and totally ignore and bypass the elective/emergent issue — which they know they cannot assert because it is far too easy to point out how abortions are not emergent procedures, which leaves them to be only elective procedures. So they are taking the only way out they can and are claiming elective abortions are essential.
But are they essential? Most abortion providers and advocates are merely asserting their services are essential; they provide no argument or evidence. The most they can do is point to supposed time-sensitivity of abortion, which is only one of the criteria for a procedure to be considered essential. The other half of what makes a procedure essential is if the life or physical health of the person will be put in jeopardy if not done within a certain time period. And they are barely trying to justify the time-sensitivity. What makes abortion time-sensitive is, in their own admission, the fact that the woman may not be able to access the procedure later or the procedure itself may be riskier. If she doesn’t get an abortion now, she might not be able to legally get one later (and that means the abortion provider doesn't make any money). While it is true an abortion is less safe for the pregnant woman the later in pregnancy she gets it and that she may not be able to legally get one after a certain point in her pregnancy, those things alone do not make abortion qualify as essential.
Accessibility of a procedure has absolutely no bearing on whether it is essential or not. As pointed out already, the time-sensitive component of an essential procedure is in direct relation to how much harm the patient will incur if the procedure is not done within a given time frame.
Will the woman’s physical life or health will be in danger if she does not get an abortion? Will her bodily systems fail if she does not get an abortion? Will she die? Very likely not. Despite a common misconception, abortion is not 14x safer than childbirth, and even if it were, that would still not make it essential. The maternal mortality rate is not high enough to assert as fact a woman’s life or health will be put at serious risk if she does not have an abortion.
Even the ACOG can only make the softest statements about abortion being essential for any other reason than not being able to get one later in pregnancy, and do not provide any evidence for their statement, “The consequences of being unable to obtain an abortion profoundly impact a person’s life, health, and well-being.” The ACOG is just saying in slightly more medical-sounding language the same terrible arguments abortion providers and advocates are saying outright: birthing a child may be financially burdensome, keep you from pursuing your goals, will keep you in a bad relationship, and require responsibility for the child. Unfortunately for abortion providers, none of these things means abortion is medically essential. In a response to the ACOG’s joint statement, over 30,000 physicians submitted a joint statement from the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), the American College of Pediatricians, Christian Medical & Dental Associations, the Catholic Medical Association, and the Association of American Physicians & Surgeons stating:
“In such an uncertain and tumultuous time, the entire healthcare profession is being called upon to conserve resources and healthcare professionals to an extent never seen before. And yet, in the midst of this call, while hospitals are postponing elective procedures and many outpatient clinics are rescheduling non-essential office visits, the abortion industry continues with business as usual.
In their recent joint statement, ACOG with several other traditionally pro-abortion medical organizations, made the preposterous claim that “abortion is an essential component of comprehensive health care” for women, even though elective abortion treats no disease process.
Furthermore, over 85% of practicing obstetricians and gynecologists do not perform elective abortions. If elective abortion were an “essential component” of women’s health care, it would be a part of every obstetric and gynecologic practice.
Currently, across the United States, services that do constitute essential health care for women, including routine Pap smears, mammograms, and pelvic exams, are being postponed in order to reduce everyone’s risk of exposure to COVID-19, and to conserve scarce medical resources...Continuing to perform elective abortions during a pandemic is medically irresponsible. Elective abortion is neither “essential” nor “urgent,” but it does consume critical resources such as masks, gloves, and other personal protective equipment, and unnecessarily exposes patients and physicians to pathogens.
Elective abortion, both surgical and drug induced, also generates more patients to be seen in already overburdened emergency rooms. Most abortion providers instruct women to go to an emergency room if they have any concerning symptoms after the abortion. Approximately 5% of women who undergo medication abortions will require evaluation in an emergency room, most commonly for hemorrhage. Surgical abortions can also result in hemorrhage. Emergency room personnel - who are already struggling to meet the demands of the COVID-19 pandemic - will be further strained to provide care to these women.”
In addition to baselessly asserting that elective abortions are essential, abortion advocates are also claiming pro-life people are using a health crisis to push politics and their specific agenda to control women. They have whipped up a faux outrage over politicians and activists attacking women’s reproductive health rights (when they specifically mean abortion). In reality, they are doing the exact thing they accuse their opposition of doing: they are using a public health crisis to score political points and are trying to push their own agenda and viewpoint on abortion. Their opposition — state health departments and state attorney general’s offices — are merely trying to get all providers to comply with state orders, not just abortion clinics. If abortion clinics would have complied with their state orders to begin with, there would be no specific call-outs by state officials needed. Instead of complying, though, they continue to physically endanger the women they claim they are helping and then point fingers at everyone but themselves to cast blame for putting women’s lives and physical health in danger.
Below is a list of all 50 states, whether the state has an order concerning elective and/or non-essential procedures, whether abortions are included or excepted in that order, and whether abortion clinics are still operating. Here you can click on the links provided to all applicable state orders. The links for “Yes” are to abortion clinics who are still open, some of which have a specific notice on their website that in spite of the COVID-19 outbreak, they are still seeing patients and doing abortions.
For states which have put out orders banning non-essential and elective procedures, you can contact your state’s governor to urge them to consider abortions elective and non-essential, and to tell abortion clinics to stop doing abortions. You can check out this resource which updates regularly to show the states which have put orders in place concerning medical procedures.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the official position of Human Defense Initiative.