As a nurse practitioner and midwife, I’ve found these past few weeks to be some of the most difficult of my career. My new normal is counseling anxious and tearful patients who are fearful that they may be forced to give birth alone. They are terrified by the thought. Patients who have invested in doulas and other birthing support now need to choose between them and their partner to be with them, and patients seeking reproductive health care are more worried and scared about access than I’ve ever seen.
In our clinic, nothing is the same as we try to minimize patient exposure, follow stay-at-home orders, and do our part to flatten the curve of COVD-19. What hasn’t changed are the cracks in our health care system and the low value we place on the reproductive rights of individuals and families that continue to be restricted, and under political attack. The COVID-19 crisis is shining a light on these cracks and burdens, often at the expense of our patients.
These harmful cracks include problematic state laws restricting and delaying our constitutional right to access abortion care. Abortion is an essential part of pregnancy care, and we are fortunate our governor has rightfully designated reproductive health care as a “critical essential service.” However, many Minnesotans are unaware of the anti-abortion movement’s success in past years, passing various laws that create medically unnecessary delays and barriers to the procedure, and make abortion unattainable for some. In fact, Minnesotans overestimate access to abortion in our state, with 86% assuming our laws support people’s rights and access to abortion rather than restrict them. And although this crisis has provided a cover for many anti-abortion politicians to renew their political agendas in national headlines, the barrage of attempts to restrict reproductive health care have been constant, even in our state. Since 1995, more than 400 unconstitutional restrictions to abortion have been proposed by politicians in the Minnesota Legislature, including a 2018 bill to fully ban abortion.
One of Minnesota’s current restrictions in pregnancy care prevents advanced-practice clinicians such as me from prescribing medication abortion, putting a huge strain on patients and doctors. This is on top of a federal statute (being challenged by 21 AG’s across the country, including Minnesota’s Keith Ellison) mandating that FDA-approved medication abortion be prescribed, counseled, and administered in-person, from a medical doctor. In our clinic, if someone is seeking a medication abortion, I am legally unable to prescribe the proper medication. This means I need to find an M.D. colleague on the spot to offer the counsel, consent, prescription, and to physically administer the medication. This is enormously disruptive, and now with COVID-19 drastically changing procedures and limiting our resources, it is dangerous for our patients seeking an extremely time-sensitive medication abortion.
It has never been clearer that deep community roots can help when the larger systems are broken, and reproductive health care is no exception. This is especially true for the communities of color who have already been failed by our health care system, and who are being hit hardest by COVID-19. Birth workers of color are working independently with families in their communities and are rallying to provide support, often uncompensated. The question is, will we learn from this experience and correct the disparities we see in pregnancy care across the state and country?
I find hope knowing that times of crisis can cultivate immense creativity, and I see this every day in the work of groups such as the MN Healing Justice Network and clinics, such as ours, that have rapidly adapted to telehealth. I feel empowered by the work of local community groups, including Our Justice, who are leading the way to promote reproductive justice, and the statewide UnRestrict Minnesota coalition educating voters, Planned Parenthood, Whole Woman’s Health, and others doing critical community organizing. If we don’t address this fight in this moment, we will only have greater consequences later on. We need to lift restrictions on nurse practitioners (NPs) and certified nurse-midwives (CNMs) providing abortion care to our clients. The onus of the responsibility should be shared among all providers of pregnancy and reproductive health care, not just our M.D. colleagues. We need to reframe women’s health care in a human rights framework. We should never find ourselves in a space where people are forced to birth alone, or forced to wait on a timely procedure due to political power grabbing. Reproductive health is a human right, and an individual responsibility, not a choice.
Jennifer Almanza, DNP, APRN, CNM, has worked in maternal and child health for over 25 years as a culture-centric doula, an in-patient/bedside RN, a case manager, a Birth Justice policy advocate and health equity research activist. Jennifer is currently practicing as a midwife and adjunct faculty in an academic-based, Reproductive Justice centered practice in Minneapolis.
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