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Excerpted From: Anna Reed, Covid: A Silver Linings Playbook, 37 Berkeley Journal of Gender, Law & Justice 221 (2022) (270 Footnotes) (Full Document)
There's some things about how we're practicing now that I don't like, and there are some things about how we're practicing that I really like, and don't want to change after sheltering in place has been lifted ... We're even looking at this idea of no-touch abortion.
These are the words of Adrienne Crawford, one of Washington D.C.'s many overworked nurse-midwives practicing at the front lines of the coronavirus (COVID-19) pandemic. With a chorus of publications examining the pandemic's detrimental impact on access to reproductive health, it seems important to amplify opinions like Adrienne's. She is not alone in seeing the silver-linings of the pandemic for her field. Amidst the loss and chaos of the pandemic, there has also been stunning innovation in reproductive health. This Article does not dispute COVID-19's devastating impacts on public health, including reproductive health. However, the pandemic has also forced the medical profession to ask itself a question that it arguably should have asked itself a long time ago: How can we scale back unnecessary medical interventions and surveillance of people with child-bearing capacity?
For two centuries, reproductive health care has become increasingly medicalized- sometimes to the detriment of the health and well-being of people seeking reproductive health care. This Article surveys positive shifts during the pandemic reversing the over-medicalization of contraception, fertility, birth, and abortion care. Specifically, it analyzes the positive benefits of 1) removing bureaucratic barriers to care, 2) mobilizing telemedicine for sexual and reproductive health care (SRH) services, and 3) expanding the range of services that may be administered at home. Some states have managed to preserve access to SRH services during the pandemic as a result of these changes, and in certain instances--particularly in the abortion context--COVID-era adaptations have actually increased access to care. For these reasons, this Article argues that the pandemic's pressure to restrain medical intervention and surveillance in reproductive health is one worth sustaining after the lingering consequences of the pandemic have been addressed.
This Article proceeds in four parts. Part I focuses on contraception and unpacks the ways in which harmful histories of reproductive coercion continues to mar contemporary contraception care practices. It then identifies key ways in which the pandemic has shifted these care practices away from intervention and surveillance toward greater investment in patient information and autonomy. Part II focuses on fertility care. It begins by locating contemporary fertility care protocols within broader historical trends of deeming certain parents “worthy” of having access to family building and others not. It then analyzes some of the ways in which the pandemic has transformed the settings in which fertility care can be accessed, and in doing so, reduced significant barriers. Part III focuses on perinatal care, connecting the historical criminalization of midwifery to the current overmedicalization of childbirth, and then suggests that the pandemic has transformed notions of what safety looks like in this context and significantly reduced intervention throughout the perinatal period. Finally, Part IV provides an overview of the history of criminalizing abortion, connects it to contemporary access barriers, and unpacks the ways in which the pandemic has generated workarounds for those obstacles.
[. . .]
The COVID-19 pandemic has been a profoundly dark time marked by devastating loss. However, we should not lose sight of the pandemic's silver linings. By easing procedural and administrative requirements for accessing care, increasing access to telemedicine, and supporting those who wish to self-manage their care at home, some governments have changed the landscape of reproductive health for the better. We must think critically and carefully about which measures have paved new pathways to care access and insist that they remain in place even in a future where the pandemic recedes. Some people have always lived with the challenges the pandemic imposed upon us all, in which administrative burdens and health care regulations are insurmountable barriers to care, clinical settings are unsafe, and home care options are preferable to clinical care. The pandemic has demonstrated that these barriers can be reduced; now it is time for advocates to argue why they must, and for policymakers to listen.
Anna Reed is a sex education teacher, community organizer, and attorney. She is currently a legal fellow at HIPS, a harm reduction service provider in D.C., Georgetown's O'Neill Institute for National and Global Health Law, and Elephant Circle.
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