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Georgia is a state notorious for its hostility to abortion access—the state's recently blocked six-week ban aimed to prohibit abortions before most people even know they are pregnant. But during COVID-19, Georgia also happens to be one of a small number of states allowing for abortion by telemedicine through a national study. And a new court ruling—plus a lack of specific legislation against telemedicine abortion in the state—may further expand the reach of abortion access.

Abortion by telemedicine provides a way for people to get abortion care without leaving home.

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If you live in the South, it's likely that you're in a county without a clinic that provides abortion care, so you'll probably have to travel. That's a lot easier if you have a vehicle, a place to stay near the clinic, money for childcare, the ability to miss work, and up to $1,000 to pay for your abortion. And it helps if you're white, a U.S. citizen, insured, cisgender, fluent in English, HIV negative, and haven't experienced sexual assault or medical trauma. Now, the COVID-19 pandemic has added another hurdle, especially for people who have lost income or are immunocompromised.

Abortion by telemedicine provides a way for people to get abortion care without leaving home.

"It's a small success," said Melissa Grant, the C.O.O. of Carafem, a clinic in Atlanta that offers abortion care via telemedicine.

See also: 'Abortion bans aren't just about abortion'—The fight for reproductive justice in the South

Carafem partners with the research organization Gynuity on a national TelAbortion study that enables patients to consult with clinic staff over the phone and meet with a physician virtually. Usually, people who are up to 10 weeks pregnant are eligible for a medication abortion, which involves taking two pills to terminate the pregnancy. Medication abortion, which is different from Plan B emergency contraception, is considered safe and effective by the FDA. For the TelAbortion study, the agency requires that patients receive an ultrasound, but that's being waived for some patients for whom going into a clinic is an additional risk during the pandemic. TelAbortion patients can receive pills in the mail—at their home address or across the border in a participating state—and have an abortion at a time and location that is best for them.

While the partnership began just over a year ago, demand for these services has increased in the wake of COVID-19. Grant said that before March, there were only a few Georgia TelAbortion patients each week. In the month of June, 30 Georgia patients received care through the TelAbortion study. Nationally, the study has provided about 1,200 abortions in 13 states since 2016, a small fraction of the almost one million U.S. abortions per year estimated by the Guttmacher Institute.

On July 13, a federal court ruling opened up the opportunity for more people to use telemedicine to get abortion care. The ruling allows medication abortion pills to be mailed to a patient during the pandemic, and will be in place until at least 30 days after the federal government's public health emergency. While this could open the door for abortion by telemedicine in Georgia, other Southern states—like Louisiana, Mississippi, Alabama, and South Carolina—currently have state laws that specifically prohibit it. And those aren't changed by the ruling.

"My hope is that this will extend way beyond a global pandemic and become standard practice."

While Carafem is the only Georgia clinic currently providing medication abortion by telemedicine, the ruling creates the possibility for others to follow suit. But they're proceeding cautiously.

"We're really encouraged about the court's decision that would make access just that much easier for folks," said Kwajelyn Jackson, the Executive Director of the Feminist Women's Health Center in Atlanta, which provides abortion care and other gynecological services. Jackson said she will work with clinic staff to determine how to implement abortion by telemedicine in a political climate that is still hostile to abortion access.

"Finally there's an opportunity in some small way to really be considerate of the specific constraints that people are facing. My hope is that this will extend way beyond a global pandemic and become standard practice," she added. 

While the potential for expanded telemedicine for abortion leaves advocates cautiously optimistic, the vast majority of people seeking abortions in the South must travel to a clinic to access in-person care. And over the years, state lawmakers and anti-abortion activists, especially in the South, have worked strategically to place hurdles between a pregnant person and abortion care.

See also: Mississippians are on the frontlines of the battle for abortion rights

"Legally it is accessible, but financially and logistically it is out of reach for many people," said Quita Tinsley Peterson, co-director of ARC-Southeast, a Southern abortion fund based in Atlanta. ARC-Southeast provides funding and practical support—rides, childcare, lodging—to people getting abortion care in Southeastern states.

Challenges to getting care

The patchwork of restrictions looks different in each state, but generally includes a variety of measures: prohibitions on state Medicaid coverage of abortion care, mandatory biased abortion counseling designed to discourage patients, requisite waiting periods of up to 72 hours before a procedure, obligatory ultrasounds before an abortion (often the provider is mandated to show and describe the image to a patient), requirements that only a physician—not midwife, physician assistant, or nurse practitioner—can provide abortion care, and burdensome standards around clinic equipment and facilities. These laws are medically unnecessary and designed specifically to provide barriers to abortion care.

Because of systemic racism and resulting economic inequality, these barriers to accessing safe abortion care impact communities of color the most.

"The culmination and compounding effect of generations of systemic racism that has kept people perpetually poor, disenfranchised, disconnected, and neglected—those are the reasons that these kinds of restrictions and laws have disproportionate impact," said Jackson, from the Feminist Women's Health Center.

And the same systemic inequities that push people to seek care outside of clinics, also result in disproportionate criminalization of those people for self-managed abortion. While six states explicitly ban self-managed abortion, many others use unrelated criminal statutes to prosecute people for terminating their own pregnancies.

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"We need to keep pushing and fighting to make all reproductive healthcare more accessible, including abortion care."

If/When/How, a national nonprofit network of legal professionals working for reproductive freedom, has a helpline dedicated to informing callers about their legal rights regarding self-managed abortion. Executive Director Jill Adams said that within the first weeks of the pandemic, calls to the helpline doubled.

"There are major gaps in clinic-based abortion access in the US," said Adams. "Self-managed abortion, which can be safe, effective, and private, has the potential to fill those gaps and a way to return agency and put the power back into people's hands so they can have an abortion that's right for them with the timing, method, location, and companion that they choose."

Organizations like the National Institute for Reproductive Health are working to roll back restrictions on abortion. Others, especially those with a reproductive justice framework like SisterSong in Atlanta, are working to create the conditions for people to be able to choose whether or not to have children, and to parent the children they have in safe and sustainable communities. 

"We need to keep pushing and fighting to make all reproductive healthcare more accessible, including abortion care," said Tinsley Peterson of ARC-Southeast.

See also: Meet five Black and Brown Southerners running for office to change the system

Facilitating access to birth control and instituting living wages are other ways to support reproductive freedom and give people the opportunity to make the choices that are best for them and their families.

"People should be able to have the children they want to have and the families they want to have. We believe society should support people to do that," said Grant from Carafem. "Everyone should be able to receive the type of care that feels best to them."

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Emily Weyrauch

Emily Weyrauch is a queer freelance writer in Atlanta. You can find her work at emilyweyrauch.com and connect on twitter @emily_weyrauch.