In the last two months, at least 10 states have banned or attempted to ban abortion access, citing the need to slow the spread of COVID-19 as a reason.
That hasn’t happened in Oregon. While Gov. Kate Brown did restrict non-essential medical procedures (and plans to start lifting those restrictions next month), abortion—as well as other reproductive health needs, such as sexually transmitted infection (STI) testing—weren’t deemed non-essential here.
“We’re lucky to live in a state where we don’t have to argue that what we do is essential services,” said Anne Udall, the president and CEO of Planned Parenthood Columbia Willamette (PPCW). “It’s really clear that Oregon and Washington see our work as essential services.”
But this doesn’t mean that the coronavirus hasn’t changed the way Planned Parenthood does business in Oregon. The Mercury recently spoke to Udall and PPCW Medical Director Dr. Paula Bednarek about how social distancing needs have affected Planned Parenthood operations—and how some of those changes might become permanent solutions.
MERCURY: How has COVID-19 impacted the services Planned Parenthood is able to provide?
BEDNAREK: We've obviously stepped up our telemedicine services [via video calls] to provide any services we can. We’ve actually created a new protocol to provide medication abortion via telemedicine that we would've previously had to provide in-person.
But we definitely still provide in-person care when we can’t do it via telemedicine. Things like surgical abortions, the evaluation and management of miscarriage… and ectopic pregnancy, we are offering in person.
Also one of the services we provide for people of all walks of life is birth control. We can do a lot via telemedicine, but people still need to be able to get their birth control, so we have all of our health centers open and functioning as pharmacies. So we can dispense birth control, [and] antibiotics. We also have them functioning as laboratories, so we can do blood testing, STI swabs, and other testing for patients who need it.
Our gender-affirming hormone therapy [is something] we’re doing via telemedicine and in-person when necessary, and PrEP we’re doing via telemedicine. And all of our normal patient checks—people who have questions about their breast health or anything else—we start with telemedicine evaluation, and anything we can’t do there, we see them in person.
The primary goal is to make sure our patients’ needs are met and that we help them stay out of the hospital, so the hospitals can focus on acute care, and we can lessen their burden.
It sounds like you’re still able to offer most of your services in one way or another. Are there any services you’re not offering at the moment?
BEDNAREK: The main visits we've temporarily suspended are wellness visits—things like screening PAP smears. We’re still doing some preventative care… but wellness visits are the ones we've ended temporarily.
You mentioned you’ve been able to provide medication abortions—also known the abortion pill—completely via telemedicine. Can you tell me more about how that works?
BEDNAREK: [On a video call], we discuss their medical history, and all the important safety implications for a medication abortion. We have a very clear checklist and criteria for when people can obtain a medication abortion without an ultrasound, and without lab work, and could actually have what we call a "no-touch" medication abortion where they can literally not leave their home.
Then they can either come to our health center and pick up their medicine—or we’re also participating in a research study called “TeleAbortion,” where we can actually mail them the medications and they truly don’t need to leave home, if they can qualify. Our primary focus is safety.
If they don’t qualify—if their periods are very irregular, or they can’t figure out their date—then we would help them schedule an ultrasound and any other lab test they may need. We can still provide the vast majority of care and counseling via telemedicine, and they can have a very decreased contact, which is important for both patient and staff safety.
We also combine it with telephone if needed—depending on what technology the patient has, and if we need to, we'll combine it with translators as well.
You've started relying on telemedicine a lot more now. Do you think that change might become permanent, even after the need for social distancing ends?
BEDNAREK: Absolutely. We have actually been providing telemedince care for medication abortion for years as part of a research study, and it had been limited more by policy, rather than by patient interest or our interest. …It’s incredibly successful, and we'll definitely continue that work.
UDALL: My sense is that we’ve always had the interest, but what’s happened as a result of COVID-19 is that a lot of restrictions were lifted by the state—and this is happening across the country.
There’s always going to be a need for people to be seen face-to-face for certain things. But we see it as more of a mix going forward.
Have you started thinking about the long-term public health effects that COVID-19 will indirectly have on the clients you serve?
BEDNAREK: We are definitely thinking about that. It’s incredibly important… the downstream effects.
One of the big things is that STIs spike if there’s not enough screening. We’re suspending that [testing] temporarily—very briefly—and we’re making sure to bring that back, understanding that the long-term effects of inadequate testing can be catastrophic at an individual level for patients, and also at a population level.
UDALL: One of the things we’re thinking a lot about is, as we’re coming out of quarantine, we’re going to see a changed economic picture for a lot of people, and our services are going to be vital. We're going to have a pent-up demand as people move off of private insurance as they lose their job, and onto OHA and Medicaid. We’re going to see a huge demand.
Is there anything else you want people to know about Planned Parenthood during this unusual time?
UDALL: Part of what we’re trying to tell people is we’re open for business. …We believe our services are offered with great care and compassion. We’re open, and we’re doing it in a way that’s respectful of COVID-19. We want to help.
BEDNAREK: We have an amazing staff, and people are very, very committed. In the midst of everyone dealing with their own suffering now, they’re still showing up.