Even where SRH has been classed as essential, very few countries have taken measures to facilitate access to this care, explains Thomasen. She notes that France, Ireland and parts of the United Kingdom have enacted temporary measures to deliver care through telemedicine – using technology to remotely provide healthcare – and other means, and believes such measures should be maintained and replicated.

Akila Radhakrishnan, President of the Global Justice Center, says one reason countries may not have prioritised SRH is because ‘we still don’t have widespread understanding that denied abortion is a matter of life and death’.

In June, the World Health Organization published the report Maintaining essential health services: operational guidance for the COVID-19 context, stating: ‘Reductions in the availability of essential sexual reproductive health and maternal and newborn health services will result in many thousands of maternal and newborn deaths due to millions of additional unintended pregnancies, unsafe abortions and complicated deliveries without access to essential and emergency care’.

Marie Stopes, an SRH provider, had expected to reach over 15 million women and girls worldwide in 2020. Their Covid-19 impact projections warn that 4 to 9.5 million vulnerable women and girls risk losing access to their services alone. The organisation highlights that during and in the aftermath of the 2013–2016 Ebola epidemic in Sierra Leone, services were hit so hard that more women died from SRH emergencies than from Ebola itself.

Radhakrishnan says ‘this is a dangerous area where women’s bodies and lives get left behind’. She says the ‘ecosystem of the ways that SRH is being disrupted is wide’, with access problems around the world compounded by restrictions on movement, the impact of supply chain issues on the manufacture and distribution of contraception and healthcare resources, and patients suffering pandemic-related rises in unemployment and financial distress.

Radhakrishnan also highlights that low-income and Black, Hispanic and minority ethnic women are – as with many aspects of healthcare, as well as the impact of the pandemic itself – worst affected globally. In countries like the United States, where maternal and infant mortality rates are exceedingly high, women are also contending with anti-choice political agendas.

Molly Duane, a staff attorney at the Center for Reproductive Rights, says ‘in the US there’s a coordinated strategy to ban abortion or push it out of reach altogether. So, as the pandemic hit the US in earnest in March, the handful of states that are always attempting to ban abortion used the pandemic as a pre-textual excuse to once again try to shut down abortion access.’

Major medical organisations such as the American Medical Association named SRH, including pregnancy, abortion and contraception care, as essential services that must be prioritised throughout the pandemic.

This advice was ignored in some states.

In Louisiana, for example, the Attorney-General called for State clinics to close, arguing ‘elective abortions are not essential procedures’. Other states’ restrictions came under the guise of prioritising healthcare resources like personal protective equipment for the fight against Covid-19. Many of these states have so many other restrictions on abortion care that access to all family planning services was already limited.

Stephen Weiner, former Co-Chair of the IBA Healthcare and Life Sciences Committee, says ‘the difficulty is that decisions about how to ration and prioritise healthcare resources are being made on political grounds and not healthcare grounds. And anything this administration can do to promote an anti-abortion, anti-family planning agenda, it will use’.

Last year, 25 abortion bans in 12 states were enacted, but blocked from going into effect by legal action from rights groups. Nine of those states have sought to ban abortion during the pandemic, according to the Center for Reproductive Rights, which has again pursued legal action against state bans.

Duane highlights that the Center has filed two lawsuits against the State of Tennessee in as many months. The first, ‘to block the state from banning abortion during the pandemic, only to see the State legislature pass a bill banning abortion at a gestational age [six weeks] at which most patients don’t even know they’re pregnant yet’. The emergency lawsuit from the Center and other groups asks the court to immediately block the law if Tennessee’s Governor signs the bill.

Although the courts have restored access to SRH in all states so far, the impact has still been severe. Duane says, ‘The patients who needed abortions in Texas when it wasn’t available didn’t just disappear’. Blocked access ‘forced unnecessary health risks upon women, many of whom will either be forced to carry to term against their will or have had to travel across state lines for access to care, and the risks there are multi-variable.’

There are many states trying to ensure access to SRH at this time. And Weiner – who is also Founding Chair, Health Law Practice at Mintz – believes the US will expand access to telemedicine for SRH post-pandemic. But he says the end of the pandemic is unlikely to stop the assaults on reproductive rights.

In late June, the US Supreme Court blocked Louisiana’s excessive restrictions on SRH services, based on a previous judgment that blocked an almost identical attempt to place undue burden on abortion access in Texas. But Weiner believes the Louisiana judgment is not the victory for pro-choice groups it seems. ‘Chief Justice Roberts wrote an opinion that many will read as “when you come back with a better crafted legislative prohibition, we will support you”. He has written the script for the next lawsuit.’