The Hidden Epidemic: Covid 19 and Domestic Violence

In March 2020, at the onset of the COVID-19 pandemic in the United States, statewide lockdowns and stay-at-home orders or advisories found the majority of Americans consigned to their homes for the safety of themselves and those around them. While this strategy was useful in some states for the management of the outbreak, it created a very dangerous situation for people who live with abusive partners. Stressful situations trigger high levels of abuse. Consequently, domestic violence became a more prevalent threat as many families faced a loss of income, increased time around family members, and the loss of family members to the virus. Sociologists have noted in the past that instances of domestic violence rise “whenever families spend more time together, such as the Christmas and summer vacations” (Taub 2020). Thus health professionals have a justifiable concern over domestic abuse cases rising over the course of the pandemic. As the stay at home guidance persisted, states searched for ways to best support people who might be struggling with domestic violence. In Massachusetts, Attorney General Maura Healey compiled a list of resources for victims of violence to help them navigate living with their abusers during the COVID-19 crisis. Healey also joined 23 other Attorneys General (Ags) in asking the Senate to reinstate the Violence Against Women Act (VAWA). VAWA expired in 2019 and while it received a passing vote from the House of Representatives, it has not received consideration in the Senate (Ferguson 2020). VAWA, originally signed into law by President Bill Clinton in 1994, has an oscillating history. Part of the statute was struck down as unconstitutional by the Supreme Court in United States v. Morrison and the law has gone through an ebb-and-flow of expiration and reinstatement by the legislature (Ferguson 2020). In their letter, the Ags cite VAWA as a comprehensive way to protect those who are “uniquely vulnerable to violence and abuse” including women of all colors and transgender people. However, the bill that once received bipartisan support in both houses of Congress is unlikely to reach the Senate floor. Votes rarely cross party lines and with many senators up for re-election, politicians are unlikely to vote on controversial bills that might jeopardize their seat. It is unfortunate and troubling that protecting women and other marginalized groups is somehow seen as too sympathetic to the other side of the aisle. The New York Times has called domestic violence during COVID-19 a “hidden epidemic” (Lee and Kelley 2020). It is a crisis within a larger crisis and is often overlooked because the gravity of the virus has overtaken much of daily news reporting. The burden of the domestic violence epidemic is often only visible to hotline workers. Domestic violence crisis centers reported a spike in calls as communities entered and remained in a state of lockdown. There are many obstacles currently facing survivors of abuse, especially call center operators working under varying conditions and the court system operating at limited capacity. These barriers, combined with an inability for victims to distance themselves from their abusers, allow an often invisible crisis to grow. Victims feel isolated from the coping techniques and safety measures that protected them before the pandemic.

It would be beneficial to continue making statewide domestic violence resources more publicized and less stigmatized. I agree with the Attorney Generals’ decision to sign on to the letter to Senate Majority Leader McConnell and other Senate leadership. Even if the pressure is not enough to bring VAWA to a vote on the Senate floor, it is important to continue advocating for the safety and support of people who lack the privilege of feeling safe while staying at home. Amanda Taub, writing for the New York Times, issues a harrowing warning: “Eventually the lockdowns will end. But as the confinement drags on, the danger seems likely to intensify. With Covid-19 ravaging the economy, such crises are set to become much more frequent” (2020). She’s absolutely correct. Stay at home mandates offer abusers personally turbulent situations and unprecedented access to control. At some indeterminate point in the future, society will return to what it was. The trauma of domestic violence, however, will not fade away. States that have made it easier for victims of abuse to access restraining orders and other forms of legal action should continue to make those resources widely available. Mental health resources should be expanded and efforts to destigmatize them should be set in motion. The Violence Against Women Act should be considered for reinstatement because it means closing loopholes and protecting populations that have been more vulnerable during this pandemic than ever before.

Ferguson, Bob. “Request to Reauthorize the Violence Against Women Act.” Received by Mitch McConnell, Lindsay Graham, Charles Schumer, and Dianne Feinstein, Office of the Attorney General of Washington, 4 May 2020, Olympia, Washington.

Lee, Christopher, and Kelley, Lauren. “Who Bears Witness to a Hidden Epidemic?” The New York Times, The New York Times, 14 July 2020.

Taub, Amanda. “A New Covid-19 Crisis: Domestic Abuse Rises Worldwide.” The New York Times, The New York Times, 6 Apr. 2020.

Medical abortion, which occurs when someone terminates their pregnancy through prescription drugs, has grown in popularity since its debut in the U.S. in 2000. The privacy, convenience, and safety this treatment offers patients (compared to traditionally invasive surgical procedures) explains why roughly 40% of all abortions in the U.S. are medical abortions (Joffe 1). Although this option has been available for twenty years, the U.S. has recently seen a surge in prescription requests during the COVID-19 pandemic. Between stay at home orders, lockdowns, and limited access to medical care during the crisis, many worry that people seeking abortions will be unable to access treatment while they are still eligible for it. This harsh reality has forced states to defend their most stringent abortion policies, particularly those pertaining to medical abortion: the more accessible and safe option for patients seeking abortions during the ongoing pandemic. Medical abortion occurs when someone takes two pills, mifepristone and misoprostol, to terminate their pregnancy. Mifepristone blocks the progesterone hormone and breaks down the uterine wall. Misoprostol, an anti-ulcer treatment, causes contractions that induce miscarriage (Adams 1). Although approved by the U.S. Food and Drug Administration, misoprostol is heavily restricted. Patients can only be prescribed the medication up until ten weeks into their pregnancy. Additionally, the F.D.A placed mifepristone in the Risk Evaluation Mitigation Strategies program, subjecting those who seek a prescription to numerous rules and regulations. While drugs classified under the Risk Evaluation Mitigation Strategies program are typically known to have severe side effects, mifepristone is scientifically proven to be safe when taken to terminate pregnancy. Unfortunately, this classification makes it much more difficult for patients to obtain a prescription. For example, mifepristone cannot be dispensed in a pharmacy. It can only be obtained through a doctor certified to prescribe the drug, an F.D.A. patient agreement, or a clinic or hospital (Adams 1). Once a patient finds a clinic where they can be prescribed the medication, they must also find a medical professional who is willing to register with the drug’s distributor. This detail, although small, has made obtaining the medication harder. Some doctors are aprehensive about registering with the drug’s distributor because it will publicly link them to abortion. If that wasn’t enough, doctors who offer medical abortions must also abide by the same government restrictions which apply to surgical abortions, such as rules of parental consent, waiting periods, and ultrasounds (Joffe 1). Eight U.S. states require every patient seeking an abortion to receive state-mandated materials claiming abortion causes “lasting emotional and mental health harm,” despite the fact that there is no evidence this is true (Rocca et al. 1). These rules and regulations are clearly only in place to make seeking an abortion more difficult. Texas continues to be one of the strictest states when it comes to abortion. On March 22, 2020, Texas Governor Greg Abbott issued Executive Order GA-09, postponing all medically unnecessary surgeries and procedures until April 21, 2020. Abbott cited the need to preserve hospital space and personal protective equipment to fight COVID-19. Because Texas is one of

seventeen states which require a physician to be physically present when dispensing medications necessary for medical abortion, Abbott’s Executive Order prohibited thousands of women from exercising their constitutional right to govern their own bodies (Donovan 1). Following Abbott’s order, the state saw a 94% increase in “requests for medical abortion by mail” (Truong 1). Instead of recognizing the incredibly high demand for this medical care, Governor Abbott and Texas Attorney General Ken Paxton continued to defend and justify the order. Luckily, Executive Order GA-09 explicitly states that any procedure that would not deplete hospital capacity or personal protective equipment may be performed. This detail encouraged pro-choice advocates, who argued that medical abortions should continue since the consultations typically do not occur in a hospital and little personal protective equipment is required. Frustrated that executive branch state officials were using a pandemic to advance their efforts to restrict abortion access, pro-choice organizations filed a law suit. The case bounced between circuit and lower courts until U.S. District Judge Lee Yeakel blocked the order, claiming it prohibited women from exercising their “fundamental constitutional right[s]” which had already been decided by the United States Supreme Court in Roe v Wade (Najmabadi 1). Judge Yeakel also extended the legal limit for an abortion to 22 weeks after the patient’s last menstrual cycle — by April 22, the expiration date of Executive Order GA-09. Although temporary, this ruling was a huge win for Texas women and pro-choice advocates. Texas is just one example of a state where politicians are using the COVID-19 pandemic to advance their political agendas and further restrict abortion acess. Unfortunately, attempts at policing people’s bodies and reproductive systems are happening all over the country. However, it’s comforting to know that the precedent set by Roe v. Wade in 1973 still holds true. It’s an individual’s constitutional right to have autonomy over their own reproductive system and we must never forget that truth.

Adams, Patrick. “Opinion | Amid Covid-19, a Call for M.D.s to Mail the Abortion Pill.” The New York Times, 12 May 2020.

Donovan, Megan. “Improving Access to Abortion via Telehealth.” Guttmacher Institute, 7 May 2019.

Joffe, Carole. “A Rare Expansion in Abortion Access Because of COVID-19.” Time, 28 Sept. 2020.

Najmabadi, Shannon. “Federal Appeals Court Allows Medication Abortions in Texas during Coronavirus Pandemic.” The Texas Tribune, 14 Apr. 2020.

Rocca, Corinne H., et al. “Emotions and Decision Rightness over Five Years Following an Abortion: An Examination of Decision Difficulty and Abortion Stigma.” Social Science & Medicine, vol. 248, Mar. 2020, p. 112704.

The State of Texas, Executive Office of the Governor [Greg Abbott]. Executive order GA-09: Relating to hospital capacity during the COVID-19 disaster. 22 Mar. 2020. Office of the Secretary of State, 22 Nov. 2020, pp. 1-3.

Truong, Kimberly. “The Demand for At-Home Abortion Is Increasing Amid the Coronavirus Pandemic.” InStyle, 23 July 2020.