By Rachel Sanoff

Earlier this year, 28-year-old Andrea*’s Pap smear results came back abnormal, meaning cell changes had been detected on her cervix. The Los Angeles resident was told to schedule a follow-up appointment with her gynecologist so that they could perform a cervical biopsy, a routine outpatient procedure for the 3 million people each year whose Pap smears potentially show signs of HPV, pre-cancer, or cervical cancer, or may otherwise be unclear. Then, in late March, Andrea received an email from her gynecologist: Her appointment had been canceled indefinitely. Due to the coronavirus, her medical facility would now be prioritizing what is considered essential health care only.

“I guess finding out what those funky cells in my cervix are or are not up to isn’t ‘essential,’” Andrea told MTV News. Her anxiety didn’t go away, even after she received another email from her gynecologist’s office in late April suggesting she can possibly reschedule the appointment for June. There are 20,417 currently confirmed cases of the novel coronavirus in Los Angeles county, and it’s not clear when the curve will finally flatten for the region. “With how things are going, do I even want to go into a hospital at the end of June?” she asked herself.

Around the country, medical centers have implemented restrictions and social distancing measures to protect both patients and doctors, as well as to not further overwhelm drastically overextended medical resources. But many people are now learning how to multitask, by keeping themselves safe from COVID-19 and managing their care for other illnesses and issues. And given that sexual and reproductive health care, in particular, are two vital facets of medicine already inaccessible to many due to legislation, gender bias, and various other forms of discrimination, many young people are now wondering how they’ll advocate for themselves in a health care system that is already stretched thin.

Molly*, who also lives in California, has been trying to get diagnosed and treated for excessive vaginal bleeding for months. “I only had nine days in the past month of no bleeding,” she told MTV News. When she called her gynecologist in late March, the 29-year-old was told that office hours were now reserved for patients receiving essential health care. For the duration of the COVID-19 pandemic so far, “essential” health care has been limited to treatments and appointments for life-threatening illnesses and injuries, or for conditions that otherwise require immediate treatment for the patient’s safety. “We did a consultation over the phone,” she says. “The doctor prescribed me heavy antibiotics and a yeast infection medication,” but the bleeding returned a few days after she finished both treatments. After another phone consultation, Molly was prescribed more antibiotics, but fears of overmedicating because of a potential misdiagnosis have kept her up at night. “I even took a pregnancy test because I have no idea what is happening to my body,” she said. “My hair is falling out excessively [from the stress] and I am bruising more easily, but I’m just told to ‘give it a few months.’"

The number of coronavirus cases in Andrea and Molly’s home state is still increasing and the stay-at-home orders show no signs of letting up. Because of these measures, more doctors in California and other states have started implementing telemedicine, or consultations with patients via video chats, into their practices. This is an understandably difficult way to provide treatment to patients, but it can be especially uncomfortable for patients in need of intimate medical care.

Abortion in the Time of Coronavirus

One of the most politicized elements of reproductive care is abortion, and conservative lawmakers wasted no time attacking it in the light of the novel pandemic. People in at least 12 states are finding it increasingly difficult to receive care that affirms their reproductive autonomy, given that lawmakers in states as far-reaching as Texas, Indiana, and Alaska have attempted to ban abortion during the pandemic under the malicious guise of being a "non-essential” medical procedure. Legislation surrounding these bans has been confusing and intimidating, with news seemingly changing every day. Judges in some states have intervened to block the bans; in Texas, Governor Greg Abbott ultimately signed an executive order on April 22 that eased restrictions, allowing abortion services to resume.

“For many, the relief from the most recent executive order comes too late,” Aimee Arrambide, executive director of NARAL Pro-Choice Texas, told MTV News. “Our state leaders manufactured an abortion access crisis amid a pandemic, making it the longest period of time since Roe v. Wade that Texans have been without access to abortion care in their state.”

According to Arrambide, the chaos resulting from appointments being scheduled and canceled repeatedly led to patients going without essential health care during a crucial window (Texas law bans most abortion after 21.6 weeks). ”Those who were able to access care had to travel out of state, risking exponential exposure to COVID-19,” she said, adding that allowing telemedical abortions in this instance would be life-changing for many people; the group is also lobbying for the state to eliminate its mandatory waiting period and in-person follow-up visits, which Arrambide said put an undue burden on people in need at any time, and especially during the pandemic.

Familiar Battles for Pro-Choice Activists

20-year-old Veronika Granado, who lives in Texas, got an abortion at the age of 17 after seeking a judicial bypass — a complicated legal process requiring numerous meetings with attorneys and judges so that Texan minors can access abortion care without parental consent. Because she is so familiar with state barriers, she sympathizes with young people: “My first concern is how hard it must be for other young teens to get this care because the whole process was already so confusing, even before COVID-19,” Granado, now a Peer Support Leader at Jane’s Due Process, an organization that helped her obtain her judicial bypass, told MTV News. “Judicial bypass already takes longer than it should, sometimes a couple weeks — and the longer you wait to get an abortion, the more expensive it is. That’s time and money a teenager might not have… It seems completely impossible.”

Moreover, the We Testify abortion storyteller wonders how a minor will navigate unsupportive guardians while living under stay at home orders; whenever she had appointments relating to her abortion, she told her mother she was visiting a friend’s house.

“The barriers [brought on by COVID-19] might be new to some people, but for young people, these barriers have been amplified,” Victoria Torres, an activist with the Chicago Abortion Fund, told MTV News. The 23-year-old, who received abortion care after the only brand of birth control pills she could afford as a college student failed her, began organizing with Advocates for Youth and joined the Fund as a helpline volunteer; she was moved by the knowledge that a lack of sex education and a lack of health insurance had hindered her ability to advocate for her own sexual health. In her work, she has already seen the economic impact of coronavirus on young people’s reproductive autonomy. Call volume increased at the Chicago Abortion Fund in April, and many of the calls Torres receives are from young people whose work hours have been reduced because of coronavirus, or who are ineligible for stimulus checks or unemployment.

“Some of us are not getting our stimulus checks because we’re still in college, or because we’re still considered dependents,” she said. “Many of us aren’t working and don’t get money — and even if we are supposed to get stimulus checks, they haven’t arrived.” Without this government assistance, Torres explained, some young people have said they’re forced to choose between paying rent or paying for their abortion, a dilemma that has already been the reality for many folks pre-COVID.

How Housing Instability Can Affect Reproductive Care

In addition to the chaos brought on by reduced incomes, out of pocket medical costs, and familial economic struggles, housing instability is also impacting young people’s access to HIV management, birth control prescriptions, and more. “So many young people who live on college campuses were forced to displace almost immediately, and moved into emergency housing or stayed with friends,” Diana Thu-Thao Rhodes, the vice president of policy, partnerships, and organizing at Advocates for Youth, told MTV News.

As a result, campus health clinics are no longer accessible to young people who relied on them, and students must focus on meeting basic needs like housing and safety before they can even consider navigating healthcare. And these barriers are discriminatory in their own way: Research has shown that LGBTQ+ youth are 120 percent more likely to experience homelessness than straight or cisgender youth.

Desireé Luckey, a 29-year-old bisexual woman, personally finds that COVID-19’s impact on public health makes her grateful for her IUD and “more confident than ever in the decision not to have children,” and she’s grateful she’s been able to use Planned Parenthood’s telehealth appointments as needed. But because she has those options, she is all the more attuned to the people who do not: “My concern is for LGBTQ+ folks who do not have reliable internet access for telehealth options or may be in living environments where it is unsafe or impossible for them” to access reproductive and sexual health care, the reproductive rights attorney told MTV News.

COVID-19’s ravaging of the global economy has also resulted in a record-breaking number of U.S. workers filing for unemployment: At least 26 million people, in the middle of a historic public health crisis have either lost employer-provided health insurance or the necessary income to pay for out of pocket medical expenses. They’re understandably worried about paying for rent, food, and other necessities — adding health care needs is one more burden with limited options.

Harmful Barriers for Those Already at Risk

People who are navigating pregnancy and planning births also face heightened dangers when seeking reproductive care during this pandemic. Among those most at risk are Black women, who are three to four times more likely to die from pregnancy complications than their white counterparts, and are now forced to navigate the high rates of Black people dying from COVID-19 complications.

“I’ve canceled any doctor appointment that I had coming up, and I know a lot of other queer people are looking into home remedies,” whether it be for various treatments or for home births, Mary E. Morall, a queer woman and doula who serves queer pregnant people, told MTV News. “LGBTQ+ people and queer Black people experience a lot of mistreatment from the medical community already or can’t access health insurance, so we don’t feel comfortable going to the doctor as is,” the 25-year-old said. “So something like this just makes the problem worse.”

And activists are worried that, as the world’s health concerns remain focused on coronavirus, the Trump administration and other governments may work behind the scenes to restrict other facets of health care. “We’ve been hearing that [the Trump administration] are getting very close to releasing the final rule for Sec. 1557,” Candace Bond-Theriault, the senior policy counsel for reproductive rights, health and justice at the National LGBTQ Task Force, told MTV News, “which is the nondiscrimination protection in healthcare services that prohibits discrimination on the basis of sex and gender identity.” Repealing this historic piece of legislation would profoundly harm trans people seeking any kind of healthcare, and especially reproductive and sexual health care, as well as other forms of affirming care.

Activists Fight Back

Working to expand sexual and reproductive health care access to numerous communities is not a new frontier for many activists. From the continued work of organizations like NARAL, Jane’s Due Process, and multiple abortion funds, to the ongoing advocacy of health clinics like Whole Woman’s Health in Texas, activists on the front lines are challenging COVID-19 restrictions just as they challenge any barrier: with accurate information and mutual aid.

Because of the overwhelming and ever-changing state of health care amid the coronavirus pandemic, Thu-Thao Rhodes told MTV News that Advocates for Youth has created a section on their website called Mutual Aid for Abortion Care During the COVID-19 Pandemic, where young people can receive up-to-date information about what services and abortion funds are available in every state. And local abortion funds like Fund Texas Choice are helping young people navigate the confusion of shifting abortion policies by guiding them through bureaucratic smokescreens and helping them pay for travel and medical services.

“I think the challenge right now is figuring out exactly what’s already out there [to access reproductive health care],” Rebecca Thimmesch, who leads youth contraceptive access work at Advocates for Youth, told MTV News. She anticipates telehealth apps will become a vital resource for young people in need of specific kinds of appointments — though she emphasizes telehealth is not an ideal option for everybody or every condition. Insurance through apps can be confusing, and some young people may be unable to receive necessary mail deliveries for treatment — like shipments of contraceptives — because of strict parents or housing instability. She points to the benefits of over-the-counter birth control pills, which would allow any young person to head into a pharmacy and stock up on medication while practicing social distancing.

Through it all, advocates stress that the kinds of obstacles that young people may encounter while navigating pandemic-era health services are frustrating, but not surprising. “Under ‘normal circumstances,’ it’s already really hard for young people to get the care they need,” Thimmesch said. “COVID is merely highlighting cracks in the system that were already there.”

*Names have been changed to protect privacy.