Iowa City clinics that provide sexual and reproductive health services are advocating for certain surgeries to be defined as essential medical procedures as state guidelines limit elective surgeries to conserve Personal Protective Equipment for health-care workers.

The University of Iowa LBGTQ+ Clinic and the Emma Goldman Clinic are two of many health care facilities that have shifted to a new norm of telehealth appointments and limited in-person visitations, and are fielding concerns from patients about suspended procedures.

In March, the governor mandated that hospitals and clinics halt nonessential and elective surgeries in order to conserve PPE to treat COVID-19 patients and conduct emergency operations.

After initial confusion as to whether the nonessential surgery ban applied to all abortions, the state of Iowa and pro-choice advocacy groups reached an agreement in court that the restrictions would apply only to “nonessential” surgical abortions that could be delayed without causing the individual undue harm.

Beginning April 28, the governor relaxed the ban on nonessential and elective procedures as long as the hospital or clinic could sustain its own supply of PPE without relying on government stockpiles and have a plan for timely COVID-19 testing for symptomatic patients. University of Iowa Hospitals and Clinics and Mercy Iowa City began ramping up elective procedures in the last two weeks.

The Emma Goldman Clinic, an Iowa City-based member of the abortion-care network that provides sexual and reproductive services, is providing medically induced, such as from a pill, or non-surgical first trimester abortions, but isn’t performing surgical abortions.

Emma Goldman Clinic Co-Director Francine Thompson said that COVID-19 has wreaked havoc on the clinic, adding that the staff had to tell patients that surgical abortions were not considered essential, contradictory to the clinic’s core messaging.

The abortion options the clinic can offer during this time, Thompson said, can compromise a woman’s confidentiality.

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“Some women cannot be at home with families or with husbands and have an abortion safely,” Thompson said. “If it is not a positive relationship, it can be problematic. It can jeopardize confidentiality. That might not have been [her] choice to have a medical abortion, but that’s all we can do for them.”

Although the government’s mandate deemed some surgical abortions “nonessential” but Thompson said she believes that such time-sensitive procedures as abortions are still necessary practices to continue during the novel-coronavirus outbreak.

“A pregnancy is a time-sensitive issue, especially an unwanted one,” she said. “It’s not about why a woman is not continuing [the pregnancy], it is her personal choice. A pregnancy not wanted and forced to continue because the service is withheld from her can have life-altering consequences.

Thompson said she has noticed individuals across the country using health-care terminology to protest stay-at-home orders and PPE-wearing mandates.

“It is interesting to notice that there is some connection to reproductive and sexual health care advocacy,” Thompson said. “‘Don’t tell us what to do with our bodies.’ You know, we’ve been saying that for years.”

Sexual and reproductive needs do not go away during a pandemic, she said, and the restrictions in place are highlighting existing inequalities in the health-care system. Individuals that relied on campuses to provide contraceptive care are now being forced to find another access to health care, she added.

Clinics that rely on building rapport with their patients are finding it difficult to provide sufficient physical, mental, and emotional support, as the UI LGBTQ+ Clinic discovered when it had to tell patients that surgeries and treatments planned months in advance were now canceled.

UI Hospitals and Clinics LGBTQ+ Clinic Co-Director Nicole Nisly said the uncertainty among gender-dysphoric patients has been difficult when surgeries deemed nonessential were suspended.

“[Patients] plan ahead for these surgeries, undergo several months of preparation, and then COVID-19 hit, and then suddenly, they stopped,” Nisly said. “You are waiting your entire life to become the gender you want, and it gets suspended indefinitely. These patients were ready.”

She described gender dysphoria as “suffering because who you are in your brain and in your heart is not what you look like on the outside,” and said that any practices relating to gender dysphoria should be considered essential.

“Some of my patients became suicidal because their surgeries were at hand and then they were not,” Nisly said. “We had no idea when we would reopen. When a patient is at high-risk, that makes the practice essential. If it does not happen, you could die. That’s the line.”