On June 29, the Supreme Court struck down a Louisiana law requiring doctors who perform abortions to also have the ability to admit and treat patients at a local hospital. The same day, Iowa Gov. Kim Reynolds signed into law a new mandatory 24-hour waiting period between consulting with a physician and having an abortion. Other state legislatures are back at work enacting new barriers on accessing abortion.

While abortion clinics prepare to navigate additional legal restrictions on patients’ reproductive rights, workers are also navigating how to safeguard patients’ health during the COVID-19 pandemic. Across the country, anti-abortion activists have flouted CDC guidelines by not wearing masks when they protest clinics and exploit new distancing protocols to increase patient harassment.

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Roxanne Sutocky is the director of community engagement for The Women’s Centers, a network of five independent abortion clinics in Pennsylvania, Georgia, New Jersey, and Connecticut. She said clinic workers and escorts in New Jersey have seen anti-abortion protesters “acting in overall unhygienic ways” including not wearing masks, gathering in large groups at close distance, and even intentionally coughing on people.

“[Anti-abortion protesters are also] using the pandemic as a way to terrorize people, saying, ‘Don’t go in there. There’s COVID in there,’” Stucky said.

Clinics across the country control the number of people inside to limit any possible exposure to the virus. This means patients at some clinics have to wait in their cars or on the street, forcing them to spend more time near anti-abortion protesters. Patients without cars have nothing separating them from shouting protesters with signs, pamphlets, and, at times, sound systems.

Wula Dawson is the development communications director for the Feminist Women’s Health Center in Atlanta, Georgia. According to Dawson, just as the health center paused its escort program as a safety precaution, the number of protesters increased. During the pandemic, Dawson said she has seen as many as 50 people congregating in front of the clinic. Usually, the crowd is closer to 20 people.

“There’s been a bit of a bottleneck with people coming into the clinic that comes down into the parking lot,” Dawson said. “Patients waiting to safely come into the clinic are waiting very near the same space where the protesters are at, without masks, side by side with each other.”

The Atlanta-based center is Black-led and most patients are people of color, according to Dawson. She said there is an obvious racial divide between patients and clinic workers and those protesting.

“It is a particularly horrible dynamic of having these men shouting at these Black women,” she said. “Their initial premise has nothing to do with saving anyone or supporting anyone. It’s about control. It is racialized and it is gendered.”

The mostly white protesters also put Black patients at additional risk from the coronavirus merely by congregating in front of the Feminist Women’s Health Center.

In a statement released after the Supreme Court’s decision on the Louisiana law, Kimberly Inez McGuire, the executive director of URGE (a network of activists with chapters across the country that focus on increasing access to abortion), highlighted how restrictions on abortion have disproportionately affected the Black community and other marginalized groups.

“In the midst of a global uprising for Black lives, we cannot ignore the ways that Black young people, women, trans, and nonbinary people continue to be harmed by the hundreds of abortion restrictions left in place, policymakers’ failure to address Black maternal death, and the ongoing legacy of white supremacy,” said McGuire.

African Americans are among the hardest hit by COVID-19 as a result of long-standing inequalities in healthcare, according to the Centers for Disease Control and Prevention.

“The hundreds of abortion restrictions across the country are part of a centuries-old scheme to control the reproductive destinies of Black and Indigenous people and women of color,” McGuire said.

Lawmakers could have increased access to telemedicine abortion as a way to reduce possible exposure to the coronavirus. Using telehealth for abortion allows doctors to prescribe medication abortions after a virtual appointment. On Monday, a federal judge ruled the requirement for women to speak with a healthcare professional in person at a clinic before receiving abortion pills was a “substantial obstacle” during the current health crisis. The ruling was a big win for supporters of increasing access to abortion through telemedicine. However, states can still enforce their own restrictions of telemedicine for abortion despite the federal ruling. Currently, 18 states have effectively banned abortions by telemedicine, according to the Guttmacher Institute.

Lawmakers in Mississippi and Tennessee, meanwhile, are increasing restrictions on abortion, along with Iowa.

Amy Hagstrom Miller, the founder of Whole Woman’s Health, which has clinics in Texas, Maryland, Virginia, Minnesota, and Indiana, said at her clinics they limit the number of people inside to ten, which, again, means patients waiting outside. Anti-abortion protesters seized the opportunity: “The anti-abortion people are basically saying to each other, ‘You should come out and protest because now the patients are more accessible.’”

Miller was also the lead plaintiff in the 2016 Supreme Court case Whole Woman’s Health v. Hellerstedt, which challenged a requirement for doctors to have admitting privileges at local hospitals before they can perform abortions. The law was almost identical to the Louisiana one struck down last month.

“In a pandemic, the need for abortions is more important,” Miller said noting that all of the reasons people normally seek out abortions are compounded during a public health crisis.

As new coronavirus cases surge, once-novel safety guidelines will likely continue either until a vaccine is produced or new cases seriously decline. Mounting restrictions also create additional costs that are difficult for independent clinics to bear. Independent clinics account for 60% of abortions in the United States, according to Abortion Care Network. A 2019 report by the group shows 136 independent abortion clinics have closed in the past six years.