In response to the COVID-19 pandemic, every state has declared a state of emergency. In early May, some states started to lift restrictions on certain types of businesses; however, a majority of residents throughout the country are under stay-at-home orders and directives that affect access to health care. As states continue to extend or modify policies to keep people safe from contracting the coronavirus and protect the health care system, those efforts must also ensure that people can receive high-quality sexual and reproductive health services.

Decisions about sexual and reproductive health are among the most fundamental and personal, and delaying access to services can have substantial consequences for many people and their families. That is why the World Health Organization’s recent guidance on maintaining essential health services includes as a high priority “services related to reproductive health, including care during pregnancy and childbirth.”

Yet, even during this pandemic, some of the governors who oppose abortion have attempted to close all abortion clinics in their state. As of early May, litigation had been filed in nine states to ensure that this urgent and vital care remains available; in several instances, court decisions have prevented the closure of clinics.

In other states, governors’ executive orders are protective of reproductive health care, including abortion. The protections in these orders provide a framework, and there is much that state policymakers can do to build on this support. Here are 10 things that states should do to protect and ensure access to sexual and reproductive health care and rights during the pandemic.

1) Ensure that reproductive health care is included within essential health care. As governors seek to reduce coronavirus transmission, they must ensure timely access to reproductive health services. Although most executive orders have not addressed these services specifically, many states are diligently working to ensure continuity of reproductive health care. As of May 8:

With nearly a quarter of states specifically addressing access to at least some aspects of reproductive health care in their COVID-19 responses and the extension of stay-at-home orders in some states, policymakers should:

2) Ensure that abortion care is accessible and timely by repealing burdensome restrictions. Abortion restrictions in place in many states already prevent timely care and, for some people, make it inaccessible. The logistical barriers created by abortion restrictions are compounded by statewide stay-at-home orders and a worsening economic downturn. State policymakers should:

3) Protect individuals’ autonomy and choices in abortion care, including self-managed abortion. As some abortion clinics close (whether voluntarily or by state order), travel is restricted and risk of exposure to the coronavirus continues, more people may choose to self-manage their abortion. Also, people who experience pregnancy complications at home, including miscarriage or stillbirth, need to be able to seek medical care without fear of arrest for suspicion of having self-managed an abortion. And, others will continue to need abortion care at a clinic later in pregnancy for a number of reasons. Policymakers should:

4) Allow pharmacists to provide contraceptive services. When pharmacists are allowed to prescribe and dispense contraceptives, people can receive their care without having to separately visit a health care provider’s office. Pharmacy access measures can reduce patient interaction with health care locations that are overburdened by COVID-19 cases, which may lower transmission risks and free up capacity of health care providers to handle other needs. To support this service, state policymakers should:

5) Increase support for publicly funded clinics. Publicly supported family planning clinics, STI clinics and community health centers provide essential health services that people continue to need during the current crisis. For some people, these providers are their only point of contact for health care. Several states have already appropriated funds so that family planning clinics can remain open in spite of the 2019 federal “gag rule” that slashed the national Title X provider network’s capacity in half. States must provide additional funds for continued support as the COVID-19 pandemic stretches providers’ resources. Policymakers should:

6) Respond to the needs of pregnant and parenting individuals and continue efforts to reduce maternal mortality. Health experts are still learning about the effects of COVID-19 on pregnant individuals. So far, there is no evidence to suggest that people who are pregnant are at greater risk of illness. However, pregnancy suppresses the immune system, making pregnant people especially vulnerable to viral respiratory infections and severe illness. The coronavirus pandemic is unfolding in the midst of a national maternal health crisis in the United States, where black women are dying from pregnancy-related causes at more than three times the rate of white women. COVID-19 will only exacerbate the existing inequities and racism that black women and other women of color experience with the health care system. In order to appropriately support all pregnant individuals during the pandemic, policymakers should:

7) Support sex education in remote learning programs. Schools that offer sex education may teach it only once in middle or high school, and students should not miss the opportunity to receive this instruction. High-quality sex education covers communication skills, emotional self-awareness and tools for healthy relationships that can help young people navigate family dynamics and explore their sexuality in healthy ways during the current crisis. To promote this instruction, state policymakers should:

8) Expand public and private insurance coverage of reproductive health services. Insurance coverage of reproductive health services is essential for access to and affordability of health care. Coverage has become even more critical during the coronavirus crisis, when people seeking care must navigate overburdened health care systems in unprecedented circumstances. States can pursue multiple approaches to ensure that people can obtain necessary care, including by expanding coverage under both private health insurance plans and Medicaid.

Experts have recommended suspending all Medicaid copayments; allowing insurance plan enrollees to obtain more than a month’s supply of their prescriptions at one time; requiring insurance coverage, without cost sharing, of COVID-19 testing, treatment and vaccination (once available); and ensuring Medicaid coverage for people who are not currently living in their state of residence. Specifically for sexual and reproductive health, state policymakers should also:

9) Broaden access to sexual and reproductive health care through telehealth. Expanding access to telehealth options allows people to interact with health care providers while practicing social distancing to reduce exposure to the coronavirus. Telehealth can be used to provide many reproductive health services, and state policymakers should permit the full range of these services during the COVID-19 pandemic by taking steps to:

10) Protect patients from religious and moral refusals of care. For decades, state laws have allowed organizations and individual health care providers with an expressed religious or moral objection to refuse to provide abortion, contraceptive and sterilization services. In almost all of these refusal clauses, there is no requirement that the refusing provider facilitate patient access to these services elsewhere. These refusal clauses limit the number of available providers for reproductive health care and could be even more burdensome—and perhaps life threatening—during the COVID-19 crisis.

At all times, and especially during a public health emergency, people need to be able to seek care without fear that it will be denied on the basis of their sex, sexual orientation or gender identity, or because the provider has a religious or moral objection to the procedure. State policymakers should:

Since March, reproductive health care providers and patients have had to navigate a new reality, and many providers have taken innovative approaches to offer care that is both effective and centers the needs of their patients. Policymakers at the state level have the responsibility to support these efforts and use the tools at their disposal to ensure that sexual and reproductive health care is accessible and available to all who need it. These policy recommendations provide a solid foundation for the provision of care now and beyond this pandemic.