With delays in reproductive health care already taking place, officials with American Civil Liberties Union of New Mexico said it could get worse as the global pandemic of COVID-19 continues.

Ellie Rushforth, a reproductive rights attorney for ACLU-NM, sent letters to elected officials Monday urging them to ensure reproductive health care will remain accessible during the public health emergency. The letters, to Governor Michelle Lujan Grisham, congressional officials and the mayors of Albuquerque, Santa Fe and Las Cruces, ask that they consider abortion care, all forms of birth control; STI screening, testing, and treatment; vaginal health and treatment; prenatal, delivery, and postnatal care as essential reproductive services that need to remain accessible.

The letters outline immediate steps, including that reproductive health care clinics and outpatient abortion providers be considered, “essential business.”

Lujan Grisham announced a stay-at-home order Monday in an attempt to slow down the spread of COVID-19, a type of coronavirus. As of Monday, March 23, the state has 83 test positive cases, with 18 new ones.

Related: Guv issues ‘stay at home’ order to slow coronavirus spread

The new public health order shuts down most businesses but does contain exceptions. One exemption is health care clinics that provide reproductive health care, according to Nora Meyers Sackett, press secretary for Lujan Grisham.

Rushforth said the public health crisis caused by the lack of infrastructure to contain COVID-19, a disease caused by a coronavirus, could affect reproductive health in a number of ways, including restricting independent movement and travel.

Rushforth also said that as restrictions go into place, there could be supply chain interruptions. That would hurt the most vulnerable, including low income families, LGBTQ communities, incarcerated people and immigrants.

“Those communities will be impacted first and the hardest,” Rushforth told NM Political Report. “We want to ensure that good healthcare is provided and civil liberties and rights are respected during this time.”

Rushforth said that many health care appointments, including prenatal care appointments, are being delayed or are being moved to telemedicine.

“As we begin to see more and more appointments moved to telemedicine, many communities in New Mexico don’t have access to broadband internet,” Rushforth told NM Political Report.

New Mexico’s infant mortality rate in 2016 was 6.3 per 1,000 live births, which is higher than the national rate of 5.9 per 1,000 live births, according to the state Health Department.

A lack of access to prenatal care can affect both an infant’s overall health and the rate of mortality, say advocates. Given the additional strain that the lack of infrastructure to contain COVID-19 has placed on the state, how that may affect a person’s ability to seek both prenatal care and postpartum care are also concerns for ACLU-NM. That’s particularly true if the person seeking prenatal or postpartum care is a person of color or rural or low-income.

“Resources are already strained for many families. Giving birth can be an expensive proposition for families,” Rushforth said.

Prior to the global pandemic, the rate of unemployment was 22 percent in New Mexico’s tribal communities, while it was four percent nationally, according to advocates.

Even though the state deemed reproductive health care facilities  as essential, advocates are worried, in part because of what they are seeing happening in other states, as well as federally.

“We’ve seen at the federal level and in other states elected officials taking advantage and exploiting the crisis to limit abortion access. Reproductive health care, including pregnancy, delivery, postnatal care and contraception are essential and we know anti-abortion extremist legislators are not above shutting down clinics,” Rushforth said.

Related: Abortion fund providers say global pandemic causing difficulties

Rushforth said another concern are protestors who still gather in front of abortion clinics in New Mexico, despite repeated appeals by state and health officials to stay at home as much as possible. Rushforth said the state needs to ensure that the protestors are not putting the providers and the patients at increased risk from COVID-19.

Another reproductive health concern is protective personnel equipment (PPE) for medical providers.

“In systems of care and hospital settings, appropriate protective equipment, like masks and gloves and other gear, are in short supply and are having to be reallocated,” Rushforth said.

Another group who could face increased difficulties during the public health emergency are the LGBTQ community, according to advocates. Rushforth said that around the country, people who are transitioning are experiencing delays or deferments on transition surgeries and medical care. Rushforth said that oftentimes, those who are transitioning have been waiting and working toward the process for years.

“It’s very challenging for folks who need that care,” Rushforth said.  

Another concern brought up in the letters is contraception. Legislators passed a bill last year that allowed people to access contraception for six months to a year, depending on the provider. That bill went into effect January 1, Rushforth said.  

But, ACLU-NM would like to expand it further during the crisis.

Currently, those who use Medicaid can access contraception medication with a prescription up to 12 months. People who carry private insurance can get contraception medication with a prescription up to six months.

“We’re recommending limitations on prescription refills be suspended or increased with appropriate guidelines to encourage social distancing and access to medication,” Rushforth said.

Rushforth said now during the public health emergency, it’s important to be vigilant to ensure reproductive healthcare remains accessible.

“We need a response plan to the COVID-19 public health emergency that protects the health, safety, and civil liberties of everyone in our community,” Rushforth said in a written statement. “Even in times of crisis, it is critical that New Mexicans continue to be able to make their own reproductive health decisions and access the care they need without interruption.”