I'm a doctor. Why it took me years to truly understand abortion care.

I never set out to become an abortion provider, but somewhere along the way to becoming a physician, it became necessary.

I spent many of my formative years in conservative Indiana, where one of my closest high school friends, a devout evangelical Christian, introduced me to pro-life rhetoric. I was still figuring out my own religious and political beliefs on the matter. She often invited me to anti-abortion demonstrations, but after quiet deliberation, I would decline. I didn’t have the vocabulary to articulate why.

Over a decade later, I am an OB-GYN in my last year of residency in Washington, D.C. As part of my training, I have learned how to treat women’s medical needs and guide them through reproductive choices. For me, being an OB-GYN means being a safe space. In this office, we talk about intimate partner violence, financial concern, fears about motherhood, breastfeeding, sexually transmitted infections, gender identity and sexual partners. Nothing is off the table, including abortion.  

Here in our nation’s capital, abortion is legal and protected, yet it remains difficult to access for Washington’s most vulnerable patients. With the overturning of Roe v. Wade, I have been reflecting on my role as a physician for women and the implications this ruling will have on health care across the country. Importantly, when I began my training as an OB-GYN, I, like many Americans, had very little understanding of what abortion care looks like.

The first time I performed an abortion, I was providing surgical care for a woman hemorrhaging in her first trimester of pregnancy. And yet at that time, I didn’t fully recognize what we provided as abortion care. Similarly, when I provided surgery for women with ectopic pregnancies, which are outside the uterus (a life-threatening emergency), and for women with medical conditions that could not support successful pregnancies without endangering their lives, I didn’t consider the care as falling under the abortion umbrella. It was not until I was learning to provide first-trimester abortions at an abortion clinic that I realized they were all one and the same. The procedures, the training, they are all part of the same category: providing necessary reproductive care to women.

I mention this because the overturn of Roe will affect medical education. At present, abortion training is required for the accreditation of obstetrics and gynecology residency programs. As laws change, trainees may receive increasingly limited education in abortion care, meaning they may not be prepared when faced with life-or-death situations or when asked to help with miscarriages and inevitable pregnancy losses. This would be a tragedy for women — and the health care system in America.

Furthermore, as abortion soon becomes illegal in over a dozen states, some with near-total bans, lifesaving care may become limited by vague terms. How critically ill must a woman be to justify an abortion? Worse, without clear policies, physicians may hesitate to treat women with ectopic pregnancies, inevitable miscarriages, pre-viable rupture of membranes and more out of fear of criminal prosecution or lawsuits.

Of course, most women need abortions for reasons that are, frankly, their business. These women may now have to travel across state lines at great personal cost to pursue their reproductive rights. And in those moments, physicians will again have to make choices antithetical to their foundational oath: when to provide abortion care, where to live in order to provide this care and how to tread the murkiness of legal variation across state lines.

It’s easy to feel helpless in the face of legal jurisdiction, but as a physician who has spent my adult life training to care for women, I assure you that we are not done yet. As a place to start, I recommend this essay on the many effects the overturn of Roe will have on our health care system. Additionally, I encourage everyone to explore the impact of Roe’s overturn in their state. Contact your elected officials. Join calls to expand the Supreme Court. Protest. Support the National Abortion Federation, Planned Parenthood and other organizations seeking to empower women to receive the care they need. For information on medication abortion, visit plancpills.org, and to learn about your legal rights, visit reprolegalhelpline.org.

In the meantime, more women in the United States will be forced to carry pregnancies to term. We must address issues of maternal mortality that will undoubtedly become more prominent as abortion care becomes limited. In some states, women lose access to pregnancy-related Medicaid and health care coverage as soon as 60 days after delivery. We can improve outcomes for women by advocating to expand access to medical care including extending postpartum Medicaid coverage and increasing women’s access to mental health resources.

Finally, we need to support health literacy and health education research. Here in our nation’s capital, much like the rest of the country, health literacy levels are ZIP-code dependent and lead to steep disparities. In order to improve health care outcomes, we must optimize our provision of health information to patients to empower them.

Lawmakers will continue to change laws, but many will be making these decisions without a medical degree. Meanwhile, many Americans may not realize what abortion care encompasses — and how often this type of care is required. In order to protect reproductive rights, we must all work hard to correct misconceptions around abortion care. Learn more. Ask questions. Speak up. At least one woman in your life depends on it.