With the vacancy on the Supreme Court, Roe v. Wade currently faces the biggest threat in our lifetime. Although Roe was insufficient in securing access to abortion for many people in the US, its repeal would catapult us into an era where one of the safest and most common medical procedures known becomes illegal in many states. For decades, abortion has occupied a politicized space in American medicine, leading to this impending crisis of millions of people losing access to this health service. No matter what happens with Roe, I choose to advocate to expand access to health care, including abortion, and call on my fellow health care providers to join me in this moral work.
My experiences working in an abortion clinic in medical school have shown me that providing abortion isn't just a health service. It's a moral imperative, and an essential piece of the spectrum of reproductive health care. I had the incredible privilege of personally experiencing this: the midwife who caught me when I was born trained me the first time I directly participated in abortion care. She became trained as an abortion provider because she understood birth work and abortion care as two critical services in reproductive health, and she taught me that as well.
Working in this clinic reaffirmed my faith in medicine as a healing practice. Our patients routinely overcame remarkable obstacles to reach us. Some traveled many hours from another state to get the medical care they needed. Others used emergency funds to pay out of pocket when insurance issues arose. Despite the obstacles patients faced, the clinic staff and nursing providers constantly remarked on how they were treated with compassion and dignity during their experience. In the face of harassment, financial difficulty, and sometimes threats to their lives or their loved ones, abortion providers continue to provide an essential health service.
One quarter of cisgender women will get an abortion in their lifetime in the United States, but just under 25 percent of obstetricians provide abortion care. This grave discrepancy exists partly because it is so difficult to obtain training in abortion care. Despite the American College of Obstetrics and Gynecology recommending that all residencies include abortion training, one study found that only 64 percent of OB-GYN residencies did so. Five percent, in fact, reported that training was entirely unavailable. Whether a residency program chooses include abortion training can depend on the individual institution, or on state restrictions preventing provision. For example, in a state like West Virginia, with only one abortion clinic but 36 ObGyn residents, ensuring adequate hands-on training can be challenging. Laws that make abortion harder to access or harder for clinics to operate, like six-week bans and admitting privileges laws, also make it harder for there to be enough clinical care situations for adequate training.
This discrepancy also exists due to an individual providers' personal objections to providing this essential health care. For a health service that is recognized as part of the standard of care and is so common, it's a significant breach of the medical oath. Statistically, that's like a general surgeon refusing to perform an appendectomy, one of the most common surgical procedures; or a primary care physician not learning how to treat diabetes, one of the most common medical conditions in the United States. This simply would not be tolerated by any other leadership in medicine. Yet abortion remains unavailable to many patients because the medical establishment has not taken responsibility for a politicization of one of the most common reproductive health services.
All of us in medicine have a responsibility to fight for this human right and engage in public political discourse surrounding abortion. My commitment to providing abortion care is grounded in the belief that everyone should make their own reproductive choices with dignity, freedom, and power. Being an abortion provider is a tremendous gift and privilege, one that I will cherish as long as I am able to practice medicine.
Chris Ahlbach is a Medical Student Research Fellow at Advancing New Standards in Reproductive HealtH (ANSIRH).