'The decision to end a pregnancy is a medical conversation, not a legal or political one'

As expected, and as many feared, the U.S. Supreme Court has rolled back the privacy rights of women to make their own choices about their healthcare in the official decision released on June 24 to overturn Roe v. Wade.

The decision in Dobbs vs. Jackson Women's Health Organization — the Mississippi case that overturned Roe — is having seismic impacts across all of American society. Much of the discussion of Friday's announcement has centered on the legal and political aspects of the ruling, as well as the concurrent opinions of the Court and their potential impact on other human rights beyond the health choices of women. Consider contraception, interracial marriage, transgender decisions and same sex marriage that are examples of many rights advocated for and achieved in the last 20 years.

From my perspective, as a woman physician leading a major academic health system, it's important to remember that this is, first and foremost a medical matter. For nearly 50 years, the Supreme Court decision in Roe affirmed a patient's right to make their own choices around healthcare — including the termination of a pregnancy — and allowed medical personnel, in medically accepted settings, to legally carry out abortions.

Healthcare providers must now acknowledge that the loss of this freedom and the state-by-state legislation to protect or restrict a pregnant person's rights will have a health impact on our communities including, but not limited to, the training and supply of badly needed obstetricians/gynecologists. Nearly 45 percent of the 286 obstetrics and gynecology residency programs across the United States are in the 26 states certain or likely to ban abortion under Dobbs. Training in pregnancy termination provides practitioners with the skills needed to manage miscarriages, uterine evacuation for a stillbirth, ectopic pregnancies, and trauma-informed care, all of which could threaten a woman's life. Without this important training, these practitioners will be less surgically prepared to provide the full scope of care for their patients. And at a time when we are facing workforce shortages across all of healthcare, the Dobbs decision will further impact our ability to attract and retain well-trained providers in women's health specialties.

The decision to end a pregnancy is a medical conversation, not a legal or political one. It is a harsh truth that for a devastating number of people in the United States, pregnancy is not a happy experience, or even a safe one. The U.S. has the highest maternal mortality rate in the developed world, and maternal deaths are still on the rise. The statistics on intimate partner violence are particularly bleak for young pregnant women (ages 24 and under). Compared to other women of the same age who are not pregnant, pregnant women face a 16 percent increased risk of dying by homicide and black women face three times the risk of dying than their white counterparts. Most are killed by a partner. For victims of intimate partner violence, contraception is neither readily available nor reliably effective. An estimated 16 percent of women ages 18 to 44 have experienced reproductive coercion — a "hidden form" of violence against women characterized by behaviors intended to exert power and control over another person's reproductive health and decisions.

Among the most impacted by the decision will be those who do not have the resources to travel out of state. It is plain and simple that someone's race, age, socio-economic status, or zip code will become determinants of health outcomes.

When cleaning out my grandmother's house, I found my great grandmother's handwritten recipe of a common mixture of herbs and heavy metals used to end a pregnancy. These were frequently dangerous for the mother, and could cause a birth defect if the pregnancy was carried to term. With Roe overturned, will the health system be overwhelmed with women who have resorted to using back-alley methods from days gone by to end their pregnancies in desperation? Perhaps not, but I believe that, using the internet, women will seek out methods to medically end their pregnancies that are unproven and dangerous. We have not yet begun to calculate the impact of this desperation on our communities.

Prior to the announcement of the Court's decision, nearly 70 percent of Americans said they support the right to make this difficult choice in consultation with a medical provider. And since Friday, a CBS News poll shows that more than half of Americans — and two-thirds of women — oppose the Supreme Court's overturning of the decision.

The best thing that we can do as a society is to support every woman's ability to plan her family. This is how female physicians navigate the demands of medical school and residency. Deciding when you want to begin or expand your family is critical to balancing the multiple demands of your personal and professional life.

You cannot tie women to an antiquated vision of what some believe life "should" be like. Women like my great-grandmother have for generations strained against the bonds of unequal laws that have had the potential to harm their health. Women today are no different. They will escape it even if they die trying.

Joanne M. Conroy, MD, is president and CEO of Dartmouth Health in Lebanon, N.H. She has led the health system since 2017.

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