[Editor’s note: The following essay was written for Policy Watch by a courageous North Carolina physician who provides reproductive healthcare to women on a daily basis. After discussing the matter with the author, we are taking the unusual step of publishing the essay anonymously because of the physician’s expressed and legitimate concerns about their safety and that of their family if their name were made public. This is obviously a regrettable situation and one that we do not take lightly. Given, however, the frequent acts of violence and harassment committed by opponents of abortion rights toward healthcare providers throughout the United States, we are convinced it is the ethical and responsible thing to do.]
As an OB/GYN caring for the women and families of North Carolina, I know abortion is a safe, essential, routine part of women’s health care. The nomination of Judge Brett Kavanaugh is only the latest in a long series of threats to women’s constitutional rights. More than 15 new abortion restrictions have been enacted in North Carolina since 2010, with devastating effects for health care access in our state. I witness every day the limitations that these laws put on physicians and the care they can offer patients. If Kavanaugh is confirmed, their already-limited access to care can only worsen.
My pregnant patients do not take the decision to have an abortion lightly. They are struggling with difficult decisions and doing what they believe is best for themselves and their families; they deserve our trust and respect. Let me share two recent patient stories as examples of the complex situations women and their families regularly face.
I met a patient who I’ll call “Tracy” in the emergency room. With bruises across her face and arms after an assault by her partner, Tracy wasn’t able to seek the abortion care she needed, between her responsibilities to her children and her partner’s extreme abuse and control. Like 10 million other Americans this year, Tracy is a victim of domestic violence, and her partner’s abuse worsened as a result of the pregnancy. She was able to come seek care in the emergency room only because her neighbors had called the police.
An ultrasound showed Tracy was more than 20 weeks pregnant, meaning that to terminate the pregnancy she needed to leave the state. Atlanta, the closest place where she could get the termination she needed to keep herself and her family safe, was four hours away. Her partner didn’t let her leave the house unaccompanied; she would never be able to go.
For Tracy, state abortion restrictions compounded the barriers she was already facing in her personal life. If our state didn’t have a forced 72-hour delay in care and an abortion ban at 20 weeks, I could have offered her a termination right then in the emergency room, the only time she was able to receive it.
It is my duty as a physician to provide my patients with the care they need at the time they need it. The state’s intrusions on reproductive choice meant I could not serve Tracy to the best of my ability. Instead, I could only connect her to the hospital’s domestic violence hotline, give her the phone numbers for clinics in Atlanta, and pray that somehow she’d get herself there in a week, before she passed the limit for abortion care in Georgia.
And there is my patient who I’ll call “Alison.” Alison was 34 weeks pregnant when I met her in the hospital. When she first learned of her pregnancy, she and her boyfriend were ecstatic. They found an OB/GYN right away and started reading pregnancy books. When it was time for the anatomy ultrasound to assess fetal development at 20 weeks, they were excited to see the baby’s gender. But at that appointment, they learned that their baby had multiple fatal conditions. Anatomy ultrasounds cannot be offered before 18-22 weeks because it isn’t until that time that health care professionals can see many of the structures so crucial to assessing the health of a developing fetus.
Alison was past the gestational age at which termination is legal in North Carolina. Without access to financial resources, there was no way she’d be able to get to Atlanta. Instead, she and her boyfriend had to cope with continuing a pregnancy they knew could not survive. She and her family had suffered through 14 weeks of mourning when I first met her.
Even after all 14 of those agonizing weeks, North Carolina’s gestational age ban forced me to treat her pregnancy like a healthy one: I had to make her preterm labor stop.
She will have to suffer through another three weeks until this arbitrary law – passed by politicians, not doctors – will no longer prevent me from offering her the appropriate medical treatment she needs. Women and families are put in very difficult positions when they learn their baby has a serious problem; these restrictive laws only make it worse.
Tracy and Alison have very different stories with the same tragic conclusion. They both need access to care I am not allowed to provide.
Politically motivated laws forced them both to continue pregnancies they do not wish to continue. This interference in the patient-provider relationship is dangerous and prevents patients from accessing critical care. As a physician, I find this reprehensible and unethical.
My patients who seek abortion do not deserve judgment or scorn. What they need is information, choice and access to essential health services in a timely manner. I urge everyone to take these stories to heart, including Senators Burr and Tillis, as they assess Judge Kavanaugh’s views and qualifications. The future of women’s health depends on it.