How My Vote Impacts our Ability to Care for Patients
By: Elise Boos, MD, MSc, Fellow at Physicians for Reproductive Health
I come from a large Cajun Catholic family in Louisiana – a boisterous, flood-resistant, costuming bunch who are experts at navigating the water ways and the streets of New Orleans by bike when parades make driving impossible. We all got married in Catholic Churches, as was expected, but on Sundays when the Saints have a noon game, no one goes to Church at all. We are a political grab bag in a liberal city nestled in a conservative state. At family functions, the cars in the driveway speak to the ability of the family bond to overcome differences. A few cars sport bumper stickers which read “Preux Life,” a play on pro-life using a common ending of traditional Cajun surnames. A few of the more fuel-efficient cars in the driveway, and one bicycle, read “Keep Your Rosaries off My Ovaries.” Our evening dinners often produce political debate, but abortion is one of those few topics that we have never tackled around the dinner table. So, when it came time for me as a third year OB-GYN resident to head off for a two-week family planning rotation, I shared the details of what I’d be doing with only a few known allies in the family, one of whom was my mother, and none of whom were my father.
My interest in family planning was piqued long before my medical training. In my early twenties, I’d spent months with midwives driving between dusty villages in India, with local health workers battling vertical HIV transmissions in rural Botswana, and sitting in a classroom in Kampala where one day I found myself discussing maternal health outcomes, all while knowing the following day I would attend the funeral of a classmate who had died of a septic abortion. I had seen the high cost women and their communities pay for lack of access to contraception, equitable obstetrical care, and safe abortion care. Returning home to New Orleans for my medical training, I discovered that patients and families in Louisiana, particularly patients of color, face similar barriers, albeit in a more developed healthcare system, making their health outcomes even more frustrating.
As a resident, I cared for a patient - who we can call Marie - with multiple fetal anomalies incompatible with life. She had vivid, traumatic memories of her prior delivery, a stillbirth near term, and she and wanted more than anything to avoid a labor induction. She didn’t want to go through the same motions she had gone through last time, to once again leave the hospital empty-handed. Despite our desire to honor her wishes, there was no provider skilled in D&E at her gestational age and she declined a transfer to another hospital, wanting to have her family with her as she grieved. As she delivered, she quietly cried, and I will admit I did the same. As I drove home that night, I made the decision to apply for a fellowship in family planning. I wanted to be a skilled surgeon and obstetrician who, regardless of the circumstances of the patient before me, could care for them safely and honor their wishes and lived experiences. And I wanted to teach others to do the same.
Fast forward several years, and I am grateful to have recently completed my family planning fellowship training. Even more exciting is the recent recognition by ACGME of Complex Family Planning as an official subspecialty. My hope is that this recognition will demonstrate to institutions, and our own colleagues, that our specialized training is critical to the health of those pregnant or at risk of becoming pregnant. In the midst of our maternal mortality crisis, the efforts of the complex family planning community, along with those of maternal-fetal medicine, are saving lives. We are doing this as clinicians, advocates, public health experts, and teachers. We are developing contraceptive plans for patients with complex medical conditions, managing early pregnancy complications with the best evidenced-based practices, and are equipped with surgical skills to care for abnormal, unintended and/or unwanted pregnancies. Perhaps most importantly, we are providing patient-centered care and reflecting on, calling out, and fighting against the racial bias that has long existed in gynecologic and obstetrical care.
The recognition by ACGME and ABOG of the Complex Family Planning subspecialty will hopefully help to ensure that in the future a patient like Marie has access to a provider skilled in the care she needs. I just hope that her plan of care will not be legislated from a bench, or decided by someone who never met her, or heard her story, or cared for her when what she needed most was for someone to believe her life mattered. I worry that our ability to care for patients will be hindered by laws and judicial decisions, which do not prioritize the safety and autonomy of patients, which tie our hands when what our patients need most are the nimble hands of a skilled surgeon and empathetic care.
On November 3, voters in Louisiana will be considering a constitutional amendment which would add the phrase, “nothing in this constitution shall be construed to secure or protect a right to abortion or require the funding of abortion,” to the state’s constitution. It makes no mention of exceptions for fetal anomalies, maternal health conditions, rape or incest. The potential impact of such policy changes has been heightened in the wake of the passing of Justice Ruth Bader Ginsberg and the possibility that the federal right to an abortion will be impacted. It will be amendments such as these that could make abortion care for any reason inaccessible to pregnant people in many states should the federal right to an abortion be abolished.
So, on the eve of our election, I am left with a deep sense of responsibility as I consider how my vote impacts our ability to care for our patients. I hope our collective vote results in good, comprehensive reproductive health policy, policy that enables all of us to respect the lives and lived experiences of our patients and ensure their safety and right to have full bodily autonomy.
Call me an optimist, but I believe our votes can save lives. And after I vote, I also plan to go fishing with my father, who has always known my intentions to care for the most marginalized and in whom I have a quiet ally after all.
