Access to safe, affordable birth control is a maternal health issue

I am a physician.

As a high-risk obstetrician (maternal-fetal medicine specialist) I pride myself on caring for women who are likely to become (or who are already) so ill that many others view caring for them as a burden. I help women achieve a safe pregnancy when colleagues have advised against pregnancy altogether. Whether it is the patient with such a complex surgical history that her cesarean delivery will include massive blood loss and a hysterectomy, or the patient with a history of liver transplant trying to carry a pregnancy for the fourth time (each unsuccessful as she struggles in and out of graft rejection), or perhaps the woman who spent weeks in the intensive care unit after each of her last two pregnancies because of complications from preeclampsia — these are the patients I care for.

When careful planning is critical for a safe pregnancy

In caring for these women, I see the highs and lows of life. I am still awed by the miracle of childbirth (it doesn’t matter how many times I witness birth, I still find it one of the most magical moments each and every time). However, I am also witness to the perils of pregnancy and childbirth. It happens more than you might think. Luckily, maternal deaths are rare, though complications that compromise a new mother’s health — hemorrhage, venous embolism, severe high blood pressure, organ failure, and intensive care admission — are on the rise. My patients, the very ill women whose health and lives may be at risk, and their families, need to determine if and when they are willing to accept the risks that come with pregnancy.

The current rhetoric of limiting access to affordable contraception will have the most dramatic effect on my patients. We are talking about preventing pregnancy to protect the mother, a concept that is too often left out of public and politically heated debates. For these women contraception is not simply a choice; it is a means of taking control of their health and future. I feel that we have a moral and ethical obligation to advocate for these patients. We need to fight and ensure that they decide if and when to attempt a pregnancy, a decision that may carry such substantial risk that it may never be a safe option.

A real life story

A colleague of mine cares for women very similar to those who come in and out of my office every day. She told me about a patient for whom complications of high blood pressure and diabetes resulted in the very premature birth of her baby. Both the mother and newborn spent time in their respective intensive care units. Both ultimately were sent home, the mother needing to start blood pressure medication and teetering on the edge of kidney failure. This new mom missed her postpartum contraception appointment. She reports she tried to get contraception shortly after that missed appointment, but after losing her job (and insurance) she was unable to afford contraception. Fast-forward six months; she is pregnant again — a pregnancy which risks this mom’s health and places an unexpected strain on her family, a pregnancy she had intended to delay.

It doesn’t have to be this way

There are many women for whom pregnancy is dangerous, and contraception is a lifeline for their long-term health. Too often there are significant barriers for women seeking affordable and effective birth control. When pre-existing conditions make pregnancy a potentially life-threatening event, limiting access to contraception is unacceptable. The medical community cannot allow this to happen. Maternal health is the keystone supporting the foundational well-being of families and children.

We need to pay attention, now

I fear the future. I fear that restrictions, roadblocks, and limited access will become the norm. What is missing in the coverage of this issue is the fact that the US has seen an unprecedented rise in maternal mortality. If government-endorsed limited access to contraception becomes reality, we have only seen the peak of the iceberg in our failure to protect maternal health.

I am a physician, an advocate, and a father. These are not separate roles, but rather so closely connected that my patients know my children’s names and my children know the events of my days. And for both, my patients and children, I am an advocate for access to safe health. I owe it to my patients to acknowledge and engage in dialogue protesting against this attack on women’s health. As a father I owe it to my children (specifically my daughter) to advocate against this emerging disparity in health care. If I sit back and do nothing, all the hours of play time I have missed, the birthday parties I was late for, and the holidays I have been on call for, mean nothing. Today’s political climate has inspired me to speak up.