I know what illegal abortion looks like, does Amy Coney Barrett?

That diagnosis had never occurred to me and was not part of my medical training in the United States. A few weeks later and a few miles away at our apartment in Lima, my baby sitter sat me down at the dining table to tell me that she was pregnant. Knowing that Maria’s husband had been unfaithful to her, I was not sure if congratulations were in order. As it turned out, he did not want to have this child and had encouraged her to pursue termination, even though it was illegal in Peru. He planned for her to take some black-market drugs. 

I called my parents back in Rhode Island. My mother, also a physician, trained at Bellevue in Manhattan in the 1960s. When I reported the plight of these unfortunate Peruvian women, my mother recalled a young woman who had come to the emergency room with pus coming out of her uterus after a back-alley procedure. I could hear her tearing up over the phone as she told me how she had to inform the husband, with their 4-year-old and 2-year-old children at his side, of his wife’s death from septic shock. My father, a kidney specialist working in South America, chimed in that the most common cause of kidney failure in young women in Chile in the ’70s was also septic shock from botched abortions.

Now eight years later and back from Peru, I’m beginning to wonder if we will have to train our medical students to consider botched abortion when they evaluate women patients. Amy Coney Barrett, the Supreme Court nominee, is strongly anti-choice. With her likely appointment, many legal scholars suspect Roe v. Wade may be overturned. Coney Barrett has signed onto full-page newspaper advertisements sponsored by Saint Joseph County Right to Life that say life begins at fertilization, a view that extends to embryos formed by in vitro fertilization. Some even speculate that Coney Barrett would seek to criminalize physicians offering terminations.

Should Roe be overturned, decisions determining a women’s right to control her body default to the states. In that case, according to the Center for Reproductive Rights, there would be 30 states where access to termination would become illegal or threatened. For example, North Dakota has a trigger ban that would prevent almost all abortion if it became legally permissible, and Arizona has an unenforced pre-Roe ban on abortion. 

Some might argue that Roe v. Wade is protected by the doctrine of “stare decisis” — the legal doctrine that once a decision has been handed down, all similar cases are approached the same way. Essentially, this obligates the court to follow previous legal precedents. In fact, Justice Roberts invoked stare decisis in June in a case from Louisiana that struck down a law obligating doctors to have admitting privileges where they conduct pregnancy terminations. This was a reversal of his earlier decision in a Texas case in 2016 that was nearly identical, in which he was a dissenter.

While Roberts cited stare decisis in his reversal, it should be known that the Supreme Court has reversed itself on other decisions.  Most notably, in 1954 the Court overturned precedent when it ruled that schools cannot be segregated in Brown v. Board of Education. Likewise, we can’t count on stare decisis to uphold Roe.

If matters of women’s access to care will be decided at the state level, then voters’ local choices will have a more direct impact on their health. When we vote for our state senators and representatives, they enact local laws. Therefore, while it behooves voters to choose the candidate that most values health at the national level, their selections at the state level may have the most impact regardless of whether Biden wins. In other words, our choices on Nov. 3 may determine if we go back to the 1950s and whether my colleagues and I start seeing women making desperate and dangerous choices about their bodies again.

Carolina Abuelo, M.D., is a primary care physician at the Charlestown HealthCare Center of the Massachusetts General Hospital and a public voices fellow with The OpEd Project.