Anniversary of Roe: Where we are, where we should be

As last Friday marked the 43rd anniversary of the landmark Supreme Court case Roe v. Wade, providers of reproductive healthcare find ourselves facing a barrage of anti-choice state legislation, anti-choice politicians in Congress, and a major Supreme Court case all threatening to roll back abortion rights.

Is this what we imagined for Roe in the year 2016? As an OB-GYN, abortion provider, and advocate, it is my job to support a woman’s well-being. Forty-three years after Roe, we should not be on the defensive, deflecting attacks on reproductive health care. We should be celebrating this long-established decision protecting medically necessary and safe care. Beyond that, we should be working toward proactive measures to continue to improve women’s health. We should be filling the existing gaps in access to abortion to ensure that every woman who needs care receives it. Sadly, we instead find ourselves struggling to keep politicians from taking us backward.

{mosads}One area where the legacy of Roe remains unfulfilled is with regard to our women in uniform, something I see firsthand as a civilian physician working within a military health care facility. Current legal restrictions affect me directly, not only as a provider but as a member of the military community. As it stands today, military women are prohibited from receiving abortion care within a military facility, with extremely limited exceptions. Moreover, they are barred by law from using military health insurance to get this care elsewhere.

These restrictions force servicewomen, and the spouses of those who serve, to seek care elsewhere and pay out of pocket for a common, legal, medical procedure. This can mean traveling hundreds, sometimes even thousands of miles, particularly if they are stationed overseas. This results in delayed access to much-needed care, increased costs, and unnecessary logistical and financial burdens.

The most common reaction my patients have when they discover their insurance plan is barred from covering abortion is: How will I be able to afford the care that I need? I recently saw a patient diagnosed with a grave pregnancy complication. She has two children and a husband in the middle of an 18-month-long deployment. Her greatest fear was not surviving for her living children, and she made the difficult decision to end her pregnancy. She struggled with this decision. She struggled with going through this without her partner at her side. She struggled coordinating medical care for herself and childcare for her children. And then, she struggled to pay. Because even though her procedure ought to have been covered given her serious medical condition, the exceptions that do exist to allow for abortion coverage in certain circumstances are very limited on paper and usually unworkable in reality.

When I sit with my patients as they face enormously complicated situations like this, I cannot help but think about how glaringly unjust these restrictions are. It is indefensible that active duty servicewomen, including those who now serve in combat roles, must pay out of pocket for safe, legal medical care. Equality is increasing every day in the military. We are willing to send women to perform dangerous jobs in the military, but are unwilling to provide them comprehensive coverage for necessary medical care. Women are putting their lives on the line to protect our country in far corners of the globe, only to have our country turn its back on them when they need care.

Why does this happen? Because a few short years after Roe v. Wade made abortion legal, anti-choice politicians in Congress led a successful effort to make it unaffordable for many. Forty years ago, the Hyde Amendment was first passed, and for decades has denied abortion coverage for women enrolled in Medicaid. In the years since, the Hyde Amendment has spawned similar policies which affect many women—this includes federal employees and their dependents, Native Americans, and Peace Corps volunteers.

Is this where we want to be 43 years after Roe? Insurance should cover the full range of medical options and procedures, including abortion, so that each woman can make the best decision for her particular set of circumstances. No matter our individual beliefs about abortion, we should be able to agree that it is not up to any of us to make a deeply personal medical decision for someone else. And yet this is what coverage restrictions do: they directly interfere with a woman’s ability to make the decision that is the best for her and her family.

So what should we be doing in 2016? One key place to start is to pass the EACH Woman Act (H.R. 2972). This legislation, introduced in the House by Rep. Barbara Lee (D-Calif.), would repeal the current restrictions on abortion coverage for our women in uniform and all other women who receive health care or coverage through public programs. The EACH Woman Act is an opportunity to advance women’s health care and honor the legacy of Roe. When a woman needs to end a pregnancy, affordable access to safe and legal abortion care is imperative. To deny women valiantly serving our country this coverage is one of the more stark examples of our failures in the 43 years following Roe. We can—we must—do better.

LoPiano is a practicing OB/GYN in Washington, D.C.