The following manuscript was submitted to the February 2017 Social Medicine Themed Writing Contest.
As I contemplate the future of our country, the future of medicine and the future of reproductive health and justice, I am truly frightened of what is to come. Since our president appears to base his desires on what makes him popular, I fear that he will gut Planned Parenthood, turn over Roe v. Wade, and make it even more difficult for women to afford and access care, all in the name of ego.
If this happens, all of us will be affected — women, men, and families of all creeds and walks of life. All of our worlds will be turned upside-down, in one way or another. However, most of us will find a way to survive, to get through it. Those of us who are most vulnerable — those without safety nets, strong social circles, money to spare — will be the ones who will suffer the most consequences.
I am an obstetrics and gynecology resident in Atlanta, GA, one of the most diverse cities in the United States. Day in and day out, my fellow residents and I serve one of the most vulnerable populations in this country. We experience small triumphs when we can convince someone to get out of an abusive relationship; when we counsel a patient to quit smoking; when we educate a teenager on birth control and she agrees. We also have more solemn moments — moments when we can’t convince her to leave. When we diagnose cervical cancer. When we tell someone they’re pregnant when they don’t want to be and can’t afford an abortion. There are often more of these moments than we’d like.
We also grow tired sometimes and wonder, why doesn’t she just leave the relationship? Why didn’t she just get a pap smear? Why didn’t she stop smoking? Why didn’t she just listen to us when we told her she should get birth control?
But it’s much more complicated than that. We are often so focused on what we know and experience that we fail to see the bigger picture; to see what the patient sees, to understand where they are coming from and what they experience. We fail to see how our social structures have failed them.
After a labor sign-out during which we had three patients under the age of 17, one of our rotating male residents (not in obstetrics) asked me, “Why are all these teenagers getting pregnant? When I was seventeen, no one around me got pregnant.” To which I replied, “Yeah, but I bet your girlfriends were using birth control.” And he sat silently, nodding his head.
When I was 17, I was in love. I swore, I had found “the one.” Other people around me had been having sex and I thought that maybe I should be, too, especially if I was eventually going to marry my boyfriend. I talked to a friend of mine and she told me about this place I could go for birth control. It was called Planned Parenthood. It was near my house so I didn’t have to drive very far. I went there for a visit. They asked me a few questions, counseled me on safe sex, and then gave me a bag full of a year’s worth of birth control pills. I never got pregnant. Thankfully so, since “the one” and I didn’t actually end up being together forever.
Compare my story with the typical inner-city or rural teenager. There may not be a Planned Parenthood nearby. They likely don’t know someone who has ever been to a place like Planned Parenthood. They probably don’t have a car or easy access to transportation. They might not even know that you can get pregnant if you have sex without birth control. There is so much going against them, that I find it amazing that the teen pregnancy rate is going down.
Do we want things to get worse in this country? Do we want more teen pregnancies, more maternal deaths, more cancer deaths? Because this is what will happen if we do not do something about the changes that the President and Congress are trying to impose. We need more organizations like Planned Parenthood, not fewer. We need to support measures that improve public education, that protect women from discrimination by insurance companies, that eliminate institutional racism. It is time for us as physicians to step up and lift our patients’ voices so that they may be heard.
If you are with me, you don’t need to march on Washington. Here are some actions that you can do, today:
- Listen to your patients. Hear their stories. Identify with them what their strengths and barriers are. Empower them by working together to create solutions.
- Identify an issue you care about that affects your patients. Education? Immigration? Criminal Justice? Women’s health? Learn as much as you can about it.
- Get involved in a local organization. Even if you just “like” or “follow” them on social media, they can keep you in the know. You can meet other like-minded physicians and community members. They may help you find local resources for your patients.
- Call and contact your local officials. Go to their websites or download the app Countable to voice your concerns about legislation that congress is passing or executive orders signed by the President.
- Don’t give up. Don’t become complacent because there is so much to be done. Keep up the fight; it is worth it in the end.
Each of us can play a role, big or small, in making our country more equitable for our patients and communities.