As a doctor and consultant gynaecologist, I generally don't air political opinions. However, the recent turmoil created by certain political decisions and rhetoric in the United States of America makes me want to speak to all women, young and old, wherever they might be. We may feel we are not affected by reproductive health laws passed by governments in other countries, so we either ignore such discussions or feel unsure as to how to speak up. But we should voice our concerns. Each one of us who has the privilege of being educated and has access to reproductive health make choices regarding our own bodies on a daily basis. Not all women around the world are as fortunate and more women may now find themselves in a position where this choice is either diminished or completely taken away from them. It may not be long before these decisions affect us and our friends and families directly.
Throughout my career, I have seen on many occasions how damaging it can be when we don't have control over our decisions regarding reproductive health. However, the tragic case of a young woman I encountered thirty years ago, is a memory that stays with me even today.
As a young medical intern in Southern India, the memory of a 20 year-old college student who came in on my shift and died from a backstreet abortion is etched indelibly in my mind. Her conservative family had taken her to have an illegal abortion, as they were sadly, perhaps too ashamed to access available safe medical care.
Instead she suffered a uterine perforation at the hands of an unlicensed doctor, if we can even call them that. Despite a huge team of doctors working for three days, her injuries were too serious and she died from septicaemia and peritonitis. This was over 30 years ago, but this scenario still happens in many parts of the world where a real choice is not available for many women, usually for societal and cultural reasons. Women should not still be suffering like this in the 21st century.
Women's health matters. The biggest freedom for women in modern times has been achieved through contraception and education, both of which are threatened by this war on a woman's right to choose. Full access to birth control is critical for all women of reproductive age - not just for preventing pregnancy, which in turn reduces the number of women undergoing pregnancy terminations (which seems to be the main issue influencing recent policy) but also to help avoid pregnancies in situations where a woman's physical and mental health may be seriously affected. Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth with 99% of all maternal deaths occurring in developing countries. The risk of maternal mortality is highest for adolescent girls under 15 years old, according to the World Health Organisation.
With the help of contraception, pregnancies can be planned, allowing children to be better looked after and, better nourished. At the same time, they give the mother a chance to recover and regain mental and physical strength. A smaller family or well-spaced family allows for education and better nutrition for the entire family, for both girls and boys included. As Melinda Gates says "if you allow a woman...to have a contraceptive tool and she can space those births, it unlocks the cycle of poverty for her."
Furthermore, different methods of contraception can manage several other serious health conditions and restricting access to contraception and birth control can have a ripple effect well beyond the reproductive sphere. They can also save women and the government significant amounts of money. For example, more work days are lost for women in the reproductive age group because of painful or heavy periods than any other condition. The non-contraceptive benefits of the combined oral contraceptive pill (the pill) include reduction of painful and heavy periods, so women have fewer days off school and work. The Pill also halves the risk of ovarian and womb cancer if taken for about five years in one's lifetime and helps in the management of many gynaecological conditions such as polycystic ovarian syndrome (PCOS), endometriosis and pelvic pain among others. The pill can also be helpful for the many women who use it to manage acne, premenstrual symptoms or for those who work in jobs where a monthly period can be debilitating, as the pill can safely be taken back-to-back.
Condoms can protect against most sexually transmitted diseases, which can increase ectopic pregnancy, chronic pelvic pain and result in repeated hospital admissions, surgery and mental anguish.
We all need to stand together to protect women's health and make our voices heard if we are to move toward a more equal society, both for ourselves and for the women who do not have access to reliable contraception and safe reproductive health choices.
Boys and girls should have access to reliable information and sexual and reproductive health education, allowing everyone to make an informed choice. The recent photo of a group of men in suits making decisions that would dictate the fate of thousands of women drove this point home: we know our bodies better than anyone else and it is dangerous for anyone else to make choices for us.