As a board-certified obstetrician and gynecologist, I have the privilege of providing healthcare to women throughout their lives. In some ways, health care for women and girls has improved, even since the beginning of my career.

The first major improvement was the passage of the Affordable Care Act (ACA) during President Barack Obama’s first term. Before the ACA, a third of women who tried to purchase a health plan themselves, charged higher premiums, or had certain health problems — such as pregnancy — were excluded from their plans. Insurance companies would sell plans to young women who did not cover contraception or pay for maternity care, the most common reasons a young woman seeks health care.

Just being a woman was a pre-existing condition, and insurance companies didn’t want to pay for it. Because of these barriers, at least 1 in 5 women in America does not have health care coverage.

The ACA changed all of that, ensuring that more women had access to health insurance initially, that it was affordable, and that they could not be denied coverage of basic health care such as pregnancy and contraception. The law also ensured that essential preventive services for women — annual check-ups, cervical and pelvic exams, birth control, and breastfeeding support — were all provided free of charge. It was a good start.

This year, the Inflation Reduction Act (IRA) built on the momentum of the ACA by going even further. Prescription drug costs will be lower, especially for Medicare seniors, and people who buy their health insurance on the ACA exchange will see lower premiums for at least the next three years.

Unfortunately, those two massive steps forward that ensured access to and affordability of quality health care could only get one Republican vote. You read that right. One Republican voted for the Affordable Care Act, and none voted for the Inflation Reduction Act. Nearly every Republican voted against your ability to get quality, affordable health care twice as long. Without Democrats in Congress and the White House, women would not have been able to make the progress we have made in the past 10 years.

But now, all this progress seems insignificant as we find ourselves helplessly looking back on an issue central to the health of women and families everywhere – abortion. Abortion is health care, not a binary choice that some politicians want you to make either “for” or “against.” Abortion care is part of the pregnancy care suite, from fertility treatment to abortion management to care for women with complicated pregnancies, and since then Dobbs cancel the decision Raw vs. Wade Abortion care is not available to women in Wisconsin.

Instead, our bodies are subject to an 1849 law that was enacted 70 years before women could vote. There are no exceptions to this law in the case of rape. There are no exceptions to incest. The only exception is for the life of the mother. But pregnant women do not have a warning light that turns on when they cross this threshold. Clinicians must use our clinical judgment — developed through years of formal education, experience, and commitment — to make complex, sensitive, and individual decisions in partnership with our patients and their families.

The effects of this criminal ban are frightening, and are not limited to one in four women who will have an abortion in their lifetime. People in our state are denied medication to administer abortion. Wisconsin women are denied treatment in emergency departments while they are actively bleeding.

even before DobbsIn Wisconsin, our maternal mortality rates were among the worst in the developed world, especially for black mothers who in Wisconsin were five times more likely to die from pregnancy than white mothers. This rate will rise dramatically as women with physical and mental health conditions are forced to take the high risk of carrying an unwanted pregnancy to term because they have lost access to basic life-saving health care.

The stakes are high. We are in the midst of a health care crisis, an economic crisis, and an ethical crisis. But our Republican leaders don’t seem to care. These so-called leaders make their own choices: they multiply politics, control, and fear rather than working together to solve problems and save lives.

As a physician, I took an oath, promised to take care of my patients and their families. I hear them and understand that only they can make decisions about their bodies in the course of their lives. This, to me, is the most personal, the most impactful, the most important choice in this election. It has never been more important than it is now.

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