The A Word—Our Collective Scarlet Letter

Abstract

Happy are you, Hester, that wear the scarlet letter openly upon your bosom! Mine burns in secret….The letter was the symbol of her calling." 1 Why are we so reluctant or hesitant to say the A word out loud? Abortion is a highly prevalent procedure, with the Guttmacher Institute's estimates of 1 in 4 US women reporting having had one by age 45 years. 2 Abortion is an evidence-based, standard-of-care option, supported by numerous, respected professional societies for all persons who are pregnant. Abortion is a part of my own specialty's board certification requirement that all obstetrics and gynecology physicians have the "knowledge, skills, and judgment relative to reproductive health rights, including access to contraception as well as to safe and legal pregnancy termination." 3 Indeed, abortion is part of comprehensive care to which every pregnant person should have access, as it is essential to routine pregnancy care. The American Board of Obstetrics and Gynecology states, "our commitment to these principles is firm and unwavering in support of OBGYNs [obstetrics and gynecology physicians] who wish to provide comprehensive reproductive health care to the patients and families they serve. Patients place their trust in the sanctity of the patient-physician relationship, and they must have confidence that their OBGYNs can provide the evidence-based counseling and care that they need without intimidation, retribution, or litigation."The June 24, 2022, Supreme Court decision regarding Dobbs v Jackson Women's Health Organization overturning Roe v Wade 4 was not based on standard-of-care medical practice, science, nor empathy related to 50% of the US population that can experience pregnancy up to 30 to 35 years each.So, why don't we, as health care professionals and leaders in our fields, enunciate the word abortion loudly and repeatedly? The World Health Organization estimates that more than 73 million induced abortions take place worldwide annually, 6 of 10 pregnancies globally end in induced abortion, 97% take place in developing countries, and unsafe abortion is a leading global cause of maternal mortality. 5 Abortion is a safe procedure, regardless of the method, medication, or surgical procedure. [6][7][8] Abortion is one of the most performed surgeries next to cesarean delivery (through which one-third of all births occur) and is safer than childbirth; pregnant persons are almost 14 times more likely to die during childbirth than from complications due to abortion. 9 When over half the US population can potentially become pregnant for about one-third to 40% of each of their lifetimes, why is the full spectrum of safe, well-studied effective