As an OB-GYN, I witness the harm of abortion bans firsthand. It’s broader than you think.

As a proud 21-year veteran OB-GYN practitioner based in South Dakota, I have never been more concerned about the future of reproductive health care in my state.

I serve a great diversity of patients — Native Americans, Hutterites, farmers, ranchers and stay-at-home parents. What do they all have in common? They love their families. Which is why only a pregnant individual and their family, informed by the expertise of their medical provider, should be trusted to carefully weigh the risks and complications of whether to continue or terminate a pregnancy. When policymakers take that agency away, it creates immense harm to both the patient and the provider.

First, medical decisions are deeply personal and private. Everyone’s situation is different, and only a patient and their doctor will fully understand all the nuances of a pregnancy. For example, how could a legislator or judge be expected to know whether a pregnancy is too dangerous to continue?

A complicated pregnancy can put a patient’s life at risk. Premature rupture of membranes in the early second trimester, maternal medical disease, fetal conditions inconsistent with life — pregnancy comes with a host of possible medical complications, and I’ve run into many of them firsthand in my practice. The U.S. has one of the highest maternal mortality rates in the developed world — with a significant number of maternal deaths being preventable. Who could possibly be qualified enough to say that’s a reasonable risk all pregnant patients should willingly assume?

Second, restrictive abortion laws don’t just impact abortion access — they’re having chilling effects on OB-GYNs and other providers well beyond abortion work. Listen, it’s hard to recruit obstetricians to South Dakota, even to cover for temporary leaves. Experts are predicting a massive national shortage of OB-GYNs in the coming years, and for South Dakotans that’s going to mean maternity deserts. Abortion restrictions disincentivize OB-GYNs like myself from continuing in this important field. They make our work a legal minefield where our jobs and livelihoods are suddenly on the line.

Speaking personally, my practice doesn’t include the administration of abortions — but I’m still fearful every day that someone might misunderstand my miscarriage care as abortion care and get me charged with a felony. I would be shopping for my own criminal defense lawyer. 

Even if I was found not guilty, what if I lost my license during the time it would take to sort things out with the courts? And am I even legally allowed to counsel someone about the option of abortion when continuing the pregnancy means minimal chance of a live infant and high chance of harm to the pregnant person? Why would any obstetric provider come work in our state when it means having to worry about all these frightening possibilities every day? When I’m at work, I want to focus all my attention on caring for my patients, not fearing for my job.

Laws targeting abortion access also cause direct harm to patients experiencing a miscarriage. Mifepristone is a drug used in over half of all abortions, but it’s also used to provide miscarriage care. After the Dobbs decision, for a while I couldn’t even offer mifepristone to a person who had experienced a miscarriage because of legal concerns. I’ve seen patients traumatized by miscarriage complications like hemorrhage and emergency surgery that could have been avoided if I had been allowed to treat them with mifepristone. Politicians and others have vilified this critical medication. These are nothing short of scare tactics.

The decision to continue or discontinue a pregnancy is a deeply personal, sensitive and complicated matter that only a patient, their family and their doctor should be involved in making — full stop. The more restrictions politicians place on abortion, the more harm I’m seeing it cause firsthand here in South Dakota. As a medical provider, I implore my fellow South Dakotans to look closely at the proposed ballot measure regarding the regulation of abortion in our state before you cast your vote this year.