Natalie Roche, MD

Advocating for Adolescents

According to Dr. Natalie Roche, an ob/gyn at the University of Medicine and Dentistry of New Jersey and a Board member of PRCH, her adolescent patients are not radically different from adult women when it comes to the issue of unplanned pregnancy. “Unwanted pregnancy is something that all women address,” she says. “Teenagers are no better or worse than anybody else in terms of understanding contraception and reproduction. They do have unique concerns as they learn to manage sexual relationships and the many emotional issues that surround unwanted pregnancies.”

Like most professionals in her field, however, Dr. Roche believes that ignorance is the biggest threat to the reproductive health of adolescents. “It’s really important that teenagers have easy access, because fear and denial are big issues for them,” she says. “They are more likely to take extreme measures to deal with their pregnancies, and there need to be systems in place to combat this.”

To this end, Dr. Roche, along with representatives from The Division of Adolescent and Young Adult Medicine at New Jersey Medical School, The Adolescent/Young Adult Center for Health and The ACLU of New Jersey, among others, is collaborating on the Minors’ Access to Confidential Care in New Jersey card, a laminated pamphlet small enough to fit into a lab coat pocket, which summarizes the complex laws regulating adolescent healthcare in New Jersey. “There’s a lot of confusion about what the law says and what rights minors have,” Dr. Roche says. “Clarification is needed not just for the physicians, but for the teens themselves, parents and other responsible people who care for teens. Every adult needs to know about these laws so they can give the right information to young people.”

Dr. Roche believes the New Jersey minors’ access card should serve as just one component in a longer process of educating adolescents about their health. “Young people have to be gradually trained to take care of their bodies,” she says. “There are positive associations with giving teenagers responsibility, and educating them about their reproductive rights is a great place to start.”

When Dr. Roche began her residency program in 1980 at the Beth Israel Medical Center in New York City, abortion training was part of the ob/gyn training program. Unlike today, the training was commonplace. “Abortion rights were more in the forefront of ob/gyn in the late 1970s and early 1980s,” she says. “It was one of the reasons people went into ob/gyn. Now you generally don’t see significant training in medical schools or in residency programs.”

The drop in abortion training in the last 20 years has strengthened Dr. Roche’s conviction that abortion care should be a part of routine ob/gyn care. “Abortion care should be treated like any other low risk ambulatory procedure,” she says. “Medical students making a choice of specialty training should consider whether they are comfortable with most aspects of their preferred specialty. It’s not just what you’re interested in—at the medical school level a student should think about their talents, interests and think about their morality, ethics and spirituality when they choose a specialty.”

As a physician who has practiced mainly in urban settings, Dr. Roche hasn’t experienced the harassment and intimidation to the extent that other providers in other, more rural areas of the country have. However, she did face anti-choice protesters when she agreed to provide abortions each Saturday in New Haven, Connecticut, in the late 1980s. She encountered protesters every weekend at the clinic, but from a patient’s perspective: “I was in my early 30s and looked pretty young, and as a black woman the protesters couldn’t conceive of the fact that I was the doctor,” she says. “They would yell at me every Saturday not to get an abortion, and every Saturday I would vow to them that I wouldn’t. The same man screamed at me every week.”

Because of the contentious climate surrounding women’s reproductive healthcare, Dr. Roche is strongly committed to her role as a physician-activist, and takes her activities on the PRCH Board very seriously. “We as physicians are the experts when it comes to healthcare,” she says. “We have a unique perspective in terms of what’s safe and what’s not, and it’s our job to advocate for our patients’ safety. Because we live in a political world, this requires activism. There’s no way around activism, and I consider it one of my responsibilities as a doctor.”