D is a 45-year-old woman, recently married, who found out she was pregnant when she went in for her first radiation treatment for breast cancer. She had been rightfully taken off the hormonal contraceptive she used for years when the cancer was diagnosed a few months before, but she was not given any alternative forms of contraception. She and her husband thought their chances of pregnancy were low, since she’d never gotten pregnant and she was old enough to be nearing menopause. She had never planned on having a child, certainly not now that she was battling a cancer diagnosis. Despite her expressed intention to terminate the pregnancy, the radiation oncologist would not begin her cancer treatment while she was still pregnant. She lives in a part of the country with poor abortion access; those of us trained to provide this common service have our hands tied by hospital and clinic restrictions.

D had to search for providers in other cities, and ended up two weeks later at a clinic three hours away, only to find out she was in the middle of a miscarriage. She came to see me, a local doctor, the week after that. I did another ultrasound and confirmed that she was still in the process of a miscarriage. We talked about her treatment options– we could wait for the process to happen naturally, use a medication to help speed it along, or do a procedure to remove the failing pregnancy tissue. This procedure is exactly the same as what I can do at other clinics for pregnancy termination, but because my hospital doesn’t recognize abortion as a necessary part of health care, I’m restricted and my patients can’t get this care in their hometown. D opted to use a medication to speed up the process. I talked with her oncology team and confirmed with them her pregnancy was not viable and they should go ahead with her treatments. She came back to see me the next week to have an IUD placed to keep from getting pregnant again.

If I had been able to do an abortion for this woman in my own clinic, D could have started her cancer treatment weeks earlier. I could have diagnosed her miscarriage earlier. Because of the stigma around abortion, she had to wait extra weeks and travel far before she could start potentially life-saving cancer treatment.