Throughout our medical education, we focus so much on ensuring our patients have access to contraceptives that we often forget to mention what should be obvious: access to the removal of those contraceptives.

This weekend, I was re-reading a chapter from Dorothy Roberts’ book “Killing the Black Body,” and I was reminded that underrepresented and underserved woman not only struggled with timely and safe contraceptive removal in the 1990s with Norplant, but still struggle today with the removal of IUDs and Nexplanons, either because providers do not know how to to do removals or because they do not want to.

Reproductive coercion takes place at both the front end and at the back end of contraceptive use. It is vital that we acknowledge this and work to ensure that our patient’s autonomy always comes first.

I work at a very liberal Federally Qualified Health Center in the Bay Area, and last week one of my colleagues had a patient scheduled for a Nexplanon removal. She had never done a removal before, so I offered to walk her through the procedure. The removal went well and the patient walked out of the clinic happy.

But that encounter left me thinking about the places where that does not happen—where, as I have been told by too many patients, doctors refused to take out their devices or referred them elsewhere because they do not have the skills to do the removal themselves.

This is reproductive coercion—whether or not intentional—and it should never happen. The autonomy around contraceptive choices that we value so much as forward-thinking providers must be equally as important when it comes to removal. We must work every day to ensure we have the physical skills as well as the skills to recognize our biases when it comes to contraception.