Pregnancy termination is a medical decision, not a legal or political one.

In its official decision to overturn Roe v. Wade, which was announced last Friday, the U.S. Supreme Court did as many had predicted and feared: it curtailed the private rights of women to make their own decisions about their health care.

The ruling in the Mississippi case Dobbs v. Jackson Women's Health Organization, which overruled Roe, is having profound effects on every aspect of American culture. The majority of the debate around last week's announcement has been on the ruling's legal and political implications, as well as the conflicting court rulings and their possible effects on other human rights outside of women's health decisions.

Consider some of the rights that have been fought for and won over the past 20 years: contraception, same-sex marriage, interracial marriage, and transgender choice.

It's crucial to keep in mind that this is, first and foremost, a medical issue from my perspective as a female physician who is the leader of a significant academic health system. For over 50 years, the Supreme Court's Roe decision upheld a patient's freedom to make their own health care decisions, including the right to end a pregnancy, and permitted medical professionals to perform abortions legally in settings that met accepted medical standards.

The loss of this freedom and the state-by-state legislation protecting or limiting a pregnant person's rights must now be acknowledged by health care professionals as having an impact on the health of our communities, including, but not limited to, the training and supply of desperately needed obstetricians and gynaecologists. In the 26 states that will undoubtedly or probably outlaw abortion under Dobbs, nearly 45 per cent of the 286 obstetrics and gynaecology residency programmes nationwide. Training in pregnancy termination equips practitioners with the knowledge and abilities to handle situations that could endanger a woman's life, such as miscarriages, uterine evacuation for a stillbirth, ectopic pregnancies, and trauma-informed care. These professionals won't be as surgically equipped to offer their patients a complete range of care without this crucial training. The Dobbs decision will also have an impact on our capacity to recruit and retain highly qualified healthcare professionals in women's health specialities at a time when we are dealing with a scarcity of healthcare workers across the board.

Pregnancy termination is a medical decision, not a legal or political one. It is a stark reality that pregnancy is not always a joyful or even a safe experience for people in the United States. Maternal deaths are still increasing, and the United States has the highest maternal mortality rate in the developed world. For young pregnant women, the statistics on intimate partner violence are especially dismal (ages 24 and under). Pregnant women have a 16% higher risk of dying from homicide than other women their age who are not pregnant, and Black women have a 3X higher mortality rate than white women. Most are murdered by a lover. Contraception is not easily accessible nor consistently effective for those who have experienced intimate partner violence. Reproductive coercion, a "hidden form" of violence against women characterised by actions meant to assert authority and control over another person's reproductive health and decisions, is thought to have occurred in 16 per cent of women between the ages of 18 and 44.

People who lack the means to go outside of the state will be among those most affected by last Friday's decision. It is obvious that factors like someone's race, age, socioeconomic situation, or ZIP code will affect their health.

I discovered my great-grandmother’s handwritten recipe for a typical combination of plants and heavy metals used to stop pregnancy while cleaning out my grandmother's home. These were frequently harmful to the mother and, if the pregnancy went to term, could result in a congenital deformity. Will the health system be overrun with women who have resorted to using illicit ways from the past to abort their pregnancies in desperation if Roe is overturned? Maybe not, but I think that women will use the internet to look for risky and unproven medical techniques to abort their pregnancies. The effect of this desperation on our communities has yet to be quantified.

Nearly 70% of Americans stated they supported the right to make this difficult decision in consultation with a medical professional before last Friday's announcement of the court's ruling. Since last Friday, a CBS News poll has revealed that two-thirds of women and more than half of Americans oppose the Supreme Court's decision to overturn the ruling.

The finest thing society can do is to encourage women to be able to plan their families. Female doctors manage the responsibilities of medical school and residency in this way. To balance the many responsibilities of your personal and professional life, you must decide when you want to start or grow your family.

Women cannot be tied to an outmoded idea of what life "should" be like. Women like my great-grandmother have struggled against the restrictions of unfair regulations that may have been harmful to their health for generations. Today's women are not any different. They won't give up until they've managed to flee it.