On Reproductive Choice: The faith difference between Melinda Gates and Amy Coney Barrett and what that means for women

I recently finished Melinda Gates book, “The Power of Lift”, and was most impressed by the intersection of her strong Catholic faith and her views on reproductive choice. The Catholic church is often seen in sharp disagreement with not only abortion but also the use of contraception. Ms Gates acknowledges this dissonance and then lays out a thoughtful argument as to why she is able to honor her Catholic faith while at the same time using her platform and funding thru the Gates Foundation to increase access to contraception that enables women to make informed decisions about whether and when to have children. It has been proven that spacing of pregnancies reduces maternal and newborn deaths as well as increases the health of children already in the family.

Foremost, Gates admits that it is not only difficult but also misogynistic for a celibate male hierarchy to be allowed to make decisions about the reproductive life of woman when these same rules can harm the mothers and the children they birth by perpetuating the cycle of poverty. It is her empathy with poor women and children, per the Franciscan teachings of the church, that has led her foundation to provide funding for innovative contraceptive options as well as increased access to these options. Thru her travels in the developing world, she came to understand that contraception prevented millions of unsafe abortions by preventing unwanted pregnancies. While 93% of Catholic women in the US have used contraception, the Catholic church was working to prevent women outside of the US from having those same choices.

Amy Coney Barrett is also Catholic but has chosen to use her faith as a way to limit reproductive options for women in this country. If she becomes the next Supreme Court Justice she may be the deciding vote in overturning access to legal abortions. Even more timely are her views on the Affordable Care Act and what that means for women and their reproductive health. Prior to the ACA, women were required to pay for contraception and could be charged more for health insurance as having babies is a costly endeavor. After the ACA was passed and the more reliable, but costly, long term contraceptive options became available for free, unintended pregnancies and teen pregnancies plummeted and the abortion rate hit its’ lowest point, dropping 14%.

Ms Barrett has a developing world example in her own home. Two of her children are adopted from Haiti. Abortion in Haiti is illegal and reliable contraception difficult to obtain. Poverty is endemic as is the role of men in controlling women’s lives. When women are unable to feed their growing families, they often place a few of their children in a religious sponsored orphanage with the intent that “when my situation improves, I will go back and get my children”. Most of these mothers are never reunited with their children because their poverty does not improve.

I have worked intermittently in Haiti as an ob/gyn physician since 2006. Some of the most horrific situations I have encountered are when desperate woman seek an illegal abortion. The maternal mortality can be exceedingly high when unskilled providers perform medical or surgical abortions. This may be the future of our country if we restrict access to contraception at the same time that we make abortion illegal.

Religious faith can be a powerful force for doing good, as evidenced by the work of Melinda Gates and her leadership in increasing access to contraception, which she believes, and has been factually proven, to lift women out of poverty. . It can also be a force that demonizes the tragic choices that women in poverty sometimes have to make in order to support their children. That is the faith of Amy Coney Barrett.

How Roe v Wade is affecting the upcoming election – and how we can change the discussion.


Life must be interesting for Ruth Bader Ginsburg. As the oldest member of the Supreme Court, she is the most likely to retire/pass away in the next 4 years, allowing the next President to change the dynamics of the Supreme Court. Either it remains with a conservative majority or changes to a more liberal bench. The SCOTUS (Supreme Court of the United Sates) appointment is the reason many conservatives still back Mr Trump, even though they confess  they don’t believe he is Presidential material.  With a conservative majority, their hope in the future involves the defeat of Roe v Wade and the outlawing of abortion.

One of the frequent arguments against abortion involves the practice of partial birth abortion. In fact, in the third presidential debate Mr Trump described partial birth abortion as “ripping a baby out of the womb only days before birth”. As an obstetrics doctor, I routinely do this. I refer to it as a cesarean and would use the nomenclature cutting rather than ripping. Spreading false rhetoric only works to push people apart. We need to look at how we can find common ground in this debate.

These are the facts. 91% of abortions are performed before 13 weeks of pregnancy and only 1.3% occur after 21 weeks of pregnancy. The majority of these later terminations are due to fetal anomalies that are not diagnosed until the 5 month ultrasound. Heart-wrenching decisions need to be made by parents in a short time frame, as most states outlaw terminations beyond 23 weeks, only 3 weeks after a diagnosis is made. In the past few years, I have been involved in 2 of these scenarios that resulted in different decisions. One child was diagnosed with a lethal heart defect that would require multiple heart surgeries to allow the child to become old enough so that she would be a potential candidate for a heart transplant. Years of surgeries, hospitalizations, medications for at best a 20% chance of life. The other mother was diagnosed with rupture of the amniotic sac at 20 weeks of pregnancy, preventing full and complete development of the baby’s lungs. One couple chose to continue the pregnancy, the other to terminate. The important point is not which option these couples chose, but that these parents were able to make a CHOICE. A decision that made sense for their family now and in the future.

Rather than focusing on the 1.3% of abortions that are classified as late-term, why not focus on the 91% that are performed prior to 13 weeks. The number of these abortions can be dramatically reduced by reliable contraception. For example, use of long acting reversible contraception (IUDs and implants) by teens has been shown to reduce the pregnancy rate by 50%.  It is always amazing to me the number of women I see for a pregnancy confirmation that have not been using birth control because they are worried about all the “bad side effects”,  but yet didn’t want to become pregnant. Do they understand that an unwanted child is a “bad side effect”. An educational campaign focused on contraception,  healthy pregnancy and involving men in contraceptive decision-making would pay back large dividends in reducing health care dollars spent on unwanted pregnancies that are often high risk.

An unwanted pregnancy that may end in abortion was not created by just one person. But it is the woman who is blamed for the decision to terminate the pregnancy. Why don’t we hold the male partner accountable? They could have used a condom if they didn’t want their partner to become pregnant.

Overturning Roe v Wade and outlawing abortion is not the answer. I have worked in many developing world countries where abortion is illegal. This does not mean that abortion does not happen, only that it becomes expensive and dangerous. Unlicensed and unqualified practitioners put women’s lives at risk in order to make money. These are some of the same countries where birth control is difficult to obtain and rape of women, both by their spouses and others, is common. During one of my trips to Haiti, I was able to save a woman’s life (the mother of 4 children) when she suffered a perforation of the uterus and horrific bowel injury by an unqualified physician. If our surgical team had not been operating that week, she would have died and left 4 children orphans. Her response when I told her that we had to remove her uterus in order to save her life was a grateful thank you because she would not have to worry any further about pregnancy. One ward of a hospital in Port-au-Prince is devoted to women who have suffered complications of abortions. Many of these women die due to lack of antibiotics and the funds to pay for adequate care.

If you are against abortion, work to increase education and access to contraception. Educate men and boys about their responsibilities. This will work to reduce 91% of abortions; those that occur prior to 13 weeks and are often due to lack or failure of contraception. Leave late-term abortion decisions to women and their families. This is a personal decision that is different for every woman. We as physicians are able to provide factual information and support women in their decisions. This should not be decided as a one size fits all policy.