“I’ve spent so much of my training trying to help people who are so desperate to end a pregnancy.”
On June 24, the Supreme Court overturned Roe v. Wade, the landmark case which, for nearly 50 years, had guaranteed the constitutional right to abortion. In the weeks since Roe fell, both abortion providers and people seeking abortions have scrambled to parse the new landscape around pregnancy — in many areas, what is legally permitted is no longer clear, and pregnant people are bearing the costs.
But doctors are still doing the work to show up for their patients: Alexandra E. Monaco, M.D., M.S., a Florida-based doctor and abortion provider, graduated from her abortion training fellowship on the same day Roe was overturned. Here, she speaks to Senior News Editor Lilli Petersen about what that moment was like, what her hopes and fears are moving forward, and what she wants people to know about abortion care in this post-Roe world.
This interview has been edited for length and clarity.
My first indication that abortion care was something I was really interested in came when I was working in a student health clinic while I was in medical school in Florida. People would come in with vague complaints, or because they were unsure if they were pregnant, and we’d do a pregnancy test. I remember some people not being happy about those pregnancies. Some providers would jump right into a congratulatory statement after a positive pregnancy test, but I quickly picked up that would not be the appropriate way to respond. I thought that was a very intimate moment and realized it was important for me, even as a medical student, to give a patient their options.
There are so many patients that I’ve taken care of whose abortions were needed, whether that was because of their medical care, or a fetal anomaly, or something going on in their life that they couldn’t — or didn’t want to — continue a pregnancy. I had a patient who went to the hospital with some vague complaints and was diagnosed with acute leukemia. She was also diagnosed with an early pregnancy. Her cancer doctors had to start treatment for her right away during that hospital admission, and the treatment was potentially toxic to the pregnancy. In order for her doctors to start treatment for her cancer, we had to remove that pregnancy. And that’s what the patient wanted to do, even though this was a desired pregnancy for her.
When it happened, it was just devastation.
I went to four years of medical school in Florida, and then did a four-year OB-GYN residency in Tennessee. Abortion is part of OB-GYN residency training, and that’s an all-encompassing term — it covers miscarriages and pregnancies people choose to end. I chose to do a little bit more training after my residency with a two-year fellowship called complex family planning, which is more in-depth training about abortion as well as contraception, and I did that in New York.
My graduation from that fellowship was on June 24, 2022 — the day Roe v. Wade was overturned. Graduating from fellowship when Roe had just been overturned a few hours earlier was very bizarre. I wore a T-shirt that said “1973,” the year Roe was decided, because it felt like the right thing to do. We were all congratulating each other for graduating, but it was a somber occasion. The decision limits what all OB-GYNs do, not just me.
I have a group text with my fellows, and we all felt the same way that day. It was a visceral reaction. But it was also an immediate call to action. We had a lot of fellows who were in restrictive states and had immediate trigger bans going into effect, which meant they had to shut down their clinics immediately.
Some fellows in restrictive states started reaching out to those of us in safe states to try to get care for patients who were able to travel. It was both incredible and devastating to see the immediate action that had to be taken the day Roe was overturned. One of my friends at a fellowship site in a restrictive state had 27 patients scheduled that day, and had to cancel all appointments because abortion immediately became illegal in her state. A colleague friend of mine in New York was doing abortions that day, and we were calling and texting each other for support. I was so thankful that we were in New York at the time. It was great to be a part of a community, but it was definitely crushing.
Abortion providers were ready for this because of the leaked Dobbs v. Jackson draft that was published in May, but when it happened, it was just devastation. I was immediately so sad for so many patients — I’ve spent so much of my training trying to help people who are so desperate to end a pregnancy, for whatever reason. I know that it’s going to be so difficult for so many patients, and those patients aren’t going to get the care they need or deserve. I cried, even though we knew it was coming. All we can do now is keep doing the work, and try to help patients as best we can.
I am up for the challenge of being there for patients.
Overturning Roe hasn’t changed my immediate plan in terms of where I’m going to work. I’m taking a position as an OB-GYN at an academic teaching hospital in Florida as the first complex family planning specialist at the hospital. I’ll be working at an independent abortion clinic as well. But it changes the scope of my practice. I can’t do abortions after 15 weeks unless it’s indicated for a fatal fetal anomaly or maternal emergency; I’m going to have to be very up-to-date on the laws, and how things are changing, and what I can and cannot do legally. It’ll be a constant balance of the doctors’ oath of “do no harm” versus doing what we can, within the limits of the law, to help patients.
I’m concerned about that. I want to take care of patients to the best of my ability, but I won’t be able to do that in certain situations, and that’s going to be really tough to deal with. It’ll be difficult to tell patients that I can’t take care of them. If I can’t help them here, I’ll do everything I can to get them care in another state, which is easier said than done. But I am up for the challenge of being there for patients.
There’s so much ugly rhetoric out there in the world. The patients are so wonderful and so thankful for us doctors just being kind to them: When we’re doing good medicine and listening to them, I think they’re pleasantly surprised. I think they probably expect to be treated poorly, because of all that rhetoric. That always breaks my heart a little bit.
This post-Roe time is going to be unprecedented. I hope that we won’t go back to the pre-1973 reality of back alley abortions, because we do have medication abortions. That’s something that we can get to patients, hopefully, one way or another. But it’ll be more difficult. I just want patients to know that there are so many providers out there who are trying to fight for them, and who want to take care of them, and will do the best we can to get them the care they deserve.