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As the Chief Medical Officer at Planned Parenthood of the Pacific Southwest (PPPSW), I see firsthand the profound impact that Roe v. Wade has had on the lives of people and families in San Diego and across our country. As I reflect on this quintessential and still highly controversial case, I am more certain than ever that choosing to lead medical services at PPPSW and advocate for all people in our 3-county region and in our country was the right decision.

Prior to coming to Planned Parenthood, I spent the bulk of my career with the United States Navy: first on active duty, then as a civilian (GS) OBGYN at the Naval Medical Center in San Diego (Balboa). Over my decade of service, it was clear to me that not everyone has access to basic reproductive health care. Right here in San Diego County, thousands of people in the military can’t afford abortion care, and it isn’t covered by their insurance. The federal government has a cruel law called the Hyde Amendment that prevents any federal tax money from going toward abortion care. 

The heartless politicians who support the Hyde Amendment try to make abortion seem like a simple issue. It’s not. Reproductive health care is complex; people’s lives are complex. Abortion is a decision that needs to be made by the person whose body is affected by the pregnancy and their medical professionalthat's it. 

After three years on active duty followed by service as the civilian Director of Family Planning and Associate Residency Program Director in OBGYN at Balboa for eight years, I have seen the damage the Hyde Amendment has on the lives of military pregnant people and their families. Many pregnant people who have fetuses with severe abnormalities that are incompatible with life, or a variety of other pregnancy complications, cannot access abortion services due to cost. Because they have federal insurance, the Hyde amendment prohibits funds to be used to allow abortion even in these heartbreaking cases. 

The military will only pay for an abortion if the pregnant person's life is in danger, or the pregnancy was a result of rape or incest. Women in the military face significantly higher rates of sexual assault, and those who need an abortion as a result of rape or incest have to be willing to come forward and report to their health care provider that their pregnancy was due to these heinous crimes against them. Military women already underreport their abuse for fear of retribution, among other reasons. Forcing women to relive their trauma to satisfy a political agenda is a disgrace. 

After Trump was elected in 2016, my own naval hospital became reluctant to even promote birth control. That’s one reason why, in early 2018, I decided to take a new position at Planned Parenthood of the Pacific Southwest — one of the largest Planned Parenthood affiliates in the country. Here I am able to provide abortion care, train the next generation of OBGYNs, and advocate for policies that protect sexual and reproductive health.

While I was excited about the opportunity to lead medical services at PPPSW and have a larger platform to advocate for everyone in my community (including my beloved military population), the decision was not made lightly. Before taking the position at Planned Parenthood, I had to make sure my husband was willing to take on the weight of this job and the hostility, and even threats, to our lives that are a routine part of being an OBGYN at Planned Parenthood. Thankfully, he not only supports me but also believes in the mission of Planned Parenthood. 

Unfortunately, not everyone in my family can share in my pride of leading this health care organization and in my advocacy work. My parents, always so proud of my accomplishments and who sacrificed so much to help me through undergraduate and medical school, do not support abortion. They are devout Catholics and tend to see abortion as a black and white issue. I knew my decision to work for Planned Parenthood would be difficult for them and many of my other relatives. But I continue to be proud of the vital health care I provide every single day.

Since I left my position at the Naval Medical Center, little has changed for the people who serve our country. A few months ago, a medical colleague asked me how she could help a service member stationed overseas access an abortion. This service member couldn’t leave her duty station due to COVID-19; she had no one to care for her other children. To make matters worse, there was no abortion provider anywhere in her region. Again, due to the Hyde amendment, she could not seek an abortion at the military hospital. She would have to find a way to fly back to the United States (in a pandemic). She did not have the resources to get the care she desperately needed and deserved. It was frustrating to know there was nothing that I could do to help her. 

Around the same time, I was connected with a couple with federal insurance who were also stationed overseas and working with the military. They found out at 22 weeks their baby had been diagnosed with a condition that was incompatible with life. Instead of spending time grieving with family, this woman had to juggle health care and travel arrangements to get the care she needed at one of our health centers in San Diego. Helping people like this through some of the toughest times in their lives is the reason I came to Planned Parenthood, and it’s why I have to speak out against the Hyde Amendment.

California champions reproductive health care by mandating all health insurance and Medi-Cal cover abortion care. Now it’s time we offer all people, especially those who serve our country in the military, the dignity of having the comprehensive reproductive health care they need and deserve.  

Toni Marengo, MD, FACOG
Chief Medical Officer
Planned Parenthood of the Pacific Southwest

Note: Dr. Marengo, a proud Navy Veteran, has been leading medical services at Planned Parenthood of the Pacific Southwest for two and a half years. She continues to see patients in Planned Parenthood clinics as a comprehensive gynecologist. She is thrilled to serve the community she grew up in (North San Diego County) and to ensure high quality and affordable reproductive and sexual healthcare services to all who need it.


Tags: Abortion

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