Columbia Nursing Graduate Shares Insights on Reproductive Rights

As a pediatric nurse practitioner and educator in women’s health, Carol Roye '86, EdD, CPNP, RN, didn’t set out to be an advocate for reproductive rights. Roye, a mother of six and grandmother of 12, doesn’t consider herself a feminist or a political activist.

But after years of caring for adolescent women in New York City’s Washington Heights neighborhood, Roye saw firsthand how politics and public policy decisions could limit her ability to provide adequate care for her patients. Disturbed by what she perceived as a relatively recent and rapid decline in reproductive rights in the U.S., Roye, director of the Center for Nursing Research at Hunter-Bellevue School of Nursing, decided to write a book. The result, “A Woman’s Right to Know: How Women’s Health Became a Political Pawn – and the Surprising Alliances Working to Reclaim it,” was published earlier this year.

“I never thought I would write a book like this, but I wanted to set the record straight and make sure my patients and my students, really everybody, would understand how reproductive rights became a political issue,” says Roye. “Knowing how the history of how reproductive rights have deteriorated will help us make the necessary changes so that women can have access to the care they need.”

Roye’s path to advocacy began in the waiting room of an abortion and colposcopy suite at a New York City hospital in the late 1980s. One of her adolescent patients had an abnormal Pap smear and needed a follow-up examination of her cervix to check for signs of cancer. Concerned that the young woman wouldn’t go to the exam alone, Roye accompanied her. At the hospital, Roye and her patient entered a waiting room solely occupied with women; none had been accompanied to the appointment by a man. “Looking around this room made me understand that women’s health had to be framed as an idea that should matter to men” Roye says. “Reproductive rights are much harder to take away if they affect fathers and not just mothers.”

In the early days of her career, Roye often encountered young women who dropped out of school to have a baby. While some of these women may have opposed abortion for personal or religious reasons, others weren’t aware of their options until their pregnancies were too advanced. “I knew we were having the conversation too late if we were already talking about what to do about an unintended pregnancy.”

But as she worked to get her patients to use birth control, Roye encountered unexpected obstacles. Many young women couldn’t obtain oral contraceptives because their insurance plan didn’t cover birth control. And, many patients with insurance coverage for contraceptives still didn’t fill the prescription because they couldn’t afford the co-payment.

Then, in the 1990s, with the advent of emergency contraception, also known as the “morning after pill”, Roye saw unwanted pregnancies all but disappear from her practice. She started prescribing emergency contraception to all of the sexually active young women she treated. Roye advised them to fill it right away, and keep it on hand to use in the event that they needed it.  Because emergency contraception only works to prevent pregnancy if taken within 72 hours of unprotected sex, Roye says it makes sense from a public health standpoint to put this in women’s hands before it is actually needed. The tactic worked and for two years Roye didn’t see a single unwanted pregnancy. “But, suddenly, I started seeing women who were pregnant because they couldn’t get the prescription filled,” Roye says. In some instances, state laws started allowing pharmacists to refuse to fill prescriptions for the morning after pill if they objected on moral grounds. As a result, “the gains that had been made started to go away.”

In her book, Roye frames reproductive health as a public health issue by connecting it to child welfare. Women are more likely to raise healthy children when they have fewer pregnancies spaced farther apart, Roye argues. The book traces the history of contraception access from colonial times through the present day, from the first U.S. birth control clinic opened by Margaret Sanger in Brooklyn in 1916 to Roe v. Wade, the landmark Supreme Court ruling legalizing abortion in 1973. She traces the rise of the religious right in the 1980s and the subsequent emergence of reproductive rights as a flashpoint in U.S. politics.

“Nurses need to understand objectively the issues around reproductive health, both to provide the best care to their patients and to be a voice of reason when public policies threaten to restrict women’s access to care,” Roye says. “I’m coming at this as a nurse and a mother and a grandmother, and I’m saying that women should have the kids they want, and not have the kids they don’t want.”