Today's Key Reproductive Issues with Physician & Surgeon Dr. Arghavan Salles

Dr. Arghavan Salles is a leading physician/surgeon, advocate for women's health, and Clinical Associate Professor at Stanford University. She has been featured in TIME magazine for her work on improving the wellbeing of physicians and advancing conversations around inclusivity in the medical field.

In our Q+A, we speak to Arghavan about her perspective on reproductive rights and how the overturning of Roe vs. Wade is impacting women’s health beyond access to abortion, as well as her own reproductive health experiences.

You’ve had a dynamic career as a surgeon, writer and consultant. Where are you most excited to focus your professional efforts now, and what aspects of women’s health and wellbeing are you most personally passionate about changing?

Dr. Salles: My work is currently focused on identifying and implementing strategies that create more inclusive workplaces. I straddle the line between research and practice, studying the challenges faced by marginalized people and using that knowledge to develop interventions. I am particularly focused on sexual harassment, in all its forms, and how it impedes the careers of women and sexual and gender minorities.

You also have a strong voice concerning gender equality bias in medicine. What made you want to start advocating for female physicians in medicine and what aspects of the medical system do you most want to see change?

Dr. Salles: I have long been a woman in male-dominate fields, dating back to my love of math in school and my undergraduate degree in engineering. It was not until I started my surgical residency, though, that I started to see how differently people treat men and women in the real world. Then when I pursued my PhD, I studied gender stereotypes and their impact on women surgeons in training. That experience was truly eye-opening because I had never studied gender in any way prior to that.

Then, once I understood the ways gender schemas and stereotypes impact how we are perceived (and what behavior is considered acceptable) I started seeing the same patterns everywhere. Women who spoke up were punished and paid a social penalty. People were quick to suggest ways that women should modify ourselves to fit in better at work (read: not ruffle anyone's feathers); they were very slow, however, to consider how the systems and structures in which we work are unjust (and even more unjust for women of color).

If we are going to truly create inclusive workplaces, we need to build systems and structures that combat our human biases. It's not enough to just want to be better or to have good intentions; we have to make equity the default (rather than the exception) and bake it into everything we do.

As a healthcare practitioner, what are some of the ways that you and your colleagues are seeing the impact of the overturning of Roe vs. Wade impact women’s health beyond access to abortion?

Dr. Salles: First of all, restricting access to abortion is devastating, full stop.

In addition, though, we know restrictions on abortion open the door for discussions about when "fetal personhood" begins. Is it at conception? Is it at implantation? Is it at a specific gestational age? All of these choices have implications for contraception and assisted reproductive technologies (ART).

If, for example, a state decides personhood begins at fertilization, then they define every frozen embryo as a life. This would severely restrict access to ART, which many people need to build their families. Restricting access to abortion also has a significant impact on medical training. If students and residents in half the states can't learn how to manage abortion (or maybe even how to manage miscarriages, ectopic pregnancies, etc), we will have a severely limited workforce skilled in this care. That is a nightmare for us all.

You’ve said that the events of this year are “not the end of the book on reproductive rights— it’s just the beginning of the next chapter.” Can you share your perspective on what needs to happen next and how people can best power positive change?

Dr. Salles: It is critical that we all engage in elections at every level and make our voices heard.

There can be a tendency to want to disengage, particularly when the government takes action to impair your access to healthcare or limits your ability to make decisions about your own body.

Unfortunately, that plays right into their hands. We have to show up, we have to organize, we have to speak and write and yell, and we have to vote. There are many who have been doing this work for years; we should support those individuals and organizations in as many ways as we can, including volunteering and donating.

You’ve written about your experience trying to conceive. What do you wish more people understood about the process of trying to make a baby?

Dr. Salles: I wish all young people understood that when your fertility declines, there is not a lot you can do about it.

There is a myth that ART can help anybody have a baby, and I suppose if you include donor eggs, donor sperm, and gestational carriers, that is true. But most people are not keen on those options when first setting out to build their families. For every public story of success with ART, there are others who aren't sharing their devastating outcomes. Those invisible stories are the ones I wish we could all see.

You recently wrote about the fact that people are used to hearing narratives about “overcoming” infertility. But, of course, so many attempts to conceive do not end with a baby and that can raise a lot of very complicated feelings. What would your advice be for someone nearing the end of the chapter of trying to conceive?

Dr. Salles: Gosh, I feel I am the worst person to try to give advice on this. I am still struggling myself. It's important to not beat yourself up over what you could or should have done. We all make the best decisions we can with the information we have available.

Even though in retrospect we may wish we had done something differently, we have to give ourselves grace. It's also important to focus on what you really value--do you want to be pregnant? Do you want a child with your genetic material? How much time, money, and emotion do you want to (or can you) put into the process while maintaining a healthy sense of self? Those answers will be different for everyone, but many fertility journeys are frustrating, isolating, and stressful. We all need support to get through it.

What are the three most critical aspects of women’s healthcare that you want to see change in the next three years and why?

We are currently seeing an exodus of healthcare workers from the industry. Women physicians, who are already more likely than men to work part-time, are at significant risk of leaving. Women physicians are, in many cases, held to a different standard than men.

That's exhausting. Add to that the negative impact of the pandemic on women's careers, and I worry there will be a significant backslide in the progress we've made. This has significant implications for the ways we care for patients because several studies suggest women provide better care, especially for other women. That's something we should all be worried about.

artwork: billie zangewa

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