As a pediatrician and public health expert, I've watched countless young girls' lives instantly change when they find out they are pregnant. And, over the last 12 years in private practice, I've helped many of them move beyond those terrifying experiences with access to quality, safe abortion care providers. Some of those young women were the survivors of rape or incest; some had a birth control failure; some made poor decisions due to their immature executive functioning and decision-making skills (the brain does not become fully "adult" until about 25). Unplanned pregnancies are universally upending for teens, but the protections Roe v. Wade afforded guaranteed they didn't have to be life-defining or even life-ending. Now they most certainly will be for so many of our American daughters. 

My heart was in pieces when the news broke in June about the end to decades of national-level abortion rights. Mothers and fathers immediately began calling into my pediatrics office in Portland, Oregon requesting birth control and asking that I meet with their teens to explain the gravity of the Supreme Court's decision to overturn Roe v. Wade. These parents were frantic to take action on their daughters' behalf because they now understood how much more devastating an unplanned pregnancy would be regarding their social, emotional and financial wellness. And, even though I care deeply about all of those evidence-based concerns, another even more concrete outcome of the Supreme Court's decision was weighing heavy on my mind.

Related: I had an abortion at 21. I have never wanted to tell my story—until now 

As a physician, I considered first what those parents who called me couldn't fully grasp: the horrifying impact the Supreme Court's decision will have on the health of our American daughters, including my own. I considered the crushing mental and physical health burdens those young women will face—the fact that their very lives now hang in the balance. 

The United States has the highest maternal mortality rates compared with other developed countries. And we know already that abortion bans will likely increase these rates. A 2021 University of Colorado study determined that pregnancy-related deaths could increase by 21% overall and up to 33% for Black women if there were a total ban on the procedure. According to the World Health Organization, women who seek an illegal abortion face a significant risk of death globally. 

Related: What President Biden’s executive order for abortion rights really means

Pregnancy is significantly more dangerous for my young patients. Adolescent mothers aged 10 to 19 who carry their pregnancies to term endure higher risks of many health problems, including infections, puerperal endometriosis, and eclampsia, compared to those aged 20 to 24 years. Their newborns, likewise, are at higher risk for low birth weight and premature birth. 

I'm sorry that we have not come further in protecting not just your emotional and social wellness but your physical health; we've gone backward.

Those health statistics don't even consider specific cases like Vivienne, a 4-year-old patient in my community with a complicated medical history including severe allergies and a clotting disorder. Vivienne's at an even higher risk of death if she ever becomes pregnant. The hormones associated with pregnancy will increase her risk of forming life-threatening blood clots. She won't be a hormonal birth control candidate for the same reason. If she does become accidentally pregnant in her teen years without proper precautions, she could die. And now that abortion is no longer a viable option for her, her mother is suddenly faced with more complicated decisions about protecting her physical wellness in her teen years and beyond. "Will she need a non-hormonal IUD at 11?" Vivienne's mom asked me last week. "Will that even be an option as reproductive rights are increasingly threatened based on comments about Griswold v. Connecticut from our current Supreme Court justices?"

I promise I will continue to do the good work of fighting for your future alongside all the other brave women and men I know who will not give up on you.

My daughter, Makena, has autism. What if she refuses to take birth control (at 8 years old, I can barely get her to brush her teeth when she's emotionally dysregulated. Makena is hazardous to herself and others when she has to get a simple blood draw) and is sexually assaulted in her teen years? What happens if she does have an unplanned pregnancy and isn't emotionally or socially mature enough to care for her health or the health of her little one? What then? Then her health will be in extreme danger, that's what. 

No wonder the American Academy of Pediatrics recently reissued a policy statement reaffirming their support of adolescents' rights to access comprehensive, evidence-based reproductive health services, including abortion.

Related: What now? How to get involved after the overturning of Roe v. Wade 

"Today's Supreme Court decision to overturn Roe v. Wade means that the once Constitutionally protected right to access an abortion is no longer guaranteed nationwide. This decision carries grave consequences for our adolescent patients, who already face many more barriers than adults in accessing comprehensive reproductive healthcare services and abortion care," they said. 

American Daughters, Vivienne, Makena: It's all our fault. I'm sorry that this country has failed you. I'm sorry that we have not come further in protecting not just your emotional and social wellness but your physical health; we've gone backward. I'm sorry that you are at risk because of my generation's decisions. I'm sorry that, as a nation, we aren't protecting your health as we should. I'm sorry that you'll have to fight harder to stay healthy than I ever have. And I promise I will continue to do the good work of fighting for your future alongside all the other brave women and men I know who will not give up on you.