To be a unionized abortion care worker, or a worker in this field dreaming of unionization, is to be stuck between every rock and every hard place.

While the image of hospital nurses rallying for better wages with their union is usually seen as a normal and admirable sight, an abortion worker doing the same is prone to a few more side eyes from every party.

We’re living in a post-Roe world now, after all, and there are numerous lawmakers to blame for everything that threatens our work. Is now really the time to complain? Among all the intense and terrifying conflicts that already exist in our work, why introduce more conflict through unionization?

The word “union” can summon visions of headlines and angry workers holding signs on a picket line. In a work field already flooded with headlines and angry protesters, the idea of more news and more anger is exhausting.

The nature of our workplaces, while still typically riddled with systemic issues like racism and ableism, makes our employers visibly more progressive than others from the outside. One thing that has been notable in reproductive health work that I never encountered in my previous fields of work is being intentional about breaks and vacations and time off—the very idea of restoration.

At this year’s Abortion Care Network conference, many employers spoke about the real issue of burnout and sustainability, acknowledging to a room filled with care workers, volunteers, and activists that the concepts of self-care and community care were not just important, but essential.

But no one proposed any solutions. In our networks, we talk about bodily autonomy, liberation and justice, and transformation and inclusion, but the organizations that comprise the U.S. reproductive rights movement rarely—if ever—talk about labor rights within our own movement.

Burnout and sustainability are, ultimately, about labor rights. Yes, progressive employers can acknowledge the need to address burnout and sustainability, but they cannot find real solutions to it without diving deep into labor rights and the role of unions in our workplaces.

Yes, even in our abortion clinics.

Labor rights are reproductive rights. Abortion care workers witness firsthand how lack of labor rights impacts patients. If a patient is struggling to take off work to get to their appointment, a senior manager can see that situation and experience frustration and anger on behalf of the patient. However, that same senior manager may experience frustration and anger when a health-care assistant takes off work on a busy clinic day. In other words, a patient can be going through a hard time, but a worker cannot be.

An employer that knows the frustration of a patient who doesn’t have paid time off can turn around and fail to notice that their own employees run out of sick days before they’re halfway through the year. Employees who themselves have a uterus and pregnancy outcomes are navigating the exact same health-care system of the patients that the employer serves. There are workers who are helping people have choices over their parenting decisions, while not having the wages or benefits to have much choice over their own parenting decisions.

Patients do not exist separately from the abortion care workers who assist them. In the same way that our organizations often unite to move mountains for patients, we must bring together the images of “our patients” and “our staff” and actually envision ourselves in the same big picture, experiencing the same national crisis. Repro workers leave their shift and need gynecological care; our patients leave their appointment and head to work to care for patients.

In the same way when we ask what our patients deserve, the answer is enmeshed with the answers to the question: What do our workers deserve? And we don’t really ask that second question much at all, despite the similarities in the answers.

It is possible to love the service while simultaneously devaluing the work through labor practices. It is possible to be fully committed to your client base while also harming your workers and thus your client base. If we really want to be complicated here (at this point, why not?), it is even possible to be fully committed to your client base and your workers, and still cause both of them harm by following the status quo and devaluing the work.

I invite everyone doing abortion access work, from frontline workers to executive directors, to take on this complexity and open up to ways to improve our work and our care through unionization. What does providing quality abortion care and service support look like? What could it look like with a workforce that can sustain itself? Alternatively, how does a suffering and traumatized workforce undermine the quality abortion care we want to provide?

Employers, trust your workers, who respond as community members, more than you trust your lawyers, who respond as lawyers.

The point of a union cannot be reduced to intimidation. The point isn’t power and control over anything but our own lives—the same thing we want for our patients and clients.

What if, in the same way we are forced to reimagine our health-care services during this crisis, we reimagined our workplace dynamics to open up to labor justice? After all, this is a matter of survival, and, as many in the movement acknowledge already, sustainability. We need the collective imagination of employers and employees to not only survive this health access crisis, but come out on the other side with everything that we dream of for both our patients and ourselves.