The American College of Abortion Advocacy
Proponents of legal abortion often couch their position in the language of female empowerment, claiming that abortion is necessary to protect women’s freedom, equality, and opportunity. But while supporters often speak about abortion in terms of “women’s rights” and remember it as a crusade of Second Wave feminists in the 1960s and 1970s, the modern abortion-rights movement did not originate entirely with the women’s liberation movement. The modern political movement pushing for legal abortion was led in large part by ideologically motivated doctors seeking to make it easier for them to perform elective abortions without facing legal consequences. Leading up to the Supreme Court decision in the 1973 case Roe v. Wade, which invented a constitutional right to abortion, a growing number of self-interested doctors coalesced around the goal of legal abortion. Before Roe, most states strictly prohibited elective abortion; however, rather than imposing criminal penalties on the pregnant women who obtained abortions, they punished the doctors who performed them.1
Ignoring the growing scientific evidence that confirmed human life in the womb, a significant subset of doctors became a crucial force behind the campaign to legalize abortion. Though medical experts had yet to develop sophisticated ultrasound technology like that we have today, doctors were already well aware that the creature in the womb was a human being. Their studies, the biological evidence, and regular medical practice made it quite clear that this was the case. Nevertheless, elite medical groups, most notably the American College of Obstetricians and Gynecologists (ACOG)—supposedly a nonpartisan membership organization—rallied to the pro-abortion cause and used their influence to lobby the Supreme Court, especially Justice Harry Blackmun. It was not the case, to be sure, that most doctors in the United States wanted abortion to be legal. But an influential group of activist doctors in prominent leadership roles did. Since then, these actors and groups, including ACOG, have hardened their pro-abortion stance, at every turn lending their voices to the political movement supporting unlimited abortion on demand.
ACOG didn’t start out as a pro-abortion lobbying group, but as its leaders slowly became involved in the policy fight to legalize abortion, they made the group what it is today: one of the most powerful and prominent abortion advocates in the U.S. At several key points in the abortion debate, ACOG has used its status as a medical organization to lend a veneer of legitimacy to the pro-abortion cause, playing rhetorical games to disguise its extremism and offering politicians cover for their radical policies.
Today, supporters of abortion often use the phrase “reproductive health care,” a euphemism meant to suggest that this gruesome procedure has something to do with women’s health. But rather than adhere to the standards of care typical of the rest of the health-care field, abortion providers use tools of healing as lethal weapons, and they often perform shoddy work that puts pregnant mothers at risk, too. At every turn, the abortion industry opposes regulations aimed at bringing their grisly work into line at least with the ethical obligations of informed consent and clinic safety. This state of affairs has obvious implications for medicine. How did a procedure that ends the life of an unborn human being—and sometimes harms the child’s mother in the process—become regarded as standard medical practice? Why do major medical organizations insist that abortion is health care yet reject typical health-care regulations and safety standards?
This status quo can be better understood by studying the evolution of ACOG. In Roe, the leaders of ACOG used their influence as medical professionals to push the court to rule in favor of abortion, enabling the justices to argue that their decision was in line with the recommendation of doctors. Today, ACOG is one of the nation’s foremost lobbying groups pushing for unlimited abortion on demand, under the guise of medical expertise.
But the organization wasn’t founded to serve as an abortion-advocacy group. It was created as a nonpartisan professional organization to educate obstetricians and gynecologists. The group’s decision to hide behind this model, while in fact becoming an advocate for unlimited abortion, illustrates how the abortion industry has been so successful at infiltrating the medical field and passing off abortion as health care.
ACOG Shifts to Advocacy of “Therapeutic” Abortion
Founded in 1951, ACOG initially handled the brewing abortion controversy by advising doctors to perform abortions only “where the death of the mother might reasonably be expected to result from natural causes, growing out of or aggravated by the pregnancy, unless the child is destroyed.”2 ACOG affirmed, in other words, that elective abortions are unethical medical practice.
During ACOG’s first decade, its leaders continued to insist that the effort to legalize elective abortion was a matter for social debate, not an issue that could be resolved by medical expertise, and thus that ACOG should not become involved in the particulars of the debate. But in the late 1960s, proabortion members of ACOG’s leadership began slowly pushing for the organization to use its influence to lobby for legal abortion. Slowly, the group’s leadership chose to redefine the words “health” and “therapeutic” as they relate to abortion, subtly ushering elective abortions under the umbrella of medical necessity.
In 1968, ACOG’s Committee to Study Liberalization of the Laws Governing Therapeutic Abortion issued a report announcing that doctors could perform “therapeutic” abortions “when continuation of the pregnancy may threaten the life of the woman or seriously impair her health.” Crucially, the report added: “In determining whether or not there is such risk to health, account may be taken of the patient’s total environment, actual or reasonably foreseeable.”3 This redefinition of “therapeutic” was broad enough to encompass any possible reason that a woman might seek an elective abortion, essentially sanctioning elective abortion by fiat, without consulting ACOG members, even when it was illegal in most states to perform elective abortions. The phrasing ACOG used in this report is uncannily similar to the wording used by the court in its 1973 ruling in Roe’s companion case, Doe v. Bolton.
As an add-on to its opinion in Roe, the court in Doe created a workaround for abortion restrictions, demanding that any state law regulating abortion include an exception for “maternal health.” But rather than limiting this to cases in which a woman’s life was threatened, the court defined health expansively, allowing doctors to exercise their medical judgment “in the light of all factors—physical, emotional, psychological, familial, and the woman’s age—relevant to the wellbeing of the patient. All these factors may relate to health.”4 This rationale has made it nearly impossible for states to enact any significant or effective regulations on abortion, even the most modest of protections. The court’s mandate evidently had its roots in the notion ACOG had begun to articulate: Doctors should be permitted to exercise their judgment about when abortion is necessary by accounting for a woman’s health, defined broadly to cover nearly any reason a woman might say she “needs” an abortion.
ACOG’s shift toward supporting elective abortion didn’t end there. In 1971, the group’s executive committee formally approved the decision of ACOG president Clyde Randall to sign an amicus curiae brief filed at the court in Doe by the pro-abortion James Madison Constitutional Law Institute.5 Randall argued at the time that ACOG should take a formal stance in favor of legal abortion, writing in a report, “The termination of pregnancy is one of the few areas in which laws now dictate what the physician may or may not do in the care of his patient.”6
It is impossible to overstate the influence that pro-abortion medical professionals such as ACOG had as the justices deliberated on Roe and Doe. ACOG filed one of the most influential amicus curiae briefs in the case, signed by nearly 200 doctors, arguing that legal abortion was necessary to enable good medical practice.7 Several of the brief’s signatories were doctors at the Mayo Clinic in Minnesota, a move aimed at influencing Blackmun, who had served as general counsel at the Mayo Clinic in the 1950s, prior to becoming a federal judge.
In their brief, the doctors argued that the Texas ban on abortion at stake in Roe “interferes with a physician’s practice of medicine by substituting the mandate of a vague legalism for the doctor’s best professional judgment as to the medically indicated treatment for his pregnant patients.” The brief went on to complain that “physicians treating pregnant women run the risk of criminal charges as the result of their professional decisions.”8 The argument, in other words, was that abortion bans are antithetical to good medicine—a compelling claim coming from elite doctors.
ACOG stated that the group opposed the abortion laws at issue because they allowed abortions only to save the life of the mother, which ACOG claimed was “unconstitutionally vague.”9 The brief offered an expansive definition of the so-called “life of the mother” consideration, arguing that “life may mean the vitality, the joy, the spirit of existence, as well as merely not dying,” meant to intimate that abortion could be necessary for a woman’s life in some sense other than immediate physical danger. The brief insisted that decisions about whether abortion was medically necessary—even under this new, expansive definition—should be left to physicians alone.
Hiding their political advocacy behind the veneer of medical expertise, these supposedly unbiased professionals told the court that abortion bans inhibited them from exercising their best judgment as to whether abortion was medically necessary in any given instance. That argument worked. Both the ACOG brief and policy advice from the American Medical Association— which likewise had begun endorsing relaxed abortion laws—appeared to have significantly influenced Blackmun’s thinking.
The opinion Blackmun wrote on behalf of the seven-justice majority in Roe hardly mentions women’s rights and focuses instead on deferring to the judgment of doctors: “For the period of pregnancy prior to this ‘compelling’ point [the end of the first trimester], the attending physician, in consultation with his patient, is free to determine, without regulation by the State, that, in his medical judgment, the patient’s pregnancy should be terminated,” he wrote.10 Blackmun also cited the AMA’s 1970 declaration holding that “the Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion that is performed in accordance with good medical practice and under circumstances that do not violate the laws of the community in which he practices.”11
The influence of these doctors on the outcome in Roe is especially clear if you contrast the ruling with the court’s 1992 ruling in Planned Parenthood v. Casey. In Roe, Blackmun grounded his rationale in large part on trusting physicians to decide whether abortion is necessary—so much so that feminists and scholars have criticized Roe for emphasizing the role of doctors to the exclusion of female autonomy.12 Even Supreme Court justice Ruth Bader Ginsburg criticized Roe on those grounds: The decision, she said, was based on “the woman in consultation with her doctor. So the view you get is the tall doctor and the little woman who needs him.”13 Roe created a right to abortion, but in Blackmun’s telling, that right functioned more to protect doctors in their practice of medicine than to let women do as they pleased.
“The decision vindicates the right of the physician to administer medical treatment according to his professional judgment up to the points where important state interests provide compelling justifications for intervention,” Blackmun wrote in Roe. “Up to those points, the abortion decision in all its aspects is inherently, and primarily, a medical decision, and basic responsibility for it must rest with the physician.”14
Casey, by contrast, places women at the center of its logic and grounds the right to abortion in liberty and autonomy, so much so that the role of the doctor in abortion—the fact that abortion even involves a doctor—all but vanishes. In Casey, the Court’s reasoning essentially removes the abortion right from the context of a doctor’s judgment and transforms it into an issue of female freedom and equality.
ACOG as Abortion Cheerleader after Roe and Doe
With its involvement in Roe and Doe on behalf of the legalization of abortion, ACOG had begun its steady march toward what it is today: an abortion advocacy organization. Since first placing its thumb on the scale in 1971, ACOG has weighed in on abortion policy at every turn to insist that restrictions are incompatible with good medicine. In more than a dozen Supreme Court cases, ACOG has filed amicus briefs advocating the least restrictive possible stance on abortion, and the court has cited ACOG’s contributions as representative of medical standards.15 In two of the most recent cases, Whole Woman’s Health v. Hellerstedt and June Medical Services v. Russo, ACOG argued against admitting-privileges requirements for abortion clinics—even though these requirements apply to all other forms of ambulatory surgical centers and even though ACOG’s own guidance states that direct patient handoff can reduce the incidence of medical errors.16 ACOG’s position on medical standards for abortion, in other words, has always stood in stark contrast to accepted medical standards and best practice for all circumstances other than abortion.
In 1996, when Congress was considering legislation to ban “intact dilation and extraction” abortions—otherwise known as partial-birth abortions— ACOG prepared a statement admitting that the group “could identify no circumstances under which this procedure . . . would be the only option to save the life or preserve the health of the woman.”17 But after collaborating with the staff of President Bill Clinton—who was preparing to veto the partial-birth ban, and who later did so twice—ACOG added this blatantly political modification: “An intact D+X, however, may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman, and a doctor should be allowed to make this determination.”18 This assertion was later quoted by the Supreme Court in Stenberg v. Carhart in defense of its decision invalidating Nebraska’s ban on partial-birth abortion.19 In 2007, ACOG issued an ethics statement suggesting that OB-GYNs should either perform abortions or refer women elsewhere to obtain one, a move that nearly led to doctors losing their board certification if they objected.20 In 2010, ACOG formed the American Congress of Obstetricians and Gynecologists, an affiliated lobbying organization that exists solely to advocate unlimited abortion on demand under the guise of medical expertise. All ACOG members are required to finance this group through their dues, even if they express their opposition to abortion.21
The evolution of ACOG from a nonpartisan medical group into an abortion cheerleader illustrates how, both before and after Roe, a critical mass of the elite medical community began to coalesce around more and more liberal abortion laws, pretending that such a position was medically necessary. This still has political ramifications today. In addition to its influence on the high court, ACOG plays an important role as a supposedly neutral source for biased reporters covering abortion.
In the debate over pro-life heartbeat bills—which prohibit abortion after a fetal heartbeat can be detected, usually at about six weeks’ gestation— some outlets have refused to use the phrase “fetal heartbeat,” instead citing ACOG guidance that attempts to diminish the reality of the unborn child’s developing heart. The Guardian, for instance, updated its style guide in 2019 to replace the phrase “heartbeat bill” with “six-week abortion ban,” citing ACOG on the point, which says that it “does not use the term ‘heartbeat’ to describe these legislative bans on abortion because it is misleading language, out of step with the anatomical and clinical realities of that stage of pregnancy.”22
ACOG’s transformation from a nonpartisan network of doctors into a pro-abortion lobbying group shows how abortion has corrupted otherwise legitimate institutions, thereby altering the terms of public debate. The organization has retained its name and, in most circles, its reputation, but it consistently advocates policies that contradict the oath calling on doctors to do no harm. That ACOG is now among the country’s premier abortion lobbyists captures the great extent to which the political movement for legal abortion was not first and foremost a goal of women’s liberation but an objective brought about by the profit-driven self-interest of medical professionals.
1. NR Symposium, “One Untrue Thing,” National Review Online, August 1, 2007, https://www. nationalreview.com/2007/08/one-untrue-thing-nro-symposium/.
2. Nancy Aries, “The American College of Obstetricians and Gynecologists and the Evolution of Abortion Policy, 1951-1973: The Politics of Science,” American Journal of Public Health 93, no. 11 (2003): 1812.
3. ACOG, Item 6.39 Report of the Committee to Study Liberalization of the Laws Governing Therapeutic Abortion: Transcript of Executive Board Meeting, 9 May 1968:4.
4. Doe, 410 U.S. at 192.
5. Aries, “The American College of Obstetricians and Gynecologists and the Evolution of Abortion Policy,” 1817.
7. Brief of the American College of Obstetricians and Gynecologists, et al., as Amici Curiae for Petitioners, Roe v. Wade, 410 U.S. 113 (1973).
9. Brief of the American College of Obstetricians and Gynecologists for Petitioners, Roe, 410 U.S. 113 (1973).
10. Roe, 410 U.S. at 163.
11. Roe, 410 U.S. at 143-44, nn.38-9.
12. See Katie L. Gibson, “The Rhetoric of Roe v. Wade: When the (Male) Doctor Knows Best,” Southern Communication Journal 73, no. 4 (2008): 312-31.https://www.tandfonline.com/doi/ abs/10.1080/10417940802418825.
13. Robert Barnes, “The Forgotten History of Justice Ginsburg’s Criticism of Roe v. Wade,” the Washington Post, March 2, 2016, https://www.washingtonpost.com/politics/courts_law/theforgotten-history-of-justice-ginsburgs-criticism-of-roe-v-wade/2016/03/01/9ba0ea2e-dfe8-11e59c36-e1902f6b6571_story.html.
14. Roe, 410 U.S. at 165.
15. See Brief of American Association of Pro-Life Obstetricians and Gynecologists as Amicus Curiae for Petitioners, Dobbs v. Jackson Women’s Health Organization (2021).
16. Committee on Patient Safety and Quality Improvement, “Communication Strategies for Patient Handoffs,” Obstetrics & Gynecology 119, no. 2 (2012): 408. https://journals.lww.com/greenjournal/ Citation/2012/02000/Committee_Opinion_No 517 Communication.50.aspx.
17. Senator Dianne Feinstein (CA), “Partial Birth Abortion Ban-Act of 1999,” Congressional Record 145 (1999): 26371. https://www.govinfo.gov/content/pkg/CRECB-1999-pt18/html/CRECB-1999-pt18-Pg26366-8.htm.
18. Yuval Levin, “The War on Science,” National Review Online, June 29, 2010, available at: https:// www.nationalreview.com/corner/war-scienceyuval-levin/.
19. Stenberg v. Carhart, 530 U.S. 914, 932-35 (2000).
20. See ACOG Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” ACOG Committee Opinion No. 385 (2007). https://www.acog.org/clinical/clinicalguidance/committee-opinion/articles/2007/11/the-limits-of-conscientious-refusal-in-reproductivemedicine.
21. Christina Francis, “The OB-GYNs Who Play Politics With Women’s Lives,” Wall Street Journal, March 3, 2020, https://www.wsj.com/articles/the-ob-gyns-who-play-politics-with-womenslives-11583279360.
22. Jessica Glenza, “Doctors’ organization: calling abortion bans ‘fetal heartbeat bills’ is misleading,” The Guardian, June 5, 2019, https://www.theguardian.com/world/2019/jun/05/abortion-doctors-fetalheartbeat-bills-language-misleading.
Alexandra DeSanctis is a staff writer at National Review and a visiting fellow at the Ethics and Public Policy Center. She is author, with Ryan T. Anderson, of the forthcoming book Tearing Us Apart: How Abortion Harms Everything and Solves Nothing, from which parts of this article are adapted.