After 49 years of labor, abortion foes received the ultimate victory in June when the United States Supreme Court struck down a federal right to terminate pregnancy. Among those most heartened by the ruling was a small organization of doctors who specialize in women's reproductive health. The group's leader, while grateful for the win, isn't ready for a curtain call. Instead, she sees her task as moving from a national stage to 50 regional ones.
The decision in Dobbs v. Jackson, which overturned a woman's constitutional right to obtain an abortion, was the biggest but not final quarry for the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG). "It actually doesn't change anything except to turn the whole discussion on abortion back to the states, which in our opinion is where it should have been 50 years ago," Donna Harrison, MD, the group's chief executive officer, said in a recent interview.
Harrison, an obstetrician/gynecologist and adjunct professor of bioethics at Trinity International University in Deerfield, Illinois, said she was proud of "our small role in bringing science" to the top court's attention, noting that the ruling incorporated some of AAPLOG's medical arguments in reversing Roe v. Wade, the 1973 decision that created a right to abortion — and prompted her group's founding. The ruling, for instance, agreed — in a departure from the generally accepted science — that a fetus can feel pain at 15 weeks, and the procedure is risky for mothers thereafter. "You could congratulate us for perseverance and for bringing that information, which has been in the peer-reviewed literature for a long time, to the justices' attention," she said.
Harrison said she was pleased that the Supreme Court agreed with the "science" that guided its decision to overturn Roe. That the court was willing to embrace that evidence troubles the American College of Obstetricians and Gynecologists (ACOG), the nation's leading professional group for reproductive health experts.
Defending the "Second Patient"
AAPLOG operates under the belief that life begins at the moment of fertilization, at which point "we defend the life of our second patient, the human being in the womb," Harrison said. "For a very long time, ob/gyns who valued both patients were not given a voice, and I think now we're finding our voice." The group will continue supporting abortion restrictions at the state level.
AAPLOG, with 6000 members, was considered a "special interest" group within ACOG until the college discontinued such subgroups in 2013. ACOG, numbering 60,000 members, calls the Dobbs ruling "a huge step back for women and everyone who is seeking access to ob/gyn care," said Molly Meegan, JD, ACOG's chief legal officer. Meegan expressed concern over the newfound influence of AAPLOG, which she called "a single-issue, single-topic, single-advocacy organization."
Pro-choice groups, including ACOG, worry that the reversal of Roe has provided AAPLOG with an undeserved veneer of medical expertise. The decision also allowed judges and legislators to "insert themselves into nuanced and complex situations" they know little about and will rely on groups like AAPLOG to exert influence, Meegan said.
In turn, Harrison described ACOG as engaging in "rabid, pro-abortion activism."
The number of abortions in the United States had steadily declined from a peak of 1.4 million per year in 1990 until 2017, after which it has risen slightly. In 2019, according to the US Centers for Disease Control and Prevention, 625,000 abortions occurred nationally. Of those, 42.3% were medication abortions performed in the first 9 weeks, using a combination of the drugs mifepristone and misoprostol. Medication abortions now account for more than half of all pregnancy terminations in the United States, according to the Guttmacher Institute.
Harrison said that medication abortions put women at an elevated risk of serious, sometimes deadly bleeding, while ACOG points to evidence that the risk of childbirth to women is significantly higher. She also is no fan of Plan B, the "morning after" pill, which is available to women without having to consult a doctor. She described abortifacients as "a huge danger to women being harmed" by medications available over the counter.
In Harrison's view, the 10-year-old Ohio girl who traveled to Indiana to obtain an abortion after she became pregnant as the result of rape should have continued her pregnancy. So, too, should young girls who are the victims of incest. "Incest is a horrific crime," she said, "but aborting a girl because of incest doesn't make her un-raped. It just adds another trauma."
When told of Harrison's comment, Meegan paused for 5 seconds before saying, "I think that statement speaks for itself."
Louise Perkins King, MD, JD, an ob/gyn and director of reproductive bioethics at Harvard Medical School, Boston, said she had the "horrific" experience of delivering a baby to an 11-year-old girl.
"Children are not fully developed, and they should not be having children," King said.
Anne-Marie E. Amies Oelschlager, MD, vice chair of ACOG's Clinical Consensus Committee and an ob/gyn at Seattle Children's in Washington, said in a statement that adolescents who are sexually assaulted are at extremely high risk of depression and posttraumatic stress disorder. "Do we expect a fourth-grader to carry a pregnancy to term, deliver, and expect that child to carry on after this horror?," she asked.
Harrison dismissed such concerns. "Somehow abortion is a mental health treatment? Abortion doesn't treat mental health problems," she said. "Is there any proof that aborting in those circumstances improves their mental health? I would tell you there is very little research about it. …There are human beings involved, and this child who was raped, who also had a child, who was a human being, who is no longer."
Harrison said the Dobbs decision would have no effect on up to 93% of ob/gyns who don't perform abortions. King said the reason that most don't perform the procedure is the "stigma" attached to abortion. "It's still frowned upon," she said. "We don't talk about it as healthcare."
Meegan added that ob/gyns are fearful in the wake of the Dobbs decision because "they might find themselves subject to civil and criminal penalties."
Harrison said that Roe was always a political decision and the science was always behind AAPLOG — something both Meegan and King dispute. Meegan and King said they also are concerned about the chilling effects on both women and their clinicians, especially with laws that prevent referrals and travel to other states.
"You can't compel me to give blood or bone marrow," King said. "You can't even compel me to give my hair for somebody, and you can't compel me to give an organ. And all of a sudden when I'm pregnant, all my rights are out the window?"
John Dillon is a freelance journalist in Boston.
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Image 1: Donna Harrison, MD
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Cite this: Pro-Life Ob/Gyns Say Dobbs Not End of Abortion Struggle - Medscape - Aug 09, 2022.