Opinion | Why the Medical Establishment Shied Away From Abortion

That individual physicians might wish to avoid turning themselves — and, potentially, their patients, co-workers and families — into targets of wrath and violence is understandable. Less understandable is the failure of the mainstream medical community, and an array of powerful institutions within it, to respond to the hostility and violence directed at clinics and abortion providers by affirming support for them. Hospital officials could have stepped forward to assert that they, too, would help ensure that abortion services remained available, particularly in states and communities where clinics were under siege. Medical school deans could have announced that they would redouble their commitment to providing training in abortion to residents at teaching hospitals.

Taking such steps would have demanded courage. Little such courage was shown. By 2017, the percentage of all abortions done in hospitals had dwindled to 3 percent, and many teaching hospitals impose restrictions on performing abortions that are more stringent than the legal requirements in their states. Although the reasons for this vary, the desire to avoid the stigma associated with abortion, and the risk of provoking abortion opponents, looms large, according to Lori Freedman, a medical sociologist who has studied the phenomenon. “Some hospital administrators are afraid the hospital will become targeted by anti-abortion forces for doing procedures at all,” she said. “Some have had such experiences already.”

Residents and medical students affiliated with the group Medical Students for Choice have pushed for more comprehensive abortion education. But at many universities and residency programs, in-house abortion services do not exist and residents must go to an outside facility such as a local Planned Parenthood clinic to receive training in the procedure.

To be sure, the relationship between mainstream medicine and abortion was ambivalent even before such concerns became widespread. As the sociologist Carole Joffe has noted, most of the nation’s leading medical organizations failed to issue any significant guidelines on abortion immediately after Roe was decided. That reticence reflected the conflicted feelings many doctors had about a procedure that some linked to infamous back-alley “butchers,” and that others associated with feminists who were claiming authority over their bodies in ways that made many male doctors uncomfortable. (Notably, although the American Medical Association asserted in a 1970 resolution that the principles of medical ethics “do not prohibit a physician from preforming an abortion,” the document stated that abortion procedures should be determined by the “sound clinical judgment” of medical professionals, not “mere acquiescence to the patient’s demand.”) Some doctors also believed that abortion was morally wrong.

In subsequent decades, professional associations such as the American College of Obstetricians and Gynecologists “danced around the issue” of abortion for fear of alienating members who might not support abortion rights, said Doug Laube, an abortion provider who served as ACOG’s president from 2006-2007. Though the organization is formally pro-choice, Dr. Laube told me that during his tenure as president he observed that the stigma associated with abortion made ACOG reluctant to “advocate for abortion services as regular, normal medical care.”

There has been some recent progress on this front, most notably an amicus brief submitted to the Supreme Court by dozens of medical organizations, including ACOG and the A.M.A., in Dobbs v. Jackson Women’s Health Organization, the case that could lead to Roe’s reversal later this year. The brief affirms that the restrictive Mississippi abortion law under review in the case is “fundamentally at odds with the provision of safe and effective health care.” Meanwhile, a new generation of abortion providers, many of them women motivated by a sense of social justice, has begun to emerge, in a field that includes family medicine doctors as well as OB-GYNs.

But even if Roe somehow survives the Dobbs case, the provision of abortion already has been transformed in ways that have left millions of women, particularly poor women and women of color, without access to services. The failure to embed abortion in mainstream medicine has made it easier for abortion opponents to target clinics with so-called TRAP (targeted regulation of abortion providers) laws that impose increasingly onerous rules and regulations on them. A wave of restrictive state measures has been enacted in recent years. It has also set the stage for laws like S.B. 8, the Texas statute enacted last year that encourages private citizens to sue anyone who performs or “abets” abortions after six weeks of pregnancy, including medical practitioners.