White coats in the state capital: OB-GYNs become political force in abortion wars

Red state lawmakers rushing to pass new abortion restrictions are being stymied by an unexpected political force — OB-GYNs.

These physicians — many of whom have never before mobilized politically — are banding together in the wake of the Supreme Court overturning Roe v. Wade, lobbying state lawmakers, testifying before committees, forming PACs, and launching online campaigns against proposed abortion restrictions. Legislators who are themselves physicians are using their medical backgrounds to persuade colleagues to scale back some of the more restrictive and punitive portions of anti-abortion laws being considered.

In Nebraska, OB-GYNs’ advocacy scuttled attempts to pass abortion restrictions in a summer special session, and the Republican-controlled legislature has punted the issue until early next year.

In West Virginia and Indiana, doctors secured smaller wins, stripping provisions out of bills that would have imposed harsher criminal penalties on physicians and patients, and ensuring exemptions for cases of rape, incest and threats to the health of the pregnant person.

“Physicians have expressed concern and, I would say, to some degree, fear. Like, ‘Please don’t interfere because you do not understand,’” Nebraska Sen. John Arch, a Republican who chairs the legislature’s health committee, told POLITICO. “There is such a thing as bad legislation, and that is borne of not understanding the topic or the issue before legislation is passed.”

The new groups’ early successes in some of the nation’s most conservative states signal the power they hope to wield in the coming months — raising money for abortion-rights candidates in the midterms and lobbying lawmakers in state capitals when new sessions convene next year — as well as in years to come.

OB-GYNs are also at the forefront of legal battles over abortion access, taking the witness stand in Michigan and submitting briefs to courts in Idaho and Texas this week about how restrictions could harm their patients.

As lawmakers debate how much to restrict the procedure — including in South Carolina, where the House later this month is expected to take up a bill banning abortion in all cases except to prevent death or serious bodily impairment — doctors are becoming increasingly vocal. They argue the laws will have devastating consequences, drive physicians out of the state, worsen existing OB-GYN shortages and strain the medical system.

While physicians have long frequented state capitols, lawmakers and lobbyists said the level of advocacy from the medical community since the Dobbs decision in June is unprecedented.

“In my eight years in the legislature, I have never seen medical providers organize themselves in the way they did for this,” said Nebraska Sen. Adam Morfeld, a Democrat. “They came together in the past for Medicaid expansion and other things, but that was mainly through existing associations and professional lobbies. Those are powerful, too, but not as powerful as hearing directly from individual doctors who have to make life-and-death decisions every day.”

Even where the doctors aren’t able to stop legislatures with Republican supermajorities from prohibiting nearly all abortions, they are working to mitigate what they see as harmful provisions.

“Our work didn’t stop them from passing the ban, but it certainly made the bill itself much less bad, and it’s important to remember the small victories when we think of this as a long fight,” said Katie McHugh, one of many Indiana OB-GYNs whose lobbying shaped key provisions of the near-total abortion ban the state passed earlier this month. “The changes we won are meaningful for the patients we’re going to see tomorrow and they lay the groundwork for the patients we’re going to see in 20 to 30 years.”

Data show the country has the worst maternal mortality rate in the developed world, in part due to a severe shortage of OB-GYNs. Half of U.S. counties have no OB-GYN, forcing patients to travel tens — or sometimes hundreds — of miles to receive care.

Anne Banfield, an OB-GYN who practiced in rural West Virginia for more than a dozen years, was one of several physicians who said among the most effective arguments they’re making to legislators is that these proposed laws stand to worsen existing medical workforce shortages.

“Not only are we going to say we want you to come to this tiny rural town, but we’re also going to say, maybe you can and maybe you can’t practice the full scope of your specialty, and maybe you’ll get arrested for trying to provide appropriate care to your patients,” she said. “That’s a really hard mountain to climb.”

In Indiana, which earlier this month enacted a near-total abortion ban that takes effect on Sept. 15, doctors are already grappling with that reality. More than a quarter of the state’s counties are considered “maternal care deserts,” meaning there is limited or no access to maternity health care, and doctors are warning the situation will deteriorate once the law is implemented.

“I was at a meeting today with state agency representatives as well as legislators, and the state people are starting to — even this early — get nervous about the loss of health care providers who provide prenatal care and deliveries,” said Indiana state Rep. Rita Fleming, a Democrat and an OB-GYN.

Many doctors who have never before engaged in politics or advocacy feel like they must leave their exam rooms and take their concerns directly to state capitols, courts and voters.

In Indiana, health care and public health workers created the Good Trouble Coalition, which placed ads in local newspapers, with the help of the progressive Better Indiana PAC, and lobbied legislators.

Doctors also formed a PAC called the Campaign for a Healthy Nebraska to dissuade lawmakers from passing limits on abortion.

Andrea Miller, the president of the National Institute for Reproductive Health, said these efforts are part of a paradigm shift underway in medicine, caused in part by more women and people of color entering the field.

“In the years I’ve been working for reproductive freedom, I have seen an organization like the American Medical Association go from being neutral on abortion — and even saying in the late 90s that they would support a ban on abortions later in pregnancy as long as it only had civil penalties for doctors and not criminal penalties — to now full-throatedly stating that bans and restrictions on abortion are anathema to health care,” she said. “The vast majority of the medical community now understands that these bans are harmful and contrary to their medical ethics.”

Doctors in general and OB-GYNs in particular broadly support abortion rights: A May survey from Medscape found that 21 percent of doctors support banning abortion at conception, with or without exceptions; the rest supported, at minimum, abortion access during the first trimester.

Still, some have mobilized in support of state restrictions — testifying before state legislative committees and in court.

“It is possible for our state to prevent abortions which intentionally end the life of my fetal patients while still allowing for physicians to exercise their expert medical judgment in order to intervene in situations where the mother's life is in danger,” Christina Francis, an Indiana OB-GYN and CEO-elect of the American Association of Pro-Life Obstetricians and Gynecologists, told lawmakers.

Yet they are far outnumbered by doctors like Caroline Rouse, an OB-GYN and advocacy co-chair for the Indiana section of the American College of Obstetricians and Gynecologists, which lobbied lawmakers during the state’s special session earlier this month. In those meetings, she said, they got into the weeds about how the wording of a health or fetal anomalies exception to the abortion ban could impact the ability to provide patient care.

“Our explanation to legislators or the media or really whoever would listen is that we don’t think there should be more restrictions, but if there are going to be restrictions there are some absolutely critical exceptions to an abortion ban that must be included in any legislation in order to decrease the unanticipated consequences of this as much as possible,” Rouse said.

Similar one-on-one advocacy is having an impact in South Carolina. During a House Judiciary Committee hearing last week, South Carolina state Rep. Neal Collins, a Republican, recounted a call from a local doctor who explained that a 19-year-old patient carrying a 15-week, non-viable fetus was turned away by a hospital because the state’s law, enacted in 2021, prohibits abortion after the detection of fetal cardiac activity, around six weeks into a pregnancy.

“The doctor told me at that point … there’s a 10 percent chance that she will develop sepsis and herself die,” Collins said. “That weighs on me. I voted for that bill. These are affecting people, and we’re having a meeting about this.”

Stories like these have convinced Collins and some of his GOP colleagues to oppose the bill under consideration unless there are “significant changes.”

In West Virginia, Senate Majority Leader Tom Takubo, a critical care pulmonologist, played a pivotal role in removing criminal penalties for physicians from his chamber’s version of a bill that would prohibit almost all abortions starting at conception.

Takubo told POLITICO he’s arguing to his colleagues in the House that keeping the penalties in will decimate the state’s health care workforce, driving doctors out of the state who fear they would face prosecution for exercising their medical judgment.

“It’s frustrating to me,” Takubo, a Republican, said. “They don’t care what the consequences are.”

OB-GYNs and other physicians are also emerging as influential voices in several state legal battles over abortion laws.

Michigan state Judge Jacob Cunningham on Friday said that doctors’ testimony during a hearing weighed “heavily” in his decision to prevent the state’s 1931 anti-abortion law from taking effect. The OB-GYNs’ stories convinced him the law would be “dangerous and chilling to our state’s population of childbearing people and the medical professionals who care for them.”

Lisa Harris, a doctor at the University of Michigan’s hospital, told the court Wednesday that because the law’s exemptions to protect the life of the mother are vaguely worded, physicians could be afraid to provide an abortion if, for example, a pregnant person has heart or lung problems or cancer.

“When it comes to medicine and people’s bodies, things are rarely 100 percent,” she said. “So in cases where we might quote a 30 to 50 percent chance of someone dying if they were to continue their pregnancy and deliver … I’m not sure that’s a high enough risk.”

In Idaho, state and national medical groups are supporting the Biden administration’s challenge to the state’s trigger law, which takes effect later this month unless federal courts intervene. And in Texas, OB-GYNs and other physicians submitted arguments opposing Gov. Greg Abbott’s challenge to the Biden administration’s guidance on abortion access for people experiencing a medical emergency.

With legislative sessions mostly over for the year and governors unlikely to call a special session in most states, some groups of doctors, including in Nebraska and Indiana, are turning their attention to influencing the November elections, endorsing candidates in their states who support abortion rights, raising money to fund ads and mailers, encouraging people to register to vote, and exploring whether it’s possible to get an abortion rights referendum on the ballot in future elections.

“The next step is to elect folks in the fall who will repeal this bill and implement abortion protections,” McHugh said of the state’s near-total ban that is set to go into effect in mid-September. “That’s a lofty goal, but not an impossible one in a place like Indiana.”

And in many states, doctors anticipate that they’ll have to revive their statehouse lobbying fights when lawmakers return early next year.

“I want to encourage people not to become complacent,” said Abigail Delaney, a reproductive endocrinologist and leader of Campaign for a Healthy Nebraska. “It will come up again, and we need to remind our elected officials where we stand.”