The American College of Obstetricians and Gynecologists filed a brief opposing Mississippi’s 15-week abortion ban as the Supreme Court considers whether to uphold the state law, calling it “fundamentally at odds with the provision of safe and essential healthcare.”

However, the organization’s support for abortion has not always been unambiguous. Following the 1973 Roe v. Wade decision, which established the right to abortion, American OB-GYNs were divided on the issue. Many abortion doctors refused to perform elective abortions, either because they were morally opposed or because they wanted to avoid the “butcher” stigma that persisted in the pre-Roe era.

This contributed to abortion remaining on the periphery of mainstream medicine and distinct from other OB-GYN care — both physically and in the minds of many Americans. It also made abortion and the clinics where it was performed easy targets for opponents.

Shortly before Roe, a group of 100 OB-GYN professors from across the country issued a paper urging their colleagues to begin teaching and performing abortions. Despite the fact that abortion quickly became the most sought-after elective surgery in the United States, their vision of integrating abortion care into routine OB-GYN practice never came to fruition.

Instead, abortion clinics like those run by Planned Parenthood proliferated, many with a woman-centered approach that seemed to alleviate the need for abortion to be more widely available.

The clinic model — a forerunner of today’s outpatient surgical centers — had good reasons. Darney claimed that hospitals were performing abortions under general anesthesia in operating rooms, which was both costly and unnecessary.

Furthermore, because many insurance companies did not cover abortions, they had to be affordable. By specializing, clinics attracted a high volume of abortion patients, lowering costs and allowing a few doctors to become skilled at the procedure.

However, the clinic model provided abortion opponents with a clear and visible target.

According to a 1995 study published in the journal Family Planning Perspectives, only 12% of OB-GYN programs were routinely training residents in abortion care by 1992.

In 1996, the accrediting body for OB-GYN residency programs began requiring abortion training, with an opt-out option, in response to pressure from that organization and others. According to survey results published in the September 2021 Obstetrics and Gynecology journal, by 2018, 64 percent of residency directors reported that their programs provided routine abortion training. Furthermore, family planning has evolved into a subspecialty of obstetrics and gynecology.

Abortion has never been safer or easier to obtain medically. The abortion pill, which accounts for more than half of all abortions in the United States, is extremely effective and has a very low complication rate.

In addition, there is a push to broaden the types of providers who can prescribe them. The FDA recently dropped a requirement that patients pick up the pills in person, allowing doctors in some states to prescribe the pills via telehealth and mail them to patients to take at home. Even in states with liberal abortion laws, doctors seeking to perform abortions face numerous political and bureaucratic roadblocks.

When Susan Yanow, a long-time reproductive rights advocate and consultant, began working to bring abortion care to community health clinics in Cambridge, Massachusetts, obtaining abortion pills was a complicated, bureaucratic process. She also stated that adding a new service to the health centers necessitated a credentialing process.

Anti-abortion activists’ public pressure often makes it easier for hospitals and group practices to refuse abortions. Some OB-GYNs claim they have been forced to sign contracts that forbid them from performing abortions even when they are not working in the hospitals or practices where they work.

Meanwhile, for religious reasons, Catholic hospitals will not perform abortions, and affiliated non-Catholic hospitals are frequently required to follow the same church-based rules. There’s also the Hyde Amendment, which forbids the use of federal funds for abortions, even indirectly.

OB-GYNs as a group have become much more pro-abortion in recent years. The American College of Obstetricians and Gynecologists (ACOG) has been outspoken in its opposition to restrictions. Furthermore, more OB-GYN residents have stated that they intend to perform abortions in their practices.

The shift in attitude has been accompanied by a demographic shift. According to ACOG, the current resident class is 86% female. However, with the Supreme Court now considering serious Roe v. Wade challenges, many of those new doctors may find themselves working in a state where the procedure is illegal.