In April 2019, when meetings like this still took place, Diane Foley took the stage in Indianapolis, looking out into the faces of anti-choice advocates and doctors who were gathered for their annual conference. The Health and Human Services official began her presentation: “Opportunities for Collaborative Engagement in Policy Development.” The bland, policy-wonkish title belied its almost-revolutionary substance: nothing less than a major shift in American health care—and a threat to the more than 4 million primarily low-income people who rely on a key government program for family planning and other care.
Title X, which Foley oversees as the head of the Office of Population Affairs—and which also includes the government’s teen pregnancy program—offers health care providers more than $286 million in funding each year. Just a month before her presentation, a new rule passed that would, for the first time, prohibit Title X recipients from performing abortions on-site or even providing abortion referrals. This effectively shut out a quarter of all clinics that were getting funding—including Planned Parenthood, which has traditionally received some $60 million a year from the program and provides more than 2.4 million patients with a slew of services, from birth control to cancer screenings to wellness exams.
The rule also opened the door for money to flow to anti-abortion health providers—just like those gathered for Foley’s presentation. Her panel was part of the three-day summit hosted by the American Association of Pro-life Obstetricians and Gynecologists (AAPLOG), a nonprofit that brings together reproductive health care professionals who oppose abortion. A pediatrician by training, Foley has been a prominent anti-abortion advocate and has in the past been affiliated with the partner organization that puts on the conference, the American College of Pediatricians, which the Southern Poverty Law Center has designated an extremist hate group for pushing anti-LGBTQ views, like linking homosexuality to pedophilia.
In fact, Foley has spent her career supporting and amplifying the kind of fringe science that was front and center at the gathering. (Other presentations focused on so-called fetal pain and “how secular biotechnology will impact…the Catholic healthcare system”; another was titled “Jewish & Pro-life? Oy Vey!!”) Before joining HHS, Foley headed Life Network, a Christian anti-abortion group that offers abstinence-only sex education and runs two Colorado crisis pregnancy centers, which are pro-life facilities that counsel women against getting abortions. Foley herself has said, “It could be considered ‘sexually harassing’ to demonstrate condom use to a class with, say, a banana,” according to a 2010 Colorado Springs Independent report. She has even reportedly compared abortion to the Holocaust and slavery, and she has claimed it causes mental illness.
For the past couple of years, she’s brought those views to bear on official policymaking and has become a partner for AAPLOG within the Trump administration. Public records shared with Mother Jones by the pro-choice watchdog group Equity Forward reveal frequent emails and phone calls between Foley and the head of AAPLOG, Donna Harrison. Harrison has written to Foley to share scientifically suspect anti-abortion research, as well as her concerns that health clinics might be able to get around the new Title X rule by dispensing medication abortion to be taken at home rather than on site. “The hair splitting becomes important in defending the Title X regs,” Harrison wrote Foley in April 2019; in response, Foley reassured Harrison that both medical and surgical abortion would be barred. In another conversation from August 2018, Foley asked Harrison to recommend AAPLOG experts on fertility awareness-based pregnancy prevention—the widely debunked “rhythm method,” for example.
This work with Foley is just one way the organization has wielded its influence in recent years. The nearly 50-year-old group may be still relatively unknown to the broader public, flying under the radar as an innocuous-sounding medical association, but the Trump era has opened the door for it to exert significant new powers: intermingling with key Trump personnel in charge of health policy, influencing administration staffing, and playing a major role in shaping the recent explosion of state-level anti-abortion legislation. AAPLOG doctors act as expert witnesses in state and federal legislative hearings and provide lawmakers with scientifically questionable claims to support abortion bans, mandatory ultrasounds, and abortion waiting periods. And then, when those laws are challenged in court, AAPLOG officials and doctors testify and submit amicus briefs on behalf of their cause. “We’re seeing [abortion opponents] take advantage of this moment,” explains Mary Alice Carter, a senior adviser at Equity Forward.
And this moment might be the culmination of much of their hard work. Just as abortion bans that capitalized on the coronavirus pandemic wind down—which AAPLOG worked to institute in at least one state—the Supreme Court is poised to rule imminently on June Medical Services v. Russo, a case that pro-choice advocates fear, and anti-abortion activists hope, has the power to gut Roe v. Wade. AAPLOG has been vocal in rallying behind the defendants in the case; in December, it filed an amicus brief on behalf of the Louisiana law that requires abortion providers have admitting privileges at nearby hospitals, and in March, AAPLOG board chair Dr. Christina Francis wrote in the Wall Street Journal that “every second counts in an obstetric emergency….That’s why it’s essential that anyone performing an abortion have the ability to admit a patient to a nearby hospital—preferably one closer than 30 miles away.” Despite cloaking her argument in medical expertise, she declined to mention that complications from abortion are rare, few women need hospital care, and women can be seen in an emergency even if their doctor lacks such privileges.
While AAPLOG’s positions have been dismissed by many in medical and scientific circles, its arguments, like those from Francis, illustrate the organization’s unique role in anti-abortion advocacy, distinct from anti-choice groups who stake their opposition on moral grounds. This war is being waged over the science. “It does feel different when you are calling into question long-standing understandings about how health care works,” Carter adds. “[AAPLOG] poses a different threat because they have that medical stamp behind them.” (Mother Jones requested comment from AAPLOG on a list of questions on three occasions; AAPLOG did not return comment on the third list of questions about its scientific research, its congressional testimony, and its relationship with the Trump administration, among other issues.)
“Abortion has been legal in the United States since 1973, and we know that it’s very safe, and very, very few women have significant complications related to abortion,” says Alina Salganicoff, director of women’s health policy at the nonpartisan Kaiser Family Foundation. “It’s certainly within [doctors’] rights to have objections to abortions, but to say that is unsafe and there are risks, when research finds that there are none, really raises a lot of questions.”
Even before the coronavirus pandemic, with its accompanying allegations of inflated death tolls and the suggestion of bleach as treatment, we’ve been living in an era of “alternative facts”—and, pandemic or no, this fight will continue to play out in the abortion debate with increasingly high stakes. “We’re in a research or science vacuum where this is concerned,” Salganicoff observes. “Abortion has some parallels to climate science. Everybody is like, ‘Based on my conclusions, these are the facts.’”
The impact is not simply theoretical. When AAPLOG and its ideological peers argue emergency contraception and IUDs are abortifacients, that life begins at the moment of fertilization, and that there is a “symbiotic relationship among pornography, sex-trafficking and abortion”—and lawmakers, federal officials, and judges believe it, or at least hide behind it—it’s ultimately patients and their families who will suffer.
The ways in which AAPLOG twists medical science to restrict a woman’s freedom are part of a long history of women’s health being used as a justification for women’s oppression. Periods were once an illness necessitating seclusion; working outside the home increased women’s risk of coronary heart disease; a woman’s raging hormones made her unfit to be president. “The man on the street might have said the same thing, but the experts said it with the solemn and intimidating authority of science to back them up,” Barbara Ehrenreich and Deirdre English wrote in the 2005 re-release of their book For Her Own Good: Two Centuries of the Experts’ Advice to Women. (Both Ehrenreich and English have connections to Mother Jones, the former as a prior board member and contributing editor, the latter as a previous editor-in-chief.)
“The role of doctor was monopolized by men at a time before women had any rights at all,” English says in an interview. The medical profession “acted to control women’s choices and to force women to conform to patriarchal structures that were in place at that time. It had nothing to do with science.” Midwives, in fact, oversaw most births until the rise of gynecology in the 1600s—which, English notes, coincided with the invention of forceps. The now-common gynecological tool was kept as a closely guarded secret by the male inventors and eventually other men assisting in childbirth to control the process and dominate the profession.
Even as women’s rights and the medical field have evolved, the negative repercussions of decades of discrimination still linger, and the regulation of abortion is undeniably connected to this history. “Controlling childbirth, controlling women’s reproductive activity is one of the important foundations of patriarchy,” English says. “Sexuality and reproduction: If you can control those two things you have women under control.”
Over time, anti-abortion groups similarly recognized the power of the scientific argument.
AAPLOG has its roots in the preeminent association for women’s health workers, the American College of Obstetricians and Gynecologists (ACOG), which has advocated for women’s health and its providers since 1951. Around the time Roe was decided in 1973, ACOG changed its policy to be more supportive of abortion access and a woman’s right to choose. In protest, a small subset of doctors formed a special interest group within the larger organization, meeting annually for four decades and advocating against abortions in statehouses, federal hearings, and court rooms. But in 2013, ACOG ended all such internal special interest groups, and AAPLOG spun into an independent organization that now includes some 5,700 health care professionals as members. (While AAPLOG claims to have doubled its membership over the past several years, it is still small compared to ACOG, which has more than 60,000 members.)
A 2018 report by NARAL calls out AAPLOG as part of an “anti-choice movement [that] has recognized that research plays a critical role in framing the national conversation about abortion and has thus invested heavily in giving pseudoscience and other intentionally misleading content the veneer of respectability.” It specifically cites the work of AAPLOG in “pushing false claims that Plan B emergency contraception causes abortion (though the medical community has overwhelmingly disproven that myth).” (“AAPLOG unashamedly supports the right of unborn children to have a chance at life and the rights of women to be informed about the harms that abortion causes,” Francis, the organization’s board chair, tells Mother Jones in an email in regard to AAPLOG’s scientific objectivity. “We exist to educate our members and the public on these issues. We are not a PAC and do not have political interests that guide how our organization is run.”)
The organization has been led since 2013 by an unassuming executive director, Dr. Donna Harrison, a board-certified but nonpracticing OB-GYN who offers up anti-abortion vitriol with an earnest expression and gentle voice. Harrison is perhaps best known publicly for railing against the abortion-inducing pill mifepristone. She’s long lobbied the FDA to pull its approval for the drug by touting data about its dangers; she even wrote an op-ed about it in the New York Times. But Daniel Grossman, director of Advancing New Standards in Reproductive Health (ANSIRH), a leading reproductive health research center, notes that such analysis is often based on incomplete information—for example, pointing to the thousands of women who’ve suffered complications from the pill without mentioning the millions who use it. “Their arguments may sound scientific to a layperson, but they’re relying on either poorly done studies or outdated data,” Grossman says. (“Not every research project on the same issue will have the exact same results,” Francis wrote in an email about varying conclusions in abortion research.)
AAPLOG mobilizes its doctors through what’s called the “Expert Witness Project.” “Dozens of AAPLOG members invest tens of thousands of volunteer hours every year to provide policy makers and state and federal judges the medical information they need,” reads AAPLOG’s self-reported profile on the nonprofit database GuideStar, as an “extension of our concern about the profound, adverse effects of elective abortion.” AAPLOG also has a mentorship program that connects member doctors to pre-meds and residents to offer a “critical opportunity for students to hear a medical professional pro-life perspective, reinforcing and informing their personal beliefs and perspectives.”
AAPLOG further pushes its science-backed campaign through research and publishing, notably in the peer-reviewed medical journal Issues in Law & Medicine and by the Watson Bowes Research Institute, which co-publishes the journal. Yet Watson Bowes, Issues in Law & Medicine, and AAPLOG operate in a complicated and sometimes-obscured web of co-dependence. The institute, which advocates anti-abortion (and anti-vaccine) science based on questionable data and provides grants for research into “life issues,” publishes studies, legal reviews, and think pieces in Issues in Law & Medicine without disclosing they are essentially the same entity. The Watson Bowes website doesn’t mention it, but tax filings indicate it is “located within AAPLOG.” The business is registered to Harrison, who is also the associate editor of the journal, and half the listed directors and officers of Watson Bowes are AAPLOG board members. Christina Francis, AAPLOG’s board chair, is Watson Bowes’ president.
Issues in Law & Medicine is not a mainstream journal, but it has been cited in more than 1,100 law review articles and in at least 14 state and federal courts of appeal opinions, including two US Supreme Court and seven state supreme court rulings, according to its website. Justice Clarence Thomas cited Issues in Law & Medicine in his dissent when the Supreme Court ruled in 2000 that a Nebraska statute banning “partial birth abortion” without medical exception was unconstitutional. And in 2018, according to a report in Newsweek, Idaho used research published in Issues in Law & Medicine as a basis for passing laws requiring doctors to tell patients an abortion could be reversed. (Abortion reversal, a widely criticized idea, is the brainchild of Dr. George Delgado, an AAPLOG board member.)
In a revealing example of how pseudoscience bounces around this opaque AAPLOG bubble, and how it gains outside legitimacy, in May 2019 AAPLOG touted new research that supported the “benefits of carrying a pregnancy to full-term” and bolstered the organization’s claim that abortion causes mental health problems. The study’s results, based solely on experiments done in rats, was published in the peer-reviewed journal Frontiers in Neuroscience. The end of the study disclosed that the research was funded by the Watson Bowes Research Institute (though it noted the “funders had no role” in conducting the study). AAPLOG did not disclose its connection when it touted the results in a press release.
This is the very kind of research that helps keep abortion restrictions in place; at least eight states require health care providers to warn women considering abortion about potential psychological effects, even though the American Psychological Association has determined that “abortion does not increase a woman’s risk for depression, anxiety or post-traumatic stress disorder.”
Similar arguments from AAPLOG popped up again last summer, in an ongoing legal battle over a 24-hour abortion waiting period law in Florida. Studies show that waiting periods can increase medical risks and prevent women from obtaining abortions, and a judge eventually deemed the law unconstitutional. But, in August, an appeals court decided the judge had erred, citing an amicus brief submitted by AAPLOG, which offered research to show that the waiting period is valid and in keeping with other procedures. As a result, the appeals judge wrote in his decision, “The State produced conflicting evidence from medical experts that the absence of such a decision-period after receiving information about the nature and risks of an abortion procedure and the procedure itself falls below the accepted medical standard of care.” Though the 24-hour waiting period is still currently on hold, the case will now return to court for a full trial and its implementation will be reconsidered.
“Science is one of the main things that people trust and that people base decisions on,” English says. “If you wrongly convince women that they’re risking depression or cancer or putting their future children they may want to have at risk, you’re adding that on top of the amount of cultural and religious blaming that also exists.”
“Almost every pro-life endeavor I’ve ever had, AAPLOG probably had some type of involvement because of their professional materials, because of the reliability of their data,” says former Rep. Trent Franks (R-Ariz.), who resigned from Congress in 2017 amid a sexual harassment investigation, in a promotional video for AAPLOG. “It gives us the ammunition that we need.”
Of course, this deep connection to policymakers is by design—and AAPLOG’s opportunities to shape the law have only expanded since Trump took office. Just one day after Trump’s election, for instance, AAPLOG notified its members that it was “submitting a list of qualified pro-life physicians willing and able to serve the new administration,” according to Rewire.News. (“Our work, and its impact, flourish regardless of who holds elected office,” Francis wrote in an email. “This is nonpartisan.”)
AAPLOG’s power is clear in the “conscience” rule from the Department of Health and Human Services, which would make it easier for health care providers to refuse care for religious reasons but has been blocked by the courts. Back in 2009, AAPLOG wrote to Obama’s HHS, objecting to the administration’s proposal to rescind a sweeping Bush-era rule that allowed health care workers to refuse patients’ treatment they found morally or religiously unacceptable. “Like pro‐life physicians generally,” it wrote, “AAPLOG members overwhelmingly would leave the medical profession – or relocate to a more conscience‐friendly jurisdiction – before they would accept coercion to participate or assist in procedures that violate their consciences.” Its requests were ignored. Ten years later, when the Trump administration considered the issue, this statement ended up verbatim in the final text of the HHS rule allowing such carveouts.
Harrison, AAPLOG’s executive director, has herself become a resource for key policymakers and their allies in the past few years. In early 2018, she was asked to help staff a key HHS position, according to the public records shared with Mother Jones by Equity Forward. In January that year, the policy director for the anti-abortion organization Susan B. Anthony List, Autumn Christensen, asked Harrison for “confidential help” finding a deputy assistant secretary for the Office of Population Affairs—the role Diane Foley would fill four months later. Christensen was looking for a “female candidate” that could “strike the careful balance of being strongly pro-life but also willing to carry out the requirements of a family planning program required by law to distribute a ‘broad range’ of contraceptive drugs and devices.”
“With the right person in place,” Christensen wrote to Harrison, “we see strong opportunities to redirect the program away from funding Planned Parenthood and instead toward funding comprehensive women’s health centers like Community Health Centers.” Christensen then forwarded Harrison’s “ideal candidate” to an HHS official.
(While Foley seems to fit the requirements discussed by Harrison and Christensen, the candidate’s name is blacked out in the released records and AAPLOG declined to share with Mother Jones the name of the person it recommended. For its part, an HHS spokesperson denied Foley was the recommended candidate, saying, “In this case we did not choose the suggested candidate however welcome input from groups in this process.”)
On Capitol Hill, Harrison has testified in front of several congressional committees—including at an April 2019 Senate Judiciary Committee hearing on the “Pain-Capable Unborn Child Protection Act,” which aims to ban abortions at 20 weeks based on the recently renewed hysteria around infanticide. Harrison was the only medical professional to offer testimony, and it was both extremely graphic and full of falsehoods about so-called fetal pain:
There are small human beings in the womb who are being pulled apart in pieces or having their skin burned off or partially delivered through their mothers’ vagina and having their brains pierced and sucked out through a suction catheter. The Pain-Capable Unborn Child Protection Act will protect unborn children in the United states from being killed in these brutal ways.
Afterward, Republican senators voiced support for the bill, repeatedly referencing Harrison’s medical credentials and deferring to her descriptions of procedures.
Trump’s tenure has also coincided with a slew of high-profile legislative opportunities for Harrison and AAPLOG outside DC. Just weeks into the administration, AAPLOG sent an email to members encouraging them to volunteer as experts in state litigation, according to Rewire.News, claiming it had “received requests from over 10 different states to identify physician experts capable of testifying in favor of or in defense of bills and laws protecting unborn human life.”
Around the same time, the records shared with Mother Jones reveal a Florida state legislator’s staff reached out to Harrison to request AAPLOG’s help in moving a law forward that would allow patients to sue doctors over an abortion up to a decade after the fact. Harrison called the bill “brilliant” and told the lawmaker that AAPLOG members could “testify regarding the long-term effects of abortion: Preterm Birth, Breast Cancer, Adverse Psychological outcomes of suicide, substance abuse and hospitalizable major depression.” (The bill ultimately died three months later.)
Two years later, in April 2019, a Michigan state Senate committee invited both Harrison and a practicing gynecologist representing ACOG to testify at a hearing on legislation that would ban “dismemberment abortion”—a politicized term for a specific type of abortion procedure, known commonly as dilation and evacuation, that is typical after the first trimester—and would punish doctors with up to two years in prison. At the hearing, Harrison focused again on fetal pain, even taking out a small model of a fetus and a medical clamp to mimic pulling its limbs off one by one as she gave a play by play of the procedure.
The ACOG doctor responded that much of Harrison’s testimony was “patently false” and did “not follow the medical consensus of the board that she is certified by.” As the ACOG doctor explained, Harrison’s testimony was in fact dangerous:
The evidence…says [dilation and evacuation] is safer than giving birth, that it is safer than other methods of abortion. It is the safest way to have a second trimester abortion. I also learned about the evidence that is widely accepted by the entire biologic, embryologic, and medical community that fetuses at this gestational age cannot feel pain…This is critical health care for women.
Still, at the end of the hearing, the committee chair, a Republican, seemed to give the doctors’ testimonies equal weight. “I’d like to hear from the American Medical Association, because apparently they’re guiding both the doctors that testified today,” he said.
“We’re seeing state after state put into legislation things with dubious medical reasoning, and that impact will continue to affect patient care going forward,” Carter from Equity Forward says. “The more we get away from the idea that there are basic scientific facts and start thinking that anyone can present medical information or scientific information as truth when it is unproven, it is incredibly scary—not only when it comes to reproductive health care, but when it comes to a range of medical procedures going forward.”
Doctors and women—particularly low-income women and women of color—are already feeling the effects of increasingly restrictive abortion laws that reach well beyond the procedure itself. Grossman from ANSIRH warns that while regulations have long pushed medically unnecessary provisions—like requiring mandatory ultrasounds or forced waiting periods, both of which AAPLOG supports—there has been a recent shift in how far anti-abortion activists are willing to go.
As an example, Grossman points to a spate of legislation from the past few years that mandates women be told they have the option of an “abortion pill reversal.” This is another medically dubious procedure that is advocated by AAPLOG; late last year, researchers attempting to determine whether abortion pill reversal is safe had to halt their work when women in the study were hospitalized because of dangerous hemorrhaging. Still, a Michigan lawmaker introduced legislation in January that would force doctors to present abortion pill reversal as a legitimate option for patients. In an even more extreme example, this year Ohio lawmakers considered a bill that goes as far as mandating physicians attempt to re-implant ectopic pregnancies or face “abortion murder” charges. An ectopic pregnancy occurs when a fertilized egg becomes stuck in a woman’s fallopian tube. If unaddressed surgically, the tube could potentially rupture, leading to massive infection and possibly death. Re-implanting the embryo is currently impossible. This is a procedure that even AAPLOG deems unfeasible, though one presentation on its 2020 conference lineup said it would discuss research to study the possibility using animals.
While ACOG declined to comment on the record about AAPLOG, Vanessa Wellbery, a senior state legislation manager for ACOG, reflected darkly on the broader landscape. “In the past decade alone, states have used medically inaccurate claims to implement hundreds of statutes and regulations that undermine evidence-based practice, impose barriers to care on women, and compromise the patient-provider relationship,” she says. “I have seen a dramatic increase in restrictions that would impose professional, civil and even criminal penalties on physicians for providing safe, high-quality abortion care to their patients.”
And that is perhaps what is most troublesome about the growing power of AAPLOG: Patients trust their doctors to give unbiased medical advice, but that may not be the reality. Nothing requires doctors to disclose their membership in an organization like AAPLOG. This could result in women getting incomplete or false information and potentially resorting to unsafe abortion methods. Without access to abortions and unbiased medical care, a woman’s literal freedom could be at risk.
Consider the case of Purvi Patel, who was sentenced in 2015 to 20 years in prison for what she says was a miscarriage. Patel was a thirtysomething woman living with her conservative Indian immigrant family in Indiana when she became pregnant. She kept it a secret. When Patel showed up at a hospital bleeding, doctors found a protruding umbilical cord. While Patel initially said the baby had been stillborn, the on-call doctor suspected a live birth and abandoned child, and he called the police. Patel eventually admitted to leaving the fetus in a shopping mall dumpster, and the doctor left his patient at the hospital to join the police search and examine the recovered fetus. He turned out to be a member of AAPLOG. At Patel’s trial, the doctor would estimate the fetus was about 30 weeks—the highest gestational age estimate from witnesses in the trial and a key factor in the case. (One other doctor agreed with that assessment.) The jury found Patel guilty of feticide and child neglect.
Though Patel was released in 2016 after an appeals court ruled the feticide law wasn’t meant to be applied to self-induced abortions, states like Georgia have passed increasingly punitive abortion bans for doctors and patients.
“Women have been criminalized in the United States, so there’s every reason that this could happen,” says Jen Gunter, a prominent gynecologist and women’s health writer. “There are a zillion situations that could conspire to make you be ambivalent about your pregnancy. What if you had confided in your doctor? And what if four weeks later you show up with a miscarriage and he decides to report you and the district attorney wants to make a name for himself? I don’t know. I don’t want to be an alarmist, but it’s happened.”
It’s no exaggeration to say the future of women’s reproductive freedom will come down to November. No matter how the Supreme Court rules in the June Medical case, the current reach of AAPLOG drives home just how much who is in power ultimately matters.
“Anti-choice politicians, from state legislatures to Congress to the White House, are working to take away people’s reproductive freedom and push access to reproductive health care out of reach,” says Amanda Thayer, deputy national communications director for NARAL Pro-Choice America, “and they’re joined by anti-choice extremists masquerading as objective medical providers to drive this ideological and harmful crusade.”
In 2019 alone, an unprecedented 25 abortion bans were signed into law across the country, not to mention the wave of other restrictions on the procedure. The president has appointed more than 185 federal judges, many with anti-abortion records. And Foley, for her part, has in just two years made significant headway in helping to reshape the face of reproductive care in America. After the Title X rule change that shut out Planned Parenthood, HHS awarded Obria, a chain of crisis pregnancy centers, a $5.1 million grant through the program. As Mother Jones reported in an investigation earlier this year, the clinic got another $500,000 through Foley’s teen pregnancy prevention program to provide “sexual risk avoidance” classes. Meanwhile, HHS has been promoting so-called natural family planning as a pregnancy prevention method, and it rewrote the criteria for Title X grants to prioritize clinics that push fertility awareness-based methods and abstinence.
“Misusing science does harm to women and does harm to science and does harm to the truth,” English says. “Women will listen to authorities, and if there’s something that is presented to them as scientific and it isn’t, they may make an extremely important life decision based on a false understanding.”
