State-level abortion debates have activated physicians as a political force like never before. A group of doctors join abortion rights supporters at a rally outside the Supreme Court in Washington, on on April 24, 2024, as it heard oral arguments on Moyle v. U.S. and Idaho v. U.S. to decide if Idaho emergency rooms could provide abortions to pregnant women during an emergency. | Andrew Harnik/Getty Images This article was adapted from the forthcoming book, Side Effects: How Abortion Bans Impact Everyone’s Health.

A gaggle of doctors in white coats gathered at the Virginia state capitol in Richmond on Friday to make their case that the safety of their patients and their ability to practice medicine is threatened by an upcoming referendum to enshrine abortion protections in the commonwealth’s constitution.

Thousands of miles away, hundreds of doctors in Idaho were making the opposite case — that physicians in general and ob-gyns in particular would continue to flee the state in alarming numbers unless voters passed a ballot measure to overturn the state’s ban on abortion.

The Virginia and Idaho doctors are clashing with their own colleagues as they work to influence the abortion laws of their states — joining those fighting in Nevada and Missouri where the issue will also be on the ballot in November. But even as they square off on opposite sides of the abortion fight, their advocacy underscores a striking trend that has emerged in American politics since the Supreme Court overturned Roe v. Wade in 2022: the political activation of American doctors.

The Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization stripped longstanding federal protections and sent decisions about abortion back to the state level, setting off dozens of state government fights over the issue’s complicated moral and medical dimensions. Yet an unexpected side effect of making abortion a state problem has been the stampede of doctors into the political arena.

Across major urban hospitals and tiny rural clinics, state abortion debates ushered in by Dobbs have spurred previously apolitical health care workers — including doctors, nurses, medical students and residents — to challenge abortion laws in state capitals, in Congress, in court, and in the court of public opinion. While many abortion providers had long been in the political trenches, physicians of all specialties, from rheumatology to oncology, joined them, changing both the medical field and U.S. politics in the process.

American doctors, who had long been less likely to show up to vote than the general population, voted at a higher rate than the rest of the nation in the 2022 midterms, a few months after the Supreme Court decision. Over the following years, they led ballot measure campaigns in Ohio and nearly a dozen other states, many of which restored or preserved access to abortion. They brought lawsuits, including in Idaho, Tennessee and Texas, challenging bans. They lobbied red-state officials to strip the most punitive provisions out of their abortion laws, and advised blue-state officials on how best to protect doctors and patients from investigations and prosecutions.

They stumped for candidates in Pennsylvania and other swing states who pledged to protect abortion rights. Some even ran for office themselves.

Anti-abortion doctors like those who assembled in Richmond — while fewer in number than their pro-abortion-rights counterparts — also entered the fray, testifying before congressional committees, lobbying on state and federal legislation, serving on state maternal mortality review committees, drafting op-eds, appearing in ads, jumping into ballot measure campaigns, and filing lawsuits.

Institutional health care power players like the American Medical Association — which historically opposed abortion — also took action in new ways even as it jeopardized their relationships with Republicans in power, filing court briefs opposing restrictions and lobbying federal and state leaders to expand access. They were joined by state medical societies that had never before taken a position on the issue and by physician groups whose work rarely if ever intersected with abortion.

Some chose to get involved despite the risk of political blowback because they feared state abortion bans were just the first salvo of government interference in health care. If they didn’t stand up now, they reasoned, it would only get worse.

“This is a direct attack on the profession of medicine, whether you’re a radiologist, a dermatologist or an ob-gyn,” said Arthur Lavin, a retired pediatrician and neuroscientist who campaigned for Ohio’s 2023 abortion rights referendum. “We know that if we are silent when millions of people are put into positions of cruelty, our turn will come next.”Sea change The fall of Roe was hardly the only trigger of this political awakening in health care, which was also driven by demographic changes that brought more women and people of color into the medical field and frustration with the government’s response to Covid-19.

But Dobbs undeniably caused a reckoning, forcing both individual doctors and medical institutions to rethink their relationships with the government and what they owed their patients inside and outside the exam room.

Kelly Hall, the executive director of the Fairness Project — a group that coaches and funds progressive ballot measure campaigns on many issues, including abortion — believed doctors’ political activation fundamentally changed the abortion rights debate, helping voters see it as a health care issue rather than a religious, moral or political one.

“It would have been impossible to pass any of the abortion ballot measures without trustworthy voices from the medical establishment,” said Hall. “It has been vital to have physicians, the most trusted source of information on health care matters, helping people understand: What’s actually involved in an abortion? What constitutes a medical emergency? Why are laws that supposedly cover life-saving care and medical emergencies absolutely inadequate? Those types of deeper-dive conversations really open up the minds and the hearts of a much broader portion of the electorate.”

Research bore this out. A 2023 Ipsos poll found that doctors were considered the most trustworthy group of all professionals. And a nationally representative 2024 study led by University of Michigan researchers found that when people watched short videos of doctors laying out an evidence-based argument for abortion access, opposition to abortion restrictions jumped from 14% to 37%.

While fewer than a quarter of ob-gyns provide abortions themselves, an overwhelming majority support access to the procedure and believe post-Dobbs bans make it harder for them to offer patients the highest standard of care. And while some physicians have always frequented state capitals and the halls of Congress, lawmakers and lobbyists said the level of advocacy the medical community engaged in after Dobbs was unprecedented.

Nebraska doctors, for instance, helped convince lawmakers not to convene a special session in the summer of 2022 to pass an abortion ban. And though lawmakers there passed a 12-week ban the following year, the lawmakers lobbied by the doctors said their advocacy helped defeat a ban after six weeks of pregnancy and a total ban beginning at conception.

“In my eight years in the legislature, I have never seen medical providers organize themselves in the way they did for this,” said Adam Morfeld, then a Democrat in Nebraska’s state senate. “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.”

In other states, including West Virginia and Indiana, doctors secured narrower policy changes, stripping provisions out of bills that would have imposed harsher criminal penalties on physicians and patients, and inserting exemptions for cases of rape, incest and health risks.

“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 state’s near-total abortion ban. “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.”

Yet the medical community, like all communities, was not a monolith. Groups of conservative, anti-abortion doctors, nurses and medical researchers also mobilized, seeking to shape politics and policy in ways they had never attempted prior to Dobbs.

“I don’t think we should primarily be advocates out in the public square,” said Christina Francis, an Indiana-based ob-gyn who leads the American Association of Pro-Life Obstetricians and Gynecologists, the group mobilizing doctors in Virginia, Missouri and other states with abortion ballot measures. “But there are going to be times when you have to be an advocate for your patient outside of the exam room.”What happened in Ohio, Francis stressed, changed everything.

Showdown in the Buckeye State It was the fall of 2023, and the anti-abortion movement — stinging from the loss of all six ballot measure fights over the procedure that had taken place since Roe was overturned — was determined to make Ohio the launching pad for their post-Dobbs political comeback.

National anti-abortion groups like Susan B. Anthony Pro-Life America and Students for Life of America sent millions of dollars and dozens of staff and volunteers to Ohio to help defeat the measure. Catholic and evangelical parishes around the state organized against it. And, unlike in the states that had already voted in favor of access, Ohio had a Republican governor, legislature, attorney general and secretary of state eager and willing to deploy legal and bureaucratic tactics to try to defeat it. What abortion opponents didn’t have was an army of doctors.

Thousands of medical professionals, most of them political neophytes, had banded together in the weeks after Roe fell to form Ohio Physicians for Reproductive Rights, which first published an open letter warning about the medical risks of the state’s six-week ban, then formed a ballot initiative committee to overturn it. Its members appeared in ads, raised money, spoke at rallies and press conferences, wrote op-eds, fanned out across the state to collect signatures to put the measure on the ballot and deployed again a few months later for a final get-out-the-vote push.

Their efforts paid off. Ohioans voted by a double-digit margin in November 2023 to override the state’s six-week abortion ban and restore access to the procedure. The ballot measure’s passage spurred lawsuits over the following months that chipped away at Ohio’s abortion restrictions and made the deep-red state an unlikely haven for patients traveling from neighboring states with near-total bans, including West Virginia and Indiana.

The Ohio vote, along with the passage of other abortion rights amendments in red and purple states post-Dobbs, fundamentally changed the political landscape as well as the medical one. For one, it revealed just how strong support for abortion access was among Republicans, prompting GOP candidates all over the country — including President Donald Trump — to back away from previous pledges to pursue nationwide bans. The doctors’ victory also convinced progressive donors and power players that GOP-dominated states like Ohio may not be lost causes, prompting national Democrats to pour money into the state this year and mount competitive campaigns to flip control of a Senate seat, several House seats and, for the first time in decades, the governor’s mansion.

Before the abortion rights ballot measure, “a lot of the professional political class was looking at Ohio and saying: ‘It’s not really winnable anymore,’” said Matt Caffrey, the Columbus-based organizing director for the advocacy group Swing Left. “And, sure, we’ve been beaten down by some tough losses. But this referendum is a critical step, because it demonstrates to people across the country that this is a place worth fighting for, not some deep red hellhole.”

Yet the Ohio campaign also lit a fire under anti-abortion ob-gyns, prompting them to form an advocacy wing in 2024 and, for the first time, engage in electioneering. Francis’ group, AAPLOG Action, has deployed its members every year since — with mixed results. They failed to stop the passage of abortion rights initiatives in Arizona and Colorado, but helped block similar measures in South Dakota and in Florida, where a ballot measure to overturn the state’s ban won 57% of votes but failed to clear the required 60% supermajority threshold.

As Idaho, Missouri, Nevada and Virginia brace for more referendums over abortion this November, her members plan to be out in force.

“What we saw in Ohio was physicians leading the pro-abortion side and saying, ‘Women are going to die if we don’t enshrine abortion in our state constitution,’ and their campaign was very effective,” Francis said. “When people hear physicians advocating for abortion, they believe them. So our thought was, ‘Well, we need to have physician voices too.’”‘The room where it happens’For some doctors, advocating for a preferred candidate or policy in the chaotic years after Dobbs was not enough. They had built influence. Now they wanted power.

After decades of watching state legislatures pass anti-abortion messaging bills that didn’t take effect because of Roe, a growing wave of doctors-turned-Democrats knew such debates carried higher stakes for themselves and their patients post-Dobbs, and they feared what kind of policies might pass if no one with a medical background weighed in.

“I wanted to be in the room where it happens,” said Anita Somani, an ob-gyn who ran for the Ohio legislature in November 2022. “If we’re going to bring reproductive rights to the state level, then an ob-gyn should be there.”

Somani was thrilled to win a seat in Columbus, and she enjoyed using her medical training to educate colleagues on both sides of the aisle. But, to her great frustration, that education rarely led to action, and her efforts following the abortion rights ballot measure’s passage to repeal Ohio laws that conflicted with it “haven’t gotten anywhere.”

When she explained to conservative colleagues the risks of pregnancy, the mechanics of abortion and the health care consequences of restrictive policies, she said, “Sometimes people agree privately, and tell me, ‘Oh, I didn’t really understand that. I had no idea.’ But if you then say: ‘This is why you should vote to protect abortion,’ they’re like, ‘Well, I can’t do that.’”Somani, like other doctors who entered politics post-Dobbs, had to temper her initial expectations of what she could accomplish.

The chances for pro-abortion rights legislation were, in Ohio and many other states, slim to none. So some bills were introduced more to make a statement than become law, such as Somani’s 2025 “Conception Begins at Erection Act,” which proposed making it illegal for men to ejaculate without the intent to procreate.

“If you think it’s absurd to regulate men, then you should think it’s equally absurd to regulate women,” Somani responded when her GOP colleagues complained.

She and other physicians elected post-Dobbs dedicated most of their efforts, however, to stopping bills they saw as harmful. When that wasn’t possible, they worked to slow down their passage or make amendments softening their impact.

“Some bills are going to go through — period,” said Iowa Democratic Rep. Megan Srinivas, an infectious disease doctor who won her seat in November 2022. Though she was unable to prevent her state from passing a six-week abortion ban, she invited fellow doctors to testify at public hearings on the bill, and what they shared about its impact provided fodder for the ACLU to later sue, blocking the bill’s implementation and maintaining abortion access in the state for another year. “Having physician voices at that table was critical,” she said.

While most policy making on abortion happened at the state level after Dobbs, doctors also set their sights on Capitol Hill.

At the time Roe fell, the only ob-gyns in Congress were conservative Republican men, including Kansas Sen. Roger Marshall and Texas Rep. Michael Burgess. Two progressive female ob-gyns, Kristin Lyerly in Wisconsin and Kelly Morrison in Minnesota, set out in 2024 to bring more gender and political diversity to their ranks.

Morrison wanted to take what she’d learned as a legislator in St. Paul about how to shore up state-level protections for abortion and use it to push for federal safeguards. Lyerly, who had been involved in advocacy for decades, felt called to do more after Wisconsin implemented a near-total abortion ban that had been on the books, but blocked by Roe, since 1849 — a law passed before women could vote.

She joined a lawsuit that blocked enforcement of that ban and allowed some abortion services to resume in Wisconsin, but it still didn’t feel like enough. Seeing “people in power making decisions based on bad information,” she said, made her want to “step into a different arena.”When her House member, GOP Rep. Mike Gallagher, resigned in the spring of 2024, she jumped into the race for his seat representing a heavily Republican district near Green Bay, but ultimately came up short.

Rather than trying again, she pivoted to recruiting and supporting other progressive candidates for state and federal office. In 2025, she organized Wisconsin doctors to hold rallies and cut ads in a high-stakes race for a seat on the Wisconsin Supreme Court, helping to defeat the conservative candidate that mogul Elon Musk spent millions backing. “Cheerleading” work came naturally to her, she joked, having played the University of Minnesota’s Golden Gopher mascot back in her college days.

Morrison, meanwhile, defeated her Republican opponent by 17 points. And, despite experiencing frustration similar to Somani’s about life in the minority party, the freshman lawmaker has felt at home amid the last two years of chaos in Washington.

“Physicians are well-positioned to be effective legislators,” she said. “We’re very accustomed to working with people from all different backgrounds and ideologies. We try to meet people where they are, to form treatment plans together, to come up with solutions. And we’re trained to handle a lot of stress and to work under a lot of pressure.”Lyerly agreed, but also worried that the very qualities that made doctors strong candidates and lawmakers — particularly their reputation as trustworthy and unbiased health care experts — would get tarnished in the fever swamps of electoral politics.

The louder she got in defense of abortion rights, the harder she found it to lobby her Republican representatives in Madison and in D.C. on other areas where she hoped to find common ground, such as expanding Medicaid coverage for new moms. Some stopped taking her calls. One even ran away from her when he saw her coming. Three years after Dobbs, she saw the medical field “at a crossroads,” forced to choose between serving as the “trusted voice of medicine that anybody will go to” and reaching for political power.

The country’s biggest and oldest medical institutions grappled with a similar dilemma as the wave of physician activism after Dobbs washed over them. The American Medical Association, for instance, found its vocal opposition to abortion bans — along with its positions on other hot-button issues like gender-affirming care, climate change, and gun control — complicated its lobbying efforts on Capitol Hill. Republican lawmakers, even those who were doctors themselves, became more reluctant to meet with AMA leaders on previously routine topics like Medicare payment rates because they viewed the group as overly focused on “social justice” and “wokeism.”

That perception took hold in Washington even as the AMA’s political action committee continued annual donations of hundreds of thousands of dollars to Republican candidates — most of whom opposed abortion rights.

The path of careful neutrality, thought Lyerly, could give doctors a better chance of sharing with Republican lawmakers “the science and the data that should be informing their decision-making on stuff that impacts the health of the people they’re supposed to be representing.”But she decided that it was more dangerous for physicians’ voices to be missing from political debates that determine who can access what kind of health services, how, and when. She also found it personally unbearable to stay quiet as politicians got “all up in our health care” post-Dobbs.

Iowa’s Srinivas, speaking to a lecture hall full of doctors, residents and medical students at ACOG’s annual conference in 2025, said she came to the same conclusion.

“The first thing my mentors in residency told me was: When you’re interviewing for a fellowship, do not ever mention politics, because in the medical world that is frowned upon. You’re supposed to be nonpartisan. You’re supposed to be only looking out for your patients,” she said. “But politics is about our patients. If we’re not involved in politics, our patients are, ultimately, the ones who suffer.”