When Steven Fleischman took over as president of the American College of Obstetricians and Gynecologists (ACOG) in 2025, he knew that controversy was practically part of the job description. But the Connecticut-based physician at Yale University School of Medicine never predicted that things would get this dire.<\/p>\n
As the premier membership group for US-based OB-GYNs, ACOG provides its more than 62,000 members with clinical guidance, educational opportunities and career help. It also advocates for abortion<\/a> rights \u2013 a stance that has long made the organization far more politically active than many other major medical societies. And in the last year, the non-partisan organization has become a leading voice in the fight against Donald Trump\u2019s anti-science crusade and the US government\u2019s embrace of medical misinformation, especially on the topic of pregnancy and childbirth.<\/p>\n After Trump suggested, without sound evidence<\/a>, that women who take Tylenol during pregnancy risk causing autism in their children, Fleishman called such suggestions<\/a> \u201chighly unsettling\u201d. After the Food and Drug Administration (FDA) convened a panel focused on the risks of taking antidepressants during pregnancy, Fleischman slammed it<\/a> as \u201calarmingly unbalanced\u201d. And after the Centers for Disease Control and Prevention (CDC) stopped recommending Covid vaccines for pregnant women, Fleischman accused its vaccine advisory committee<\/a> of failing to follow \u201clongstanding tradition of robust, unbiased review of reputable scientific evidence\u201d.<\/p>\n Steven Fleischman, president of the American College of Obstetricians and Gynecologists. Photograph: Stephen Greathouse\/Courtesy of ACOG<\/p>\n ACOG is now preparing its members to handle what may prove to be one of biggest upsets in the history of US medicine: the One Big Beautiful Bill Act, whose changes to Medicaid and the Affordable Care Act<\/a> will leave an estimated 10 million people without insurance and hundreds of hospitals at risk of cutting services, laying off staff, or closing altogether.<\/p>\n \u2018Who do I listen to?\u2019<\/p>\n For the first time in Fleischman\u2019s memory, if not ACOG\u2019s lifespan, the 75-year-old organization is now advising people to question the CDC.<\/p>\n \u201cThat is terrible for patients, because it is really hard to figure out: \u2018Who do I listen to? I\u2019ve always listened to the CDC. Am I not supposed to listen to the CDC? Who is this ACOG that\u2019s telling me something different?\u2019\u201d Fleischman said in an interview late last year.<\/p>\n Over the summer, ACOG became the first national medical society to reject funding from the Trump administration. The group made the move, in part, over fears<\/a> that the administration\u2019s executive orders restricting diversity, equity and inclusion (DEI) efforts from groups that receive federal funding would warp ACOG\u2019s research and hurt efforts to advance health equity.<\/p>\n \u201cI feel like we\u2019re seeing a lot of organizations, medical and otherwise, cave<\/a>. We certainly saw a lot of legal organizations caving early. I\u2019m proud ACOG didn\u2019t,\u201d said Dr Kristin Lyerly, a Wisconsin-based OB-GYN and ACOG member. The group, she said, \u201cdeclined federal funding so that they could continue to do their life-saving work, work that saves moms\u2019 lives\u201d.<\/p>\n The Trump administration<\/a> has divided US medicine. Major medical institutions have yielded to its agenda over the last year. After the administration denounced gender-affirming care for minors, for instance, dozens of hospitals stopped providing the service. Northwestern University and Brown University \u2013 which run some of the top medical schools and hospitals in the country \u2013 have also made deals with the Trump administration to stop providing pediatric gender-affirming care (and, in Northwestern\u2019s case, pay the administration $75m).<\/p>\n People wave signs to passing cars during a rally outside of Seattle children\u2019s hospital after the institution postponed some gender-affirming surgeries for minors following an executive order by Donald Trump on 9 February 2025. Photograph: Lindsey Wasson\/AP<\/p>\n But some medical membership organizations have, like ACOG, grown more political. Groups like Society for Maternal-Fetal Medicine joined ACOG in rebuking the administration officials\u2019 comments about Tylenol and Covid vaccines, while the American Academy of Pediatrics sued the administration for cutting $12m of its funding and for changing the childhood vaccine schedule. (ACOG filed an amicus brief in the latter case, alongside several other medical groups.)<\/p>\n As state legislatures start deciding how to implement the One Big Beautiful Bill Act\u2019s cuts and implement work requirements for Medicaid, ACOG plans to lobby legislators to keep pregnant and postpartum patients from losing coverage, as well as push states to apply for government grants that fund rural access to healthcare. The organization is also backing a congressional bill that would expand access to rural emergency labor and delivery services, since more than 500 rural hospitals<\/a> have closed their labor and delivery units over the last 16 years.<\/p>\n \u201cThe reality is that this is a very scary time for many people. There have been fundamental changes made to our public health infrastructure, some of which may be irreparable, though I hope that\u2019s not the case,\u201d Rachel Gandell Tetlow, ACOG\u2019s vice-president of government and political affairs, said in an email. \u201cWhile ACOG cannot replace some of these entities or fix these monumental problems on our own, we can continue to be an unwavering voice in support of medical evidence.\u201d<\/p>\n Rachel Tetlow, ACOG\u2019s vice president of government and political affairs. Photograph: Courtesy of ACOGA \u2018guerrilla war against science\u2019<\/p>\n When Trump took office, OB-GYNs were still reeling from the supreme court\u2019s 2022 decision to overturn Roe v Wade, which unleashed a wave of state-level abortion bans<\/a> that imperiled physicians\u2019 ability to do their jobs. Vast numbers of OB-GYNs leapt into abortion rights advocacy. Doctors who had never before lobbied started testifying in front of state legislative committees<\/a>, forming political action committees and canvassing for pro-abortion rights ballot measures.<\/p>\n From left, Amanda Zurawski, Dr Ingrid Skop, Michele Goodwin, Dr Monique Wubbenhorst, and Dr Nisha Verma, are sworn in to the Senate judiciary committee hearing titled \u2018The Assault on Reproductive Rights in a Post-Dobbs America\u2019, on 26 April 2023. Photograph: Tom Williams\/CQ-Roll Call, Inc\/Getty Images<\/p>\n ACOG expanded its state-level lobbying efforts, since states now have far more leeway to determine their own reproductive health policies. During the 2024 election cycle, ACOG\u2019s political action committee donated $83,400 to local and state candidates and parties \u2013 more than double what it spent on local and state elections in 2020, according to the non-profit Open Secrets, which tracks money in US politics<\/a>. Now, Fleishman said, ACOG has set aside money to hire a lobbyist in every state.<\/p>\n \u201cI remember going to briefings, when we had our legislative lobby days back in 2000, when we used to have 75 people come,\u201d Fleischman recalled. \u201cWe now have over 800 people come to our lobby days.\u201d<\/p>\n But ACOG\u2019s advocacy has made it a target for the right. The Heritage Foundation\u2019s Project 2025, a notorious blueprint of conservative policies, calls out ACOG as \u201cpro-abortion\u201d and urges the Department of Health and Human Services (HHS) to stop working with the group; the Alliance Defending Freedom, a powerhouse Christian law group that has architected much of the right\u2019s legal attacks on abortion and transgender rights, also demanded<\/a> that the HHS cease its work with ACOG. (Between 2018 and ACOG\u2019s decision to stop taking federal funding, the US government awarded ACOG\u2019s non-profit affiliate almost $8m for a grant to review and update recommendations<\/a> for preventive services for women.)<\/p>\n This political advocacy also coincided with a dramatic drop in trust in doctors \u2013 the very thing that lent ACOG\u2019s activism credibility. A study of nearly 500,000 US adults<\/a> found that, between April 2020 and January 2024, trust in doctors and hospitals plunged by about 30%. People who trusted doctors less were also less likely to be vaccinated against Covid \u2013 indicating, perhaps, that these people are drifting away from formal medicine writ large. For Fleischman, it can feel as though the mere possession of medical expertise \u2013 the quality that knits ACOG together \u2013 is politicized, cast as a cause for suspicion.<\/p>\n \u201cThey\u2019re saying that we don\u2019t know what we\u2019re talking about,\u201d Fleischman said. \u201cThat\u2019s a problem.\u201d<\/p>\n The Trump administration\u2019s sweeping cuts to Medicaid may also soon intensify this problem, since people who lack insurance are less likely to trust the US healthcare system<\/a>.<\/p>\n Daniel Treisman, a political scientist at the University of California, Los Angeles who has written about how authoritarians distort and weaponize information, suggested that some Americans now see scientists\u2019 statements as \u201cmere opinion\u201d.<\/p>\n \u201cYou have this guerrilla war against science in the public sphere,\u201d Treisman said. As the Trump administration tramples on scientific institutions, researchers need to cultivate independent avenues to provide the public with information, he advised. \u201cAll scientific communities, all knowledge-based communities, need to work on boosting their credibility. Performing some essential function is really crucial to their survival.\u201d<\/p>\n Reckoning with misinformation has indeed become one of ACOG\u2019s top priorities over the last year. Its Combatting Misinformation initiative<\/a> has pumped out papers pushing back against unfounded rightwing claims about hormonal birth control<\/a>, abortion<\/a>, sex education<\/a> and vaccines<\/a>. The papers are often written in plain language, with straightforward titles like Facts Are Important. The goal is not only to reach providers \u2013 long ACOG\u2019s main audience \u2013 but also patients.<\/p>\n A Stand up for Science rally on 7 March 2025, in Nashville, Tennessee. Photograph: George Walker IV\/AP<\/p>\n The best possible cure, in Fleischman\u2019s view, is for ACOG members to try to re-engage their patients one-on-one.<\/p>\n