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AAPLOG Response to SMFM Reproductive Health Services Survey

In late December of 2019, the Society for Maternal-Fetal Medicine (SMFM) distributed a survey to its membership, some of whom are members of the American Association of Pro-Life OB/GYNs. The survey was entitled “SMFM Reproductive Health Services Survey,” and purported to assess how and whether its membership provided contraception and abortion. The survey has multiple significant flaws, which AAPLOG believes will bias the results.

The most significant problem with the survey is that respondents’ answer choices were limited, notably excluding some management strategies used by pro-life physicians. In a key part of the survey, the respondent is asked how they would “most likely manage a patient” who desired termination for various reasons and at various gestational ages. Many options were provided, but one of the most important options was missing: respondents could not choose to neutrally discuss the patients’ legal options and to decline to refer the patient to an abortion provider. This is significantly problematic in two ways.

First, this is poor survey design. When there are only a few options which are clearly mutually exclusive (e.g. Hispanic or non-Hispanic), a list is sufficient. However, when there are more options, especially when there may be permutations that the survey administrator is unfamiliar with, there should always be an “Other” or “Not listed” option, with room for comment. This survey does not list a key option, and does not provide space for a pro-life physician to choose and elaborate on their management strategy. 

Second, the currently worded survey shows ignorance of a key group that the survey was supposedly designed to assess. A simple focus group or a review of pro-life physicians’ literature could reveal that to decline referral after neutrally discussing legal options is a common strategy, and should have been listed. For these two reasons (failure to abide by basic research principles and lack of preparedness to assess multiple groups), this part of the survey is poorly designed.

The survey also demonstrates significant verbal bias against pro-life physicians when it asks for the “three most important factors that impacted your decision not to provide abortion services or limit the abortion services you provide.” The three options listed have an underlying assumption that the reasons for pro-life physicians not referring for abortion stem from ignorance or lack of training.  For example:  the first option is “Moral or religious reasons,”   Other options include “Lack of training…in performing procedure(s),” “Institutional restrictions….,” “State level restrictions…,” and “Community pressure…” among others. These options are designed to fit the narrative of the survey designers, which is clearly that abortion is the preferred option, and anyone who does not chose to participate in this option is deficient in some professional capacity. The survey is designed to demonstrate this underlying bias and fit the objections to participation in ending fetal life into the narrative of professional defects.

It is interesting that one key option is missing—indeed, perhaps the most common one for pro-life physicians- the scientific reason that abortion not only ends the fetal life of one of our patients, but also has long term detrimental consequences for the woman who is aborted, when compared with women who give birth under similar circumstances.  The scientific fact that a new human being exists at the moment of sperm egg membrane fusion is clearly demonstrated in  early embryology.   This new and individual human organism should be respected as are other organisms.  An additional fetal consideration is the fact that certainly by 20 weeks gestation, and perhaps by 12, the fetus is capable of  the physiological response we characterize as “pain” in animals of similar developmental level.  These are just a few of the many scientific considerations which bear on the pro-life physician’s professional judgement that elective abortion is not the best option for solving the problems that the patient may present with.  Yet, the survey does not present any option based on medical or scientific evidence, which betrays the overt bias of the survey writers. 

To be clear, AAPLOG does not wish to mount an ad hominem attack against this research team or SMFM; however, AAPLOG does want to draw attention to the ways the survey writers show that they don’t understand or consider the perspective of pro-life physicians.

There are other semantic  problems with the survey. For instance, the title is not neutral, as “Reproductive Health Services” implies that abortion resolves a disease condition, which it does not. A title that pro-life and pro-choice physicians would both agree on would simply avoid euphemisms and say “Contraception and Abortion.” This attempt at neutrality is not made.

AAPLOG maintains a Maternal Fetal Medicine subsection. Our MFM physicians would be willing to help in the crafting of an accurate survey which would accurately reveal the reasons why our physicians do not participate in the death of their fetal patients without a clear life of the mother indication.

AAPLOG expresses concerns that because the survey is biased, pro-life physicians who begin it may stop taking it or choose answers that “best fit,” but don’t truly reflect their practice patterns. For this reason, ahead of release of its results, AAPLOG cautions policymakers, professionals, and the wider public against using the results of this survey.