The Doctor Who Wrote the Powerful, Manipulative Playbook for the Anti-Abortion Movement
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Illustration: Angelica Alzona
The most enduring images of anti-abortion protestors in the ’90s depict murderers and zealots, the thousands of protesters who blockaded clinics in Kansas during Operation Rescue’s “Summer of Mercy” or the 31-year-old man who shot abortion provider Dr. David Gun three times in the back. But another set of activists were creating a more enduring movement in a squat brick office building on the aptly named Mercy Road in Omaha, Nebraska, where research labs shared space with chapels and the chief medical officer, a man named Dr. Thomas Hilgers, kept a wall display he referred to as the “Miracle Baby Bulletin Board.”
Dr. Hilgers, now in his late 70s, has spent his life using his medical expertise to support the anti-abortion movement, publishing books alleging the “faulty science” of Roe v. Wade and training a generation of medical professionals to interpret anti-abortion politics through the language of scientific fact. He was among the first abortion opponents to see that case studies might be better received than pamphlets telling women how they might be judged after an abortion. While state legislators imposed days-long delays on abortion-related procedures, Dr. Hilgers and his staff at the Pope Paul VI Institute for the Study of Human Reproduction built an adjacent form of activism, constructing a medical practice and research facility to offer alternative treatments to what Hilgers refers to as the “highly abortive culture” of mainstream obstetrics and gynecology—a program that could market itself to church leaders as an answer to all their constituents’ tricky questions about how to plan families in accordance with their faith.
Since its founding in the mid-’80s, the Pope Paul VI Institute has grown from a small office into a 14,000-square-foot medical complex garnering nearly $2.5 million in revenue a year. In 2019, the center reported around $1.5 million in tax-deductible donations and is a partner in Amazon’s charity program, Amazon Smile. The institute claims to have trained well over 3,000 medical professionals during the course of its operation and sees up to 900 patients a year. Its influence is global: In 2015, Poland’s health ministry cut funding for in vitro-fertilization in favor of the clinic’s signature—if widely disputed—alternative fertility treatment plan.
The Institute houses a hormone laboratory, an ultrasound center, a clinic, and lecture halls where employees conduct research, treat patients, and train visiting residents, many of whom return to their home states to open affiliated clinics. An affiliated business, FertilityCare Centers of America, oversees 300 clinics in all 50 states. Through its imprint, the non-profit has published hundreds of brochures on “fertility abuse” and how to approach abstinence along with more run-of-the-mill booklets on, for example, breast self-exams.
In its decades of operation, the staff of the Institute has developed alternatives to nearly every aspect of reproductive health
In its decades of operation, the staff of the Institute has developed alternatives to nearly every aspect of reproductive health. The result of Dr. Hilgers’ life’s work has been the creation of a parallel medical system, one formed in opposition to secular reproductive practices that is now, in essence, considered broadly legitimate if not particularly mainstream. It prefigured the modern anti-abortion movement by a generation; few organizations have had such an effect on how anti-abortion activists frame and justify their work. Some of the most high-profile doctors in America pushing pseudoscientific theories about pregnancy and abortion trained there. And the preoccupation with medical science over Biblical mandates typified in an organization like Obria, the network of crisis pregnancy centers that rebranded as an anti-birth-control wellness clinic in 2019 to secure federal funding, was first pioneered at Pope Paul.
Hilgers and his staff have trained popular Christian motivational speakers and OBGYNs at Bella Health, a slick network of Colorado wellness-minded clinics funded in part by the local Archdiocese. Marguerite Duane, the practitioner the Trump administration called on to teach a federally sponsored natural family planning webinar, practices the cycle-tracking model Dr. Hilgers invented. According to one OBGYN, the theory that ectopic pregnancies could be re-implanted—an impossible surgery that made itself into proposed state legislation in 2019—was a regular topic of conversation among visiting residents at Pope Paul in the ’90s. And George Delgado, the doctor largely responsible for pushing the shaky science of an “abortion pill reversal” treatment, said he came up with the idea along with a handful of other alumni based on his time studying there.
If there’s a visible anti-abortion doctor in America, chances are they’ve at one point been affiliated with Dr. Hilgers’s institute—a well-funded, on-message operation educating an entire generation of lobbyists in lab coats who insist reproductive health as it’s practiced isn’t just morally wrong but biologically unsound. The tactics they created to champion an alternative medical reality are some of the most effective the anti-abortion movement has to this day.
Depending on which version of events is to be believed, Dr. Thomas Hilgers either founded the Pope Paul Institute as an iconoclast striking out on his own or as a persecuted man of faith shunned by the broader medical community. An anti-abortion activist since his undergraduate days when he founded one of the first collegiate anti-abortion organizations in the country, Hilgers was a medical student at the University of Minnesota when Pope Paul VI handed down the Humanae Vitae in 1968, forbidding the use of contraceptives for followers of church. In a relatively obscure section of the encyclical, the Papal authority called on “men of science” to “study natural rhythms” and find solutions to the contraceptive problem outside of artificial means. For many years afterward, Dr. Hilgers would say he felt the Pope was speaking directly to him.
For many years afterward, Dr. Hilgers would say he felt the Pope was speaking directly to him
Five years later, while the doctor was a resident at the Mayo Clinic, the Supreme Court handed down its decision on Roe v. Wade. Hilgers either resigned or was asked to leave the program when he refused to practice in a facility that performed abortions, according to conflicting accounts given by the doctor and his wife. For the next few years, Hilgers bounced between appointments at friendly facilities and continued to be active in the anti-abortion movement, traveling internationally and taking particular note of cycle-tracking methods that promised to replace pharmaceuticals as a method for birth control.
As he told one interviewer, the idea to found an institute came when he visited a California hospital that had been researching natural family planning and found the medical professionals were friendly towards abortion—a disqualifying belief, as far as he was concerned. When even the Catholic Creighton University, where Hilgers had been teaching, rejected his proposal for a research program because, as he recalls, it “represented a singular point of view,” the doctor decided to found something himself. The tax-exempt Pope Paul VI Institute for Human Reproduction opened in 1985 to build “a culture of life in women’s healthcare.” By 1993, it was getting attention from the mainstream press, which marveled at the medical equipment sitting next to religious texts and referred to the organization as “the only one of its kind in the United States.”
Initially, Hilgers’s practice focused on the Creighton Model FertilityCare system he’d begun to develop some years earlier, essentially a standardized form of fertility tracking with workbooks and instruction on how to interpret cervical mucus or menstrual flow to “unravel the mysteries of the menstrual cycle”
in order to determine when best to have “selective” as opposed to “spontaneous” sex. (As in most of the Institute’s medical materials, the FertilityCare system is deeply integrated with more philosophical writing on the sanctity of the marital act.)
That charting system would later become the backbone of NaProTech, the somewhat clumsy acronym for Natural Procreative Technology, practiced since 1991 and most widely known for its promise to replace IVF but also used, primarily by religiously affiliated doctors, to diagnose and treat repetitive miscarriage, ovarian cysts, menstrual cramps, postpartum depression, and a host of other health problems. Broadly, the idea is that by studying a person’s cycle and hormone levels, a trained NaProTech clinician can diagnose underlying reproductive issues. Treatments might include exploratory surgery for endometriosis or progesterone injections and supplements for infertility.
Though hundreds of anti-abortion doctors have been using this technique for going on three decades, NaProTech is treated with deep skepticism by mainstream medicine: Most of the data on its success in treating infertility is generated by the Institute or affiliated practitioners. The American College of Obstetrics and Gynecologists doesn’t endorse NaProTechnology. As the head of the infertility division at the University of Southern California told Mother Jones in 2017, Hilgers “is not practicing evidence-based, 21st-century Western medicine.”
Undeterred, the Institute has released a number of books under its imprint about its treatments, including an edited collection of testimonials to the revolutionary power of NaProTech called In Her Own Words and a textbook for providers that weighs over one and a half pounds. Last year, Dr. Hilgers, who decades ago helped craft an amicus brief in favor of overturning Roe v. Wade, published a book on what he refers to as the “fake science” behind the court’s original decision. “Our schools and healthcare institutions have abandoned the Hippocratic Oath,” he writes, calling the reasoning behind the landmark abortion case “pre-medieval and clearly out of touch with scientific reality.” In the book, the doctor primarily takes issue with the assertions that legal abortion is safer than childbirth and that pregnancy is a “process” rather than a single event during which life begins.
Dr. Hilgers’s methods invite less attention than other forms of experimental treatment because a doctor who offers fewer interventions than conventional wisdom recommends does little overt damage. The real question around NaProTech’s viability as an alternative to IVF, after all, is whether it’s more effective than just having regular unprotected sex. But as an incubator for a certain strain of right-wing lobbying, the organization’s impact has been immense, sketching a blueprint for standardized—if not iron-clad—medical alternatives to secular reproductive practices. As other doctors and many lawmakers have found, it’s easier to portray healthcare as a political conspiracy if you can offer an alternative that appears on the surface to be based on fact.
If there’s a visible anti-abortion doctor in America, chances are they’ve at one point been affiliated with Dr. Hilgers’s institute
For instance, in the early 2000s, a doctor named George Delgado traveled to Omaha to study with Dr. Hilgers, where he was taught to administer progesterone injections to prevent miscarriage and soften postpartum depression. Back in California, Delgado used that training to develop what he referred to as an “abortion reversal” treatment that would allegedly counteract the effects of medicated abortion with similar injections, a hormone therapy referred to as “unproven and unethical” by his peers. By 2012, Delgado had a website and a phone hotline for women to call if they wanted to reverse the effects of an abortion pill. Just three years later, Arizona mandated that doctors inform women their abortions could be reversed using Delgado’s methods as a matter of state law. In 2016, that particular law was repealed by the court, but the broader disinformation campaign waged by anti-abortion OBGYNs and researchers has had a long tail. The alleged links between breast cancer and abortion are mentioned in at least five pieces of state legislation. The term “partial-birth abortion”—a string of words with essentially no meaning—is enshrined in federal law. In 2019, Ohio lawmakers alleged that ectopic pregnancies could be “re-implanted” in the womb, an almost certainly mythical procedure first suggested by an early IVF researcher that’s been taken up by fringe anti-choice doctors as a way to imagine avoiding an unintentional “abortion” when a fertilized egg implants outside the womb.
As the first anti-abortion research facility in the United States dedicated to finding alternatives to secular medicine, the Pope Paul VI Institute—now the St. Paul VI Institute—invented this form of activism, when it discovered allegations backed by case studies and medical degrees that could be presented as reasonable alternatives to existing practice. After all, you need to create the illusion of options if you’re going to portray standard medicine not as a form of healthcare, but as a series of choices made by a political regime.