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Dr. Emily Hawes-Van Pelt, an OB-GYN working in Minneapolis, didn’t consider herself an expert on fighting racism in health care. Then in May 2020, George Floyd was murdered a few blocks from her hospital. “What we knew about the world, many of us”—she looked out at an audience of doctors, most of them Black like her—“became very clear to lots of people. ​I was angry, I was bitter, I was frustrated, and I thought, What can I do? How can I help? How can I change anything?”

Hawes-Van Pelt’s answer was the same one that other OB-GYNs have come to in recent years as their specialty has faced crisis after crisis: She jumped into advocacy work. She got involved with a coalition of two dozen medical groups pursuing systemic solutions to long-standing racial disparities in US women’s health. She joined Minnesota’s Maternal Mortality Review Committee, helping to analyze cases of people who die in and around childbirth—disproportionately women of color—for lessons to prevent similar deaths.

Five years on, that burst of energy and determination has turned into immense strain, as the women’s health system confronts a barrage of Trump 2.0 attacks against initiatives for patients of color and research more broadly. With the White House and state governments denying the very idea of systemic racism and targeting anything that smacks of diversity, equity, and inclusion, structural change seems further away than ever, and recent gains are at risk of being stalled or erased. 

That daunting new reality hung over the recent annual meeting of the 60,000-member American College of Obstetricians and Gynecologists (ACOG), the leading medical organization in the US focusing on women’s reproductive health. In a sign of the times, the ACOG committee Hawes Van-Pelt was part of, formerly called the District DEI Delegation, had a new, less contentious name: the Collective Action Advancing Respect & Equity Delegation. 

At the meeting in May, Hawes-Van Pelt addressed a roomful of colleagues about health equity challenges. Even with federal funding slashed for research and large-scale health initiatives, she reminded them, they still have the power to fight bias in meaningful ways: by listening to patients, by being honest and respectful, by showing empathy and grace. Unlike research and medical education, she said, “this doesn’t require funding. This is change that we can make as individuals in our own practices.”

The clouds began gathering during the first Trump administration, as Covid killed Black and brown people at disproportionate rates, laying bare the racism and inequities that permeate American public health.

It was a message heard often at this year’s ACOG conference. In an ordinary year, the meeting attracts thousands of people who come to brush up on topics from menstruation to menopause—and, of course, to schmooze. This year in Minneapolis, many of the conversations were about how providers in one of the most politicized fields in medicine are weathering an unprecedented series of storms.

The clouds began gathering during the first Trump administration, as Covid killed Black and brown people at disproportionate rates, laying bare the racism and inequities that permeate American public health. Just as the pandemic was fading, the Supreme Court overturned Roe v. Wade, ushering in a wave of state laws criminalizing abortion providers and making routine care for pregnant patients infinitely more complicated. States likewise began ramping up attacks on transgender care, which is often provided by OB-GYNs. 

Even before Donald Trump was reelected, conservatives had ACOG in their sights. Project 2025—the Heritage Foundation’s 900-page blueprint for a second Trump administration—calls out the organization by name, referring to some of its members as “pro-abortion ideologues” for their work advising the government on what forms of birth control ought to be covered by the Affordable Care Act. At the annual meeting, ACOG’s deputy general counsel, Francisco Negron, pointed to Trump’s anti-DEI executive order that instructs agencies to investigate federal contractors as part of their efforts to stamp out “DEI programs and principles”—and specifically identifies medical associations as potential targets. “Diversity, equity, and inclusion, which we all thought was about fairness, the administration perceives as unlawful discrimination,” Negron told a packed room of physicians during a session titled “Through........

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