WASHINGTON -- Reproductive freedom took center stage during Biden鈥檚 State of the Union address, but abortion rights advocates had mixed reactions, raising concerns about the president trying to capitalize on what will be a central campaign issue while avoiding using the word 鈥渁bortion.鈥

Abortion rights have proved to be a potent issue driving voters to the polls and boosting Democrats since the U.S. Supreme Court ended a constitutional right to the procedure nearly two years ago. The issue could be pivotal in the presidential race and congressional contests this year.

During Thursday鈥檚 speech, Biden deviated from his prepared remarks, skipping over the word 鈥渁bortion鈥 and instead using the phrases 鈥渞eproductive freedom鈥 or 鈥渇reedom to choose.鈥

The word was used once in his prepared remarks, when he introduced Kate Cox, first lady Jill Biden鈥檚 State of the Union guest and a Texas woman who was forced to flee the state for an abortion after finding out her fetus had a fatal condition. The text had Biden saying, 鈥淏ecause Texas law banned abortion.鈥 Instead, he said 鈥淏ecause Texas law banned her ability to act.鈥

It鈥檚 common for elected officials, especially Biden, to go off script or make in-the-moment tweaks for a host of reasons.

鈥淏y not saying the word 鈥榓bortion,鈥 it implies that it鈥檚 taboo or something to be ashamed of,鈥 said Kellie Copeland, executive director of Pro-Choice Ohio. 鈥淚t鈥檚 stigmatizing and harmful. The president should do better.鈥

Amy Hagstrom Miller, president and CEO of Whole Woman鈥檚 Health, which manages abortion clinics in Maryland, Minnesota, New Mexico and Virginia, said there was an 鈥渦proar" across the organization as staff members texted their reactions to each other.

鈥淎bortion is what we provide and what people are being denied,鈥 she said. 鈥淧eople don鈥檛 call us for a reproductive freedom appointment. They don鈥檛 ask for a bodily autonomy visit or a choice procedure. They call for abortion care, and abortion is a professional medical term for the health care we provide. Avoiding the word just shows the power of the historical stigma around abortion.鈥

The pushback over how he addressed the issue in his State of the Union speech is the latest example of Biden's fraught history with the topic. Many in the abortion rights movement have long viewed him as an imperfect messenger.

Biden initially opposed the 1973 Roe v. Wade decision, saying it went too far. He also opposed federal funding for abortions and supported restrictions on abortions later in pregnancy.

The Biden campaign's strategy is to let the president be who he is 鈥 an 81-year-old Catholic man whose views on the issue have evolved and who still doesn鈥檛 use the word abortion much. His aides also want to highlight his evolution on the issue and how he still grapples with what can be an uncomfortable topic but believes firmly in the freedom of choice.

鈥淒onald Trump on the other hand has repeatedly used disgusting and derogatory language when referring to women, and he will institute a national abortion ban," said Lauren Hitt, spokesperson for the Biden campaign. "The choice in this election is incredibly clear."

Trump has taken credit for appointing three Supreme Court justices who made overturning Roe v. Wade possible.

Biden's aides believe they can reach a broader swath of voters by framing the issue around reproductive freedom, as the fallout from the Supreme Court鈥檚 decision to overturn Roe v. Wade has moved beyond access to abortion and into areas such as IVF and birth control.

The strategy might appeal to some voters but alienate others, said Sophia Jordán Wallace, a political science professor at the University of Washington.

鈥淭he question is if people sincerely believe that this framing is because he鈥檚 thinking about abortion plus other issues or whether he鈥檚 using that framing to avoid saying the word 鈥榓bortion鈥 due to discomfort,鈥 she said,. She added that Biden could be more explicit about how his perspective on abortion has changed, something many voters may be able to relate to.

鈥淭hat鈥檚 a story they can tell,鈥 she said.

Polling has found that Americans broadly support abortion rights, and voters in seven states have either affirmed the right or defeated attempts to weaken it since the Supreme Court ruling. An Associated Press-NORC Center for Public Affairs Research poll conducted in June 2023 found that about two-thirds (64 per cent) of U.S. adults think abortion should be legal in at least some circumstances. Another survey conducted later that year also found that 60 per cent of U.S. adults think the outcome of the 2024 election will be very important for abortion policy.

Many advocates say they want to see Biden offer more full-throated support for abortion rights in particular and have said they sense discomfort in his approach to speaking on the topic.

鈥淎bortion could very well be the issue that the election hinges on,鈥 Nourbese Flint, president of the national abortion justice group All(asterisk) Above All Action Fund. "If President Biden wants to speak to the American electorate, whatever their faith, he should use his bully pulpit to be bold on abortion access.鈥

The State of the Union address was the latest showcase of Biden's complicated relationship with the topic.

He told The New Yorker last week: 鈥淚鈥檝e never been supportive of, you know, 鈥業t鈥檚 my body, I can do what I want with it.鈥欌

Last month in New York, Biden referred to himself as a 鈥減racticing Catholic鈥 before saying, 鈥淚 don鈥檛 want abortion on demand, but I thought Roe v. Wade had it right.鈥 He used similar words on the 51st anniversary of that court decision.

And during a Maryland fundraiser last year for his reelection campaign, he said: 鈥淚鈥檓 a practicing Catholic. I鈥檓 not big on abortion. But guess what? Roe v. Wade got it right.鈥

Advocates also have criticized Biden鈥檚 use of the phrase 鈥渁bortion on demand,鈥 which they say was once an abortion rights rallying cry that was co-opted by the anti-abortion movement.

鈥淭hose comments around 鈥榓bortion on demand鈥 are tied to stigma around abortion,鈥 said Dr. Jamila Perritt, president and CEO of Physicians for Reproductive Health.

Still, she said, 鈥淲e need to make clear that we are much better off under that leadership than under those who want to ban abortion outright.鈥

Biden has repeatedly called on Congress to restore Roe v. Wade protections, and his administration has made several moves to improve reproductive health care access. That includes defending the FDA's approval of the abortion drug mifepristone and supporting the agency in allowing pharmacies to get certified to dispense the drug.

Federal agencies under his administration also have improved abortion access for veterans and service members, issued guidance reminding abortion providers of their federal protections when performing abortions during medical emergencies, and filed lawsuits to defend the right to travel to another state for abortion care.

Biden has been endorsed by major abortion rights organizations, including Planned Parenthood and Reproductive Freedom for All, whose CEO, Mini Timmaraju, praised Biden for speaking "powerfully about the harms of abortion bans and attacks on IVF鈥 in his State of the Union remarks.

Biden used part of his address to thank Vice President Kamala Harris, who has embarked on a multistate reproductive freedom tour.

Jennifer Driver, senior director of reproductive rights at State Innovation Exchange, called Harris a 鈥渃hampion for abortion rights," but said, 鈥淲e also need the president to be vocal on this issue.鈥

Associated Press writers Colleen Long and Linley Sanders contributed to this report.

The Associated Press鈥痳eceives support from several private foundations to enhance its explanatory coverage of elections and democracy. See more about AP鈥檚 democracy initiative here. The AP is solely responsible for all content.