A Current Look at Reproductive Health Policy in the United States

History of Reproductive Health Legislation

Abortion has long been analyzed and debated in the US. According to Planned Parenthood, racist and discriminatory abortion policies in the US have been prevalent since slavery.

At the time, white supremacy gave White enslavers the disillusioned idea that they had control of Black women’s bodies. Even after slavery was abolished in the 1860s, societal judgment left Black women unable to get abortions without facing discrimination.

The first formal abortion policy in the US was introduced in 1910 after male doctors, with the support of religious leaders, pushed for the ban. Despite nationwide restrictions, women who could afford to travel could access abortion in other regions.

As time passed and activism pushed for bodily autonomy, several states began adopting more liberal abortion laws. In 1973, Roe v. Wade legally acknowledged a person’s fundamental right to an abortion, stating that it is a legal and constitutional right.

A few years later, in 1976, the Hyde Amendment was implemented to minimize abortion access by allowing government-funded insurance programs to deny abortion coverage, excluding certain circumstances. This amendment left low-income individuals seeking an abortion unable to access them. Many other litigations have focused on abortion access since this amendment was implemented.

In 2022, the US Supreme Court decision in Dobbs v. Jackson overturned Roe v. Wade. The decision to overturn this landmark case left reproductive policy and abortion rights in the hands of the states, empowering some states to regulate and ban abortion at various stages of pregnancy.

According to the Annals of Internal Medicine, “In the aftermath of the decision, some state governments have begun to impose stringent restrictions and complete bans on the provision of abortion, whereas others have sought to protect and expand access.”

Access to abortion care has become heavily dependent on the political majority in an individual’s state and how state legislatures enforce state laws, despite many healthcare organizations deeming reproductive healthcare services and abortion access essential.

Abortion Services and Coverage

Beyond determining the laws or abortion bans in their respective states, individuals seeking an abortion may also have to consider what their insurance will cover.

According to the United States Department of Health and Human Services (HHS), most health insurances cover reproductive health services considered preventative care with little to no costs.

Federally funded insurance will cover abortion care, depending on the circumstances. The Affordable Care Act (ACA) requires most health plans to provide and cover contraceptive care, including hormonal birth control, implanted devices, emergency contraception, and more. Federal Medicaid will only cover abortion costs in cases of rape, incest, or life-threatening danger. However, many state Medicaid options offer broader coverage.

While not as expected, a few private insurances will cover some abortion services. However, Emergency Medical Treatment and Labor Act (EMTALA), revised in 2022, notes that any hospital that participates in Medicare, including family planning clinics, must deliver all available emergency medical services required to stabilize or save a patient, including abortion, when applicable.

State-Level Policies to Date

According to the New York Times Abortion Policy Tracker, after federal laws changed, the following states have banned abortions with no exceptions for rape or incest:

• Alabama
• Arkansas
• Idaho
• Kentucky
• Louisiana
• Missouri
• Oklahoma
• South Dakota
• Texas
• West Virginia
• Wisconsin

Some states even allow legal repercussions against healthcare professionals who provide abortion care. Other states either have a gestational limit, a blocked ban, legalized abortion, or legalized abortion with new protections.

Recent Legislation

Although reproductive healthcare is complicated and highly politicized, most medical professionals fiercely defend access to abortion for improved health outcomes. Deeply respected healthcare organizations have repeatedly advocated for comprehensive reproductive healthcare, legal abortions, and legal protections for gynecologists and other professionals providing abortion care.

With this in mind, many political leaders are working to pass policies and laws to protect reproductive access and abortion rights.

For example, a recent court case in Washington involving multiple states sued for less restrictive regulation of mifepristone, the FDA-approved medication abortion pill. The preliminary injunction delivered by Judge Thomas O. Rice of the Eastern District of Washington prevented additional restrictions on abortion pill access in 17 states and Washington, DC.

Just hours earlier, a Texas federal judge ruled directly opposing Rice’s decision. Judge Mathew Kacsmaryk’s decision attempts to reverse the FDA approval of mifepristone and ban it nationally, a first for the US. The conflicting decisions lead many to believe another Supreme Court case is coming.

Beyond these two court cases, many other bills have been proposed to protect abortion access. The California Legislative Women’s Caucus, in collaboration with the California Future of Abortion Council, announced its 2023 reproductive justice and abortion rights bill package on March 13, 2023.

The package includes multiple policies to improve access to abortion care, contraceptives, reproductive education, insurance coverage, and more. The set of bills also has plans to enforce privacy and protection policies for patients and healthcare professionals.

Recommendations by Healthcare Organizations

While legal and personal opinions around abortion care are variable, the medical consensus is that abortion care is a critical component of healthcare. A 2020 Report by the Center for Reproductive Rights highlights statements by multiple global healthcare and human rights organizations, emphasizing and encouraging access to comprehensive reproductive health services.

According to the report, the Committee on the Elimination of Discrimination Against Women strongly urged access to gender-sensitive services, including pre-and post-natal care, contraception, and abortions.

Beyond the efforts of that committee, the United Nations Secretary-General and the Office of the High Commissioner for Human Rights (OHCHR) have echoed this sentiment, bolstering the need for comprehensive reproductive care.

Other global organizations, notably the World Health Organization (WHO), have stressed the critical importance of abortion care and equitable maternal healthcare.

The report concludes, “Human rights experts have made clear that timely, uninterrupted access to comprehensive sexual and reproductive healthcare — including contraception, abortion, and maternal healthcare — remains essential.”

Beyond international organizations, many domestic organizations, including the American College of Physicians (ACP), have advocated for reproductive freedom and bodily autonomy.

This organization, like many others, opposes restrictions on any reproductive health services, noting that each patient should have the liberty to make their own reproductive health decisions in collaboration with advice from licensed healthcare professionals.

Beyond affirming an individual constitutional right to medical freedom, the organization condemns laws limiting or criminalizing equitable access to all reproductive health services.

“ACP reaffirms one's right to obtain comprehensive reproductive health services without undue government interference, including abortion; supports efforts to expand access to care through the freedom to travel to seek medical care and ability to receive prescription medication in the mail or via other shipping and delivery services; and opposes efforts to criminalize the practice of medicine and restrict access to care,” stated the ACP in the Annals of Internal Medicine.

Overall, the war on reproductive health is far from over. The topic has grown beyond a women’s health issue, impacting people of all genders, sexualities, races, abilities, and other backgrounds.

Without solid legislation protecting access to care, many people will likely suffer. Although data has suggested that abortion access and reproductive decision-making freedom are critical components of public health and well-being, the debates among policymakers continue. As the policies unfold, patients and healthcare professionals must monitor laws.