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Published: 08/27/2024

ACP believes that individuals have the , in partnership with their physician or health care professional, on matters affecting their individual reproductive health, including about types of contraceptive methods they use or whether or not to continue a pregnancy.  ACP strongly medically unnecessary government restrictions on any health care services and has with over 75 health care organizations to oppose such legislative interference.

Background

Since the U.S. Supreme Court ended the federal right to abortion in its June 2022 ruling in Dobbs v. Jackson Women’s Health Organization, reproductive health policy varies significantly on a .  More than a dozen states have entirely banned or severely curtailed access to abortion services, with other states contemplating additional restrictions to state law;  and multiple legal challenges ongoing. 

Since Dobbs, patients have experienced a dramatic increase to already significant barriers to accessing time-sensitive and essential services.  In 2023, traveled out of state for abortion care, and appointment waiting times have even in states that have protected abortion rights in state law.  An increasing number of patients, including in states that have banned abortion, are also obtaining medication abortion via telehealth from clinicians operating under “shield laws” in protective states.  In multiple states, vague medical emergency exceptions to abortion bans have left patients and health professionals in danger, with pregnant patients in medical emergencies being told to return after their condition had worsened because of narrow exceptions.  Restrictions have also profoundly impacted physicians and other professionals facing prosecution or the loss of their licenses for providing evidence-based care. Additionally, with about in states with severe abortion restrictions, abortion bans are creating issues with physician training that will have long-term impacts on patient care.

While the Center for Disease Control and Prevention’s most recent numbers show that maternal deaths declined in 2022 after peaking in 2021 amidst the COVID-19 pandemic, the United States continues to have the among high-income countries.  Health inequities and racism are determining factors in the high maternal mortality rate, with Black and Indigenous women facing mortality rates those of white women regardless of local availability of maternity care.  Though the between a higher incidence of maternal mortality and abortion restrictions has been long established, this connection has intensified in some post-�ٴDz�����.�� Restrictions on evidence-based care and the threat of criminal and professional penalties have existing workforce shortages, with some clinicians relocating to states with legal protections and medical students and residents from states with abortion restrictions.

In March 2023, the Annals of Internal Medicine published which assessed the post-Dobbs legal landscape and reaffirmed ACP’s opposition to undue and unnecessary governmental interference in the patient-physician relationship that criminalizes the provision of health care.   As federal and state governments consider reproductive health policy, ACP will continue to speak out in opposition to attacks on the patient-physician relationship.  Since Dobbs, ACP also has increased our advocacy in the courts, including at the U.S. Supreme Court, joining numerous amicus briefs pushing to protect the rights of patients and physicians.

Federal Activity

Abortion

At present, there is no clear legislative path in Congress to broadly protect abortion rights at the federal level.  Although significant action is unlikely in the current Congress, ACP will continue to advocate vigorously for the restoration and protection of reproductive rights and in opposition to new restrictions at the federal level.  ACP supports legislation including the Women’s Health Protection Act (H.R.12/S.701), which would codify abortion rights in federal law, and the Ensuring Access to Abortion Coverage in Health Act (H.R. 561), which would guarantee insurance coverage of abortion care.  ACP has also in support of the Secure Access for Essential Reproductive Health Act (H.R. 459), which would strengthen privacy laws to ensure abortion-related health data cannot be shared without patient consent.  ACP opposes passage of proposed national bans on abortion, which are similarly unlikely to pass the current Congress.

Although federal authority to guarantee abortion rights is limited without additional legislation, President Biden has taken executive action to better protect under HIPAA, to emergency medical care, and to protect and increase access to reproductive health services to the extent possible under current law.  ACP has supported these actions, while recognizing more needs to be done to restore protections for individuals providing and receiving evidence-based care. 

Although the Dobbs decision purported to return the right to regulate abortion to “the people and their elected representatives”, access to reproductive health care across the country continues to be mediated by federal courts.  In two June 2024 decisions relating to abortion, the Supreme Court declined to rule on the substance in an indication that this area of health policy will continue to see significant litigation.  ACP has spoken out about the dangers of courts overturning evidence-based medicine on a political basis and joined an amicus brief in one of these cases, Alliance of Hippocratic Medicine v FDA, as part of its membership in a of health professional and allied groups advocating to protect reproductive health care.

Family Planning

While most policy efforts have focused on abortion, there has been renewed focus on the legality of and patient access to the full spectrum of reproductive health care since Dobbs. ACP believes access to contraception is and supports funding the to deliver evidence-based family planning services.  While affordable contraception has become for some patients to access post-Dobbs, the FDA in 2023 announced the of the country’s first over-the-counter birth control pill.  Additionally, in June 2024, the Senate voted not to advance the (S.4445), which would establish federal protections for in vitro fertilization services (IVF).

Maternal Health

ACP also supported the 2021 American Rescue Plan Act’s for all states to extend Medicaid coverage from 60 days to a full year postpartum, extending coverage for a crucial period when a significant number of pregnancy-related deaths occur, and has for Congress to establish permanent nationwide 12-month postpartum Medicaid coverage.  ACP has joined with other organizations to urge Congressional appropriators to increase funding for the Title V Maternal and Child Services Block Grant, which provided access to health care and public health services for an estimated 60 million people in fiscal year 2021, including 98 percent of infants, 92 percent of all pregnant people, and 58 percent of children nationwide.  The College has also continued to advocate for passage of the Black Maternal Health Momnibus Act.  ACP is a member of the American Medical Association’s Maternal Health Workgroup, a coalition of national medical specialty societies working together to improve maternal health in the United States.  The workgroup’s focus includes addressing maternal health through health information technology and data standards, addressing prior authorization to improve maternal health outcomes, and developing maternal health-related data elements for inclusion in the United States Core Data for Interoperability (USCDI).

State Activity

Abortion

Given current limitations on the federal level, the action on reproductive health policy has shifted mainly to the states where there has been a groundswell of activity.  While abortion has long been one of the most actively legislated issues at the state level, many states have also taken action to alter state laws that came into effect upon the overturn of Roe.  ACP is introduced by state legislators in 2024. 

New legislative trends have developed following the Dobbs decision in both states that have sought to restrict and to protect abortion services.  Many restrictive states have recently acted to expand abortion bans, adopt-state level restrictions on medication abortion, and seek to prevent patient travel to states where abortion is legal. Conversely, those states supportive of abortion rights have generally moved to establish reproductive rights or to remove pre-Roe restrictions on abortion from their state laws, and at least 22 states have enacted legislation that would protect patients and/or clinicians from legal punishment for seeking abortion services in their state.  Legal challenges in state courts have determined the legal status of abortion in numerous states post-Dobbs, and multiple state-level cases concerning abortion restrictions are .

Family Planning

As ACP warned in our reaction to Dobbs, the end of federal abortion rights threatened to erode protections for other services guaranteed under the right to privacy such as contraception or fertility treatments.  In February 2024, the Alabama Supreme Court ruled that embryos were legally children under the state’s fetal personhood law, leading to clinicians pausing IVF services across the state.  Although services have after Alabama legislators passed a law protecting clinicians from liability for providing standard-of-care IVF treatments, legislators are considering new restrictions and additional litigation is expected.  With 19 states having some form of fetal personhood laws on their books, this situation signaled how reproductive care could face additional restrictions going forward.

Maternal Health

In response to high maternal mortality rates, 49 states, DC, and Puerto Rico have established to investigate pregnancy-related deaths, with 41 states adopting a standard review process developed by the CDC.  Unfortunately, Idaho in 2023 became the first state to its review committee after legislators did not extend its mandate despite persistent challenges in maternity care.  As the federal government has encouraged states to expand Medicaid coverage post-partum, almost every state has chosen to expand Medicaid coverage for some period of time following birth, including at least that have implemented or plan to implement twelve months post-partum coverage in their states.  Only Wisconsin and Arkansas have not yet enacted or planned implementation of this coverage extension.

References

• ACP Statement on Dobbs v. Jackson Women’s Health Organization &
• ACP’s Advocacy in the Courts
• ACP Sex and Gender Learning Hub
• ACP Statement of Principles on the Role of Governments in Regulating the Patient-Physician Relationship
• U.S. Department of Health and Human Services:
• National Advocates for Pregnant Women: