Reproductive health

Special collection

This collection examines issues related to reproductive health, including the legality of reproductive services (reproductive rights), access to those services (reproductive health), and how societal factors such as race or social status impact access to and decisions about reproductive health (reproductive justice). This includes everything from contraception and comprehensive sex education, to abortion and pre-natal and pregnancy care, as well as other issues that inform a person’s full reproductive autonomy. This special collection brings together knowledge and insights from organizations addressing reproductive health related issues and explores the impact foundations and nonprofits are having on this work.

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Featured

Increasing Financial Access to Contraception for Low-Income Americans

June 27, 2023

Access to contraception is fundamental to reproductive autonomy and economic mobility for parents and their children. Today in the U.S., the cost of contraception severely limits access for those without health insurance. Although the Affordable Care Act eliminated cost-sharing for contraception for those with health insurance, substantial cost-sharing remains for uninsured individuals who seek care through Title X—a national family planning program that offers patient-centered, subsidized contraception and reproductive health services to low-income individuals. I propose two changes to Title X to increase the affordability of contraception for uninsured Americans: (1) make contraceptives free for low-income clients through a change to the guidelines issued by the Office of Population Affairs and Health and Human Services and (2) increase congressional appropriations for the Title X program to fund this change in guidelines. Similar to the Affordable Care Act's elimination of cost-sharing for contraception for Americans with health insurance, this proposal eliminates cost-sharing requirements for contraception for uninsured, low-income Americans through the Title X program. This policy proposal is supported by highly relevant evidence from a randomized control trial conducted at Title X providers. Eliminating costsharing for contraception through Title X would increase use of preferred contraceptive methods; reduce pregnancies that are mistimed or not desired, including those ending in abortion; and generate substantial enough savings in other government spending that the program would more than pay for itself.

Featured

The Benefits of Licensed Midwifery and Community Birth in New Mexico, Among BIPOC Birthing People

May 1, 2023

Black, Indigenous and people of color (BIPOC) families comprise a disproportionately low percentage of home and freestanding birth center births in New Mexico, despite NM Medicaid coverage of care by Licensed Midwives (LMs) in these settings. This research explored why low income BIPOC seek out and benefit from care by LMs, as well as the factors that facilitate and obstruct access.

Featured

Birth Equity Funders’ Summit: 2022 Report

April 1, 2023

Maternal morbidity and mortality, preterm birth, and infant mortality rates in the United States are among the worst in the developed world, with rates particularly high among Black and Indigenous people. To date, we've seen growing rates of disparities across the U.S., and these are expected to worsen with the reversal of Roe v. Wade. While significant public and private dollars have been committed to maternal and child health across the U.S., there have been limited gains and growing disparities. There is an urgent need for funders to examine the funding needs of clinical care systems, the community support continuum, and social drivers of poor outcomes – and the interaction of all three to provide culturally congruent experiences and improved outcomes for birthing people. It is critical to reconsider what is being funded, how it is being funded, and who is getting support.The Birth Equity Funders Summit was hosted in partnership with the Mom and Baby Action Network's (M-BAN) 2022 Summit. M-BAN's Summit aimed to amplify best practices from practitioners focused on developing, implementing, and evaluating maternal and infant health programs, policy, and advocacy. The Summit attracted practitioners from CBOs, birth workers, government actors, corporate partners, students, and more. The rich agenda provided fertile ground for funders to learn about the vast quantity of important work taking place across the country and was a critical foundation for the discussion at the Birth Equity Funders Summit.

Featured

The Status of Women in Florida Reproductive Rights

March 29, 2023

Many women in Florida face significant barriers to accessing quality and affordable care, impacting their reproductive health and the health and well-being of their families. As of 2016, 16.4 percent of women in Florida received inadequate prenatal care, and 8.5 percent of babies were born with a low birth weight (Anderson et al. 2016). According to IWPR's Poverty and Opportunity Index for the 50 states and Washington, DC, Florida ranks 48th out of 51 for the share of women age 18‐64 who have health insurance (82.8 percent; IWPR 2022), leaving many women without insurance to cover reproductive health costs. Additionally, one in three low‐income women in the United States rely on a health center or publicly funded clinic for contraception and preventative reproductive health services (Ranji et al. 2019). Yet one in five women in Florida live in a county without an abortion provider (Anderson et al. 2016), leaving many women without access to affordable reproductive health care.An in‐depth analysis of the current state of women's reproductive rights and health in Florida is critical for the development of policies and programs that will improve access and outcomes for women across the state, particularly in light of the pandemic and ongoing economic crisis. To facilitate state-level discussions as well as the development and promotion of relevant policies, this White Paper provides information on a range of issues related to women's reproductive health and rights in Florida, including abortion, contraception, infertility, and sex education. In addition, the paper presents data on fertility and natality and highlights disparities in women's reproductive health outcomes by race and ethnicity. It also explores the decision of some states to extend eligibility for Medicaid family planning services and provides data on several other topics that affect women's reproductive health, including access to health insurance. The White Paper ends with recommendations for policies to improve women's access to reproductive health services and additional research to address existing gaps in the literature.

Maternal Suicide in the U.S.: Opportunities for Improved Data Collection and Health Care System Change Issue Brief (Updated Sept 2023)

November 29, 2023

Maternal suicide is a leading cause of maternal mortality in the US. While maternal mortality has rightfully garnered increasing attention in recent years, maternal suicide has been historically overlooked as a cause of maternal mortality because national maternal mortality rates previously excluded suicides as pregnancy-related deaths, instead classifying maternal suicides deaths as incidental or accidental deaths. According to the provisional data from the Centers for Disease Control & Prevention (CDC) there was a record high number of deaths in 2022 from suicide for the general US population. It is important to continue to address suicide prevention efforts for the general and maternal population.

Report: U.S. Counties with the Highest Maternal Mental Health Risk and Lowest Resources Revealed

November 29, 2023

The risk factors contributing to maternal mental health (MMH) disorders are complex and known to disproportionately impact communities of color, rural communities, and other groups facing systemic inequities. However, until recently, little has been known regarding the geographic county-level distribution of risk nor the available MMH provider resources.Earlier this year, with financial support from Plum Organics, the Policy Center released the first-of-its kind interactive map to track MMH risk and providers by county. The map uncovered an immense need for increased access to MMH providers and programs.The report illustrates where, in the U.S., mothers are at the greatest risk for suffering from maternal mental health disorders and where the greatest need for providers are. An estimated 62 million birthing-age, American women, or 96% of the potential perinatal population live in maternal mental health professional shortage areas. 13,885 providers are needed across the United States to fill these shortage gaps.

Fact Sheet: Maternal Mental Health

November 29, 2023

This fact sheet explores the prevalence and range of disorders associated with maternal mental health disorders.

Birth in a Burning World: The Intersecting Extreme Heat and Maternal Health Crises in Sindh Province, Pakistan

November 1, 2023

Extreme heat worsened by climate change is deepening a maternal health crisis inPakistan already marked by high rates of maternal and newborn deaths even whencompared to most neighboring and other low-income countries.This report provides a window into a major problem that evidence suggests is global: growing extreme heat—and the growing climate crisis more broadly—is having myriad deleterious impacts on maternal and newborn health and well-being with potentially lifelong consequences. Governments need to take urgent action to curb greenhouse gas emissions. While much can be done to reduce the harms of extreme heat including on pregnant people, there is no clear way for low-income communities to adapt their way out of burgeoning heat set to worsen without action.This report is based on interviews with 16 women in Shikarpur District, Sindh Province, Pakistan, who were either pregnant or recently postpartum during the 2022 heatwave. We also interviewed five health providers or officials in the district. In addition, we consulted epidemiologists, doctors, and other experts in maternal health and the climate crisis, especially regarding extreme heat exposure. We also looked at epidemiological studies and other scientific findings showing links between poor maternal and newborn health and extreme heat.

Maternal Mental Health Overview

November 1, 2023

This fact sheet provides information about maternal mental health conditions.

Self-Care, Criminalized: The Criminalization of Self-Managed Abortion from 2000 to 2020

October 30, 2023

Self-Care, Criminalized: The Criminalization of Self-Managed Abortion from 2000 to 2020 aims to reduce the criminalization of self-managed abortion in the absence of Roe by examining and identifying trends in the criminalization that occurred in the presence of its protections.This report details the criminalization of 61 cases of people criminally investigated or arrested for allegedly ending their own pregnancy or helping someone else do so. The report explores cases between 2000 and 2020 that occurred across 26 states with the greatest concentration in Texas, followed by Ohio, Arkansas, South Carolina, and Virginia.A follow-up to Self-Care, Criminalized: Preliminary Findings, released in 2022, this full report builds on the initial findings to show how people can interrupt and stop abortion criminalization. We share even more quantitative data about case progression as well as a thorough mixed methods analysis, including de-identified case narratives, related to how cases came to the attention of law enforcement, how law has been misapplied to prosecute people, use of technology in the cases, scrutiny of a pregnant person including their abortion and pregnancy loss history, and the lasting harm and negative consequences from this criminalization.From this research, we know more about who has been criminalized for self-managing an abortion, how these cases made their way into and through the criminal system, the laws and practices that enable criminalization, and what is at stake for the accused.

Pharmacist-Prescribed Hormonal Contraception: A guide for what you need to know about pharmacy access to birth control

October 24, 2023

The questionnaire used by pharmacists and doctors to initiate a birth control consultation is identical.Only the Food and Drug Administration can make any drug (including birth control) OTC, and there are no mechanisms for state legislatures to accomplish this task. Pharmacy access only extends prescription points; it does NOT make birth control OTC.Research shows that pharmacists safely prescribe birth control and that patients—particularly low income and uninsured women—want this point of access.

#WeCount Report: April 2022 to June 2023

October 24, 2023

#WeCount is a national abortion reporting effort that aims to capture the shifts inabortion access by state following the June 24, 2022 Dobbs v Jackson's Women'sHealth Organization Supreme Court decision. The Dobbs decision overturned Roe vWade, removing the federal protection that Roe had provided since 1973, whichpermitted abortion in all US states until fetal viability. In the wake of the Dobbs decision,many states have implemented total abortion bans and/or other extreme restrictions onabortion care, with restrictions that carry civil and criminal penalties for those whofacilitate abortion. In some states, new abortion restrictions have been litigated in court,resulting in week-by-week changes to the legal status of abortion, creating confusionand abortion care churn. In other states, the enforceability of pre-Roe abortion restrictions remains unclear, and some abortion providers suspended care due to fearof criminal persecution either temporarily or permanently. At the same time, some stateshave passed protective legislation that has potentially increased access – for residentsand people coming from ban states – and protected providers. Given the shifts in wherepeople obtain abortion care in the year following the decision, this national reportingstudy measures abortions obtained within the formal healthcare system in each state.#WeCount previously reported on the number of abortions from April 2022 to March2023, per month, nationally and by state, and restrictiveness level. This reportdocuments the number of abortions from April 2022 to June 2023, representing one fullyear of abortion delivery post-Dobbs. Due to ongoing recruitment and enrollment ofproviders, we now have more complete data, meaning that numbers in some states forApril through March have been revised from our previous reports. Additionally, we haverefined our methods for imputation and our pre-Dobbs data for comparisons (seeMethods). The data include clinician-provided abortions, defined in this report asmedication or procedural abortions completed by a licensed clinician in a clinic, privatemedical office, hospital, or virtual-only clinics (ie, clinics that only provide telehealthabortions) in the US known to offer abortion care during the period of study. This report does not reflect any self-managed abortions, defined as any attempt to end a pregnancyoutside the formal healthcare system, including using medications, herbs or somethingelse, or obtaining pills from friends or online without clinical assistance. However, thisreport does include telehealth abortions provided by virtual-only clinics in states where itis permitted by law. These data reflect the changing circumstances of abortion provisionin the US and can be used by healthcare systems, public health practitioners, and policymakers so that their decisions can be informed by evidence.