The Shifting Policy Landscape in Reproductive Health

Since the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization and accelerating over the past year, reproductive health policy in the United States has become increasingly fragmented and unstable. Recent federal actions have introduced new barriers across the continuum of reproductive care. These actions include changes to Title X family planning funding, substantial reductions to Medicaid, rescission of federal Emergency Medical Treatment and Labor Act (EMTALA) guidance related to pregnancy emergencies, and renewed regulatory scrutiny of mifepristone. Together, these changes affect access to contraception, miscarriage management, abortion, emergency pregnancy care, and assisted reproductive technologies such as in vitro fertilization (IVF). We examine how overlapping and, at times, internally inconsistent federal and state policies are reshaping reproductive health care delivery. We review the role of Title X in sustaining the reproductive health safety net, analyze how insurance loss and clinic destabilization limit contraceptive access, and describe how conflicts between abortion bans and EMTALA obligations delay emergency care. We also examine how political challenges to the U.S. Food and Drug Administration's authority over mifepristone threaten evidence-based management of early pregnancy loss and abortion and how rhetorical federal support for IVF contrasts with the absence of enforceable coverage protections. Nurses play a critical role in identifying gaps in care and advocating policies that protect evidence-based reproductive health services. The purpose of this series is to critically examine emerging federal and state health policy changes and their implications for the health and well-being of women, childbearing families, and young children and to provide evidence-based analyses that inform the nurses who care for these populations. The author solicitation and preparation of each article are overseen by series coordinators Mindy B. Tinkle, PhD, RN, WHNP-BC, CNE, FAAN, associate professor, and Nick Edwardson, PhD, MS, associate professor, College of Nursing, University of New Mexico, Albuquerque, NM.