The Moral Imperative to Ensure Access to Healthcare in a Changing Reproductive Health Climate
Evidence-based policies that can help promote maternal and infant health
Access to contraception, receipt of quality medical care, and the ability of individuals to make their own reproductive decisions are critical elements of basic healthcare and health equity for all. The recent overturning of Roe v. Wade and related trigger laws have severely limited access to safe abortions in parts of the United States, especially for women with low incomes and women of color. Other threats to reproductive autonomy include the potential for revisiting the right to contraception and the high rate of preventable maternal mortality in the United States, which is higher in the United States than in any other wealthy nation and is far higher for Black mothers. Combined, these issues have created a moral imperative to ensure access to quality healthcare and bodily autonomy and to strengthen policies that promote maternal and infant health. A new analysis confirms the varying degrees of reproductive autonomy across the country and highlights the importance of an array of federal and state-level policies and their potential impacts on maternal and child health. Findings include the following:
- Person-centered contraceptive access supports and promotes reproductive autonomy, sexual well-being, menstrual regulation, and preventive health measures, but access varies by geography.
- On average, state contraceptive access expanded between 2006 and 2021, but by 2021 access to contraception was markedly more limited in states in the Midwest and the South than in the Northeast and the West.
- The periods before and after pregnancy are crucial for a woman’s and her infant’s health, yet not all women have access to health insurance during this time.
- More than one in four new mothers with Medicaid-covered prenatal care was uninsured before pregnancy, one in five became uninsured two to six months postpartum, and one in three was uninsured in either period.
- Women with low incomes who had access to health insurance through Medicaid expansion were more likely to report having a preconception health conversation with a healthcare provider before pregnancy and to use effective contraception methods during the postpartum period.
- Place matters: municipal budget allocations can have consequences for severe maternal morbidity (SMM). Municipalities that spend more on fire and ambulance services, transportation, public health, housing, and libraries tend to have lower rates of SMM, whereas those with higher police spending had higher rates of SMM.
- Expansions of the earned income tax credit are associated with significant positive effects on employment for unmarried mothers and improved self-reported mental health for all mothers.
It’s a critical time for reproductive rights in the United States, one that calls for heightened attention to the rapidly changing landscape of reproductive polices across the country and effective, evidence-based policies that promote maternal health and equity for those who have consistently been left behind.
Read the Research
Dispersion of Contraceptive Access Policies across the United States from 2006 to 2021
Principal Investigator: Whitney S. Rice, Emory University, Rollins School of Public Health
Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, and Postpartum Contraception
Principal Investigator: Laura Wherry, New York University, Robert F. Wagner Graduate School of Public Service
Municipality-Level Variation in Severe Maternal Morbidity and Association with Municipal Expenditures in New Jersey
Principal Investigator: Felix Muchomba, Rutgers University, School of Social Work
Post-ACA, More Than One-Third of Women with Prenatal Medicaid Remained Uninsured before or after Pregnancy
Principal Investigator: Lisa Dubay, Urban Institute