Toolkit: Reproductive Health

Published: 10/7/2025

ACP believes that individuals have the right to make their own decisions, in partnership with their physician or health care professionals, 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 opposes medically unnecessary government restrictions on any health care services and has joined with over 75 health care organizations to oppose such legislative interference.

ACTION:

ACP encourages members leaders to advocate with state officials to restore and protect access to abortion services under state law and oppose interference with the patient-physician relationship. 

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 state-by-state basis.  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 2024, more than 155,000 patients traveled out of state for abortion care, representing 15% of all US abortion patients.  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, although some restrictive states are seeking to crack down on this practice.  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 half of OB-GYN programs 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 (CDC) most recent numbers show that maternal deaths declined in 2023, the United States continues to have the highest rates of pregnancy-related deaths among high-income countries.  While the overall maternal mortality rate has declined slightly, stark racial disparities persist, with Black women facing mortality rates more than three times as high as non-Hispanic white women.  Though the link between a higher incidence of maternal mortality and abortion restrictions has been long established, this connection has intensified in some states post-Dobbs.  Restrictions on evidence-based care and the threat of criminal and professional penalties have exacerbated existing workforce shortages, with some clinicians relocating to states with legal protections and medical students and residents gravitating away from states with abortion restrictions.

In March 2023, the Annals of Internal Medicine published Reproductive Health Policy in the United States: An American College of Physicians Policy Brief, 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

Shortly after taking office, President Trump signed multiple executive orders to restrict abortion, including repealing a Biden administration order directing federal agencies to protect abortion access and reinstating the “Mexico City Policy” which bars foreign organizations receiving U.S. global health funding from providing or promoting abortion using other sources of funding.  The Trump administration also dropped the federal government’s lawsuit against the state of Idaho which sought to guarantee access to abortion when medically indicated in emergency care under the Emergency Medical Treatment and Labor Act (EMTALA).  Additionally, the Trump administration has proposed a rule to prevent pregnant veterans from receiving abortion care at VA hospitals, including in cases of rape, incest, or when the veteran’s life is at risk.  ACP joined with six other medical societies to submit a joint letter expressing concerns about this proposed rule.

Although Congress has introduced legislation to both protect and restrict abortion access, policies remain unlikely to pass in the current Congressional landscape.  ACP supports the Women’s Health Protection Act of 2025 (H.R. 12/S2150) would prohibit state restrictions on abortion and guarantee the right to travel out of state for abortion care.  Alternatively, ACP has joined other medical and health professional organizations in a joint letter to oppose the “Born-Alive Abortion Survivors Act” which misrepresents care during pregnancy complications and represents a dangerous government intrusion into medical care.  Other legislation such as the Life at Conception Act would recognize fetal personhood and implement a national abortion ban.

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 essential and supports funding the Title X program to deliver evidence-based family planning services.  ACP has called for Congress to provide at least $390 million in funding for Title X in fiscal year 2026.

Additionally, the One Big Beautiful Bill Act (OBBBA), signed into law in July, enacted a one-year prohibition barring “prohibited entities” who provide abortion services from receiving Medicaid funds for family planning services.  While the Hyde Amendment has long blocked federal funds from paying for abortions for Medicaid recipients, the new requirement blocks Medicaid payments to abortion providers for other services that may be offered such as contraception and family planning services.  Multiple lawsuits, including one suit filed by twenty state Attorneys General, have challenged this provision.

The OBBBA provision follows a June 2025 ruling by the Supreme Court in Medina v. Planned Parenthood that Medicaid recipients do not have the federal right to choose to receive their care from any qualified healthcare professional, allowing South Carolina to enforce its ban on Planned Parenthood participating in the state’s Medicaid program for non-abortion services.

While affordable contraception has become more difficult for some patients to access post-Dobbs, the FDA in 2023 announced the approval of the country’s first over-the-counter birth control pill.  Additionally, in June 2024, the Senate voted not to advance the Access to Family Building Act (S.4445), which would establish federal protections for in vitro fertilization services (IVF).  Similar legislation has not yet been reintroduced in the current Congress.

Maternal Health

ACP supported the 2021 American Rescue Plan Act’s allowance 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 advocated 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 59 million people in fiscal year 2023, including 99 percent of infants, 94 percent of all pregnant people, and 51 percent of children nationwide.  ACP has also advocated with partners for $100 million in annual funding for the CDC’s Surveillance for Emerging Threats for Mothers and Babys (SET-NET), which supports state, local, and territorial health departments to monitor the impact of exposure to illnesses such as Zika, syphilis, and COVID-19 on pregnant individuals and their babies.

The bipartisan Preventing Maternal Deaths Reauthorization Act of 2025 (HR 1909/S2621) would reauthorize funding for the CDC’s Safe Motherhood and Safe Infant Initiative, including state maternal mortality review committees, while also requiring the CDC to disseminate best practices on how to prevent maternal mortality and morbidity.

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.  State legislatures have introduced nearly 800 abortion-related bills in 2025.

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 ongoing.

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 since resumed 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 at least 24 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 maternal mortality review committees 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 dissolve 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 48 states and DC 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