Beyond Abortion: Defining The Real Boundaries of Reproductive Health Policy

Many people believe that abortion is the primary focus of reproductive health policy initiatives, yet it represents a fraction of how these laws are transforming the reproductive healthcare landscape. Since a substantial majority of people in America will eventually be faced with a reproductive healthcare decision, it is essential for the public to understand current and future policy. Reproductive healthcare involves “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes” (World Health Organization, 2018). As such, reproductive policy covers abortion, as well as IVF & fertility treatments, contraception access, and miscarriage care & emergency medicine. In order for U.S. reproductive policy to evolve in an efficient manner, it is essential to correct widespread misconceptions to allow for a deeper understanding of the reproductive healthcare spectrum.

IVF & Fertility Treatments:

In vitro fertilization (IVF) is a unique fertility treatment in which an egg and sperm are integrated outside of the body through the utilization of assisted reproductive technology. Since infertility impacts 1 in 8 couples in America, many people assume that IVF access is protected at a federal level. However, this is a major misconception because many people cannot access this treatment, due to a lack of insurance coverage for IVF, diminishing fertility clinic availability (especially in rural or underserved regions), and high cost (thousands of dollars). At the beginning of 2025, President Trump signed an Executive Order to increase access to in vitro fertilization for Americans by “aggressively reducing out-of-pocket and health plan costs for such treatments” (The White House, 2025). Although this order seems to directly impact the American people in a manner that would allow for expanded access, this does not require insurance companies or government programs to pay for IVF. Currently, fertility treatment is covered based on varying insurance plans, rather than a federal guarantee. One of the methods President Trump used to promise IVF coverage for American families was signing a law that allows parents to withdraw up to $5,000 from their retirement accounts without penalty when they give birth or adopt a child. One of the main concerns with this law is that many people cannot afford the initial costs of starting an IVF cycle, which is five times the amount that President Trump is allowing people to withdraw. Going forward, it is necessary that American policy addresses concerns for IVF and fertility treatments, like making IVF more affordable and accessible. Additionally, policymakers must be cognizant of other challenges in contraception access, which vary among the states.

​Contraception Access:

Contraception access is determined by both the availability of contraceptive methods and the policies that allow for accessibility. Contraception access refers to an individual’s ability to attain FDA-approved birth control methods without undue financial, legal, or medical barriers. This may include insurance coverage requirements, availability of providers, age/consent laws, and protections that enable individuals to make reproductive decisions independently. Many women utilize contraception, as “82% of U.S. women ages 18 to 49 said they used some form of contraception in the past 12 months. Nearly half (48%) said they used more than one method” (Federal Overview - State of Access: A Contraceptive Policy Scorecard, 2025). At the federal level, there are many acts that allow for the increase in coverage for FDA-approved contraceptive methods, like birth control pills, IUDs, and more. To build the foundation of individual contraception access, cases in 1965 (Griswold v. Connecticut) and 1972 (Eisenstadt v. Baird) accepted the right to attain contraception. For financial means, the Affordable Care Act requires many private health insurance plans to cover FDA-approved contraceptive methods. Although the public may believe that contraception is widely accessible and affordable, many are not aware of the unequal access to these methods across the states. Currently, sixteen states are labelled as a “restrictive policy environment” for contraceptive access, based on their limiting conditions on access to contraceptive means (Federal Overview - State of Access: A Contraceptive Policy Scorecard, 2025). One example of a restrictive policy environment is found in the contraceptive policies in Florida. Since this state has failed to adopt the Medicaid expansion under the ACA, access for low-income residents has declined significantly. Additionally, Florida has created an environment with restrictions for cases, as providers are allowed to refuse care for religious or moral reasons and require abstinence-only instruction in sex education. Moving forward, contraceptive access needs to be stabilized throughout the states through strengthening the federal regulations under the ACA and expanding public clinics.

Miscarriage Care & Emergency Medicine

Miscarriage care and emergency medicine refer to the treatment received by a pregnant patient who requires immediate intervention. Some components of this complex topic include the diagnosis of the miscarriage, removal of pregnancy tissue, management of complications (heavy bleeding, infection, severe pain), and follow-up care. This national dilemma affects “up to 20%” of pregnancies, as it has significant physical and psychological implications (MacWilliams et al., 2016). At the federal level, the Emergency Medical Treatment and Labor Act requires that U.S. hospitals provide access to emergency medical screenings/examinations and stabilizing treatment. This act is the federal legal baseline to protect people in need of emergency care. In addition to the severe physical trauma a miscarriage causes, there is often grief, anxiety, and depression that may also result from this. Counseling/therapy, support groups, and psychiatric care are all necessary elements that can effectively assist during the mental health aspect of follow-up care. Currently, there is no federal mandate requiring hospitals to provide this counseling. Additionally, different insurances may not provide access to these fundamental support elements. Looking ahead, it is essential that policymakers move in the direction of supporting women who face miscarriage in both the physical and emotional aspects.

IVF & fertility treatments, contraception access, and miscarriage care & emergency medicine are all fundamental aspects of reproductive policy that extend past the popular topic of abortion. In terms of reproductive policymaking, it is essential to focus on state implementation, financial affordability, and clinic accessibility. It is very important for the general public to be aware of current reproductive health policy to shape the future of policymaking for reproductive health. Addressing these key misconceptions in reproductive policymaking allows for the protection of physical health and emotional-wellbeing for all. 

Ahana R. Dutta is an undergraduate student at the University of Virginia planning to major in Behavioral Neuroscience, on the pre-med track. Her focus is on becoming a physician, prioritizing the combination of patient advocacy and empathy through the use of both scientific understanding and thoughtful judgment. She believes medicine is fascinating due to its constant evolution in every aspect, and she hopes to be an integral part of this progress by adapting and committing to lifelong learning.

References

FastStats. (2021, August 3). Www.cdc.gov. https://www.cdc.gov/nchs/fastats/reproductive-health.htm

Federal Overview - State of Access : A Contraceptive Policy Scorecard. (2025, July 11). State of Access : A Contraceptive Policy Scorecard. https://stateofaccess.prb.org/federal-overview?utm_source=chatgpt.com

MacWilliams, K., Hughes, J., Aston, M., Field, S., & Moffatt, F. W. (2016). Understanding the Experience of Miscarriage in the Emergency Department. Journal of Emergency Nursing, 42(6), 504–512. https://doi.org/10.1016/j.jen.2016.05.011

The White House. (2025, February 18). Fact Sheet: President Donald J. Trump Expands Access to In Vitro Fertilization (IVF). The White House. https://www.whitehouse.gov/fact-sheets/2025/02/fact-sheet-president-donald-j-trump-expands-access-to-in-vitro-fertilization-ivf/

World Health Organization. (2018, August 27). Reproductive health. Who.int; World Health Organization: WHO. https://www.who.int/westernpacific/health-topics/reproductive-health