Since the 2022 overturning of Roe v. Wade, the reproductive health space has been fraught with tension. The last year was no different, with some states enacting total bans on abortion, while others have moved to protect reproductive rights.
MedCity News reached out to advocacy organizations the Guttmacher Institute and National Family Planning & Reproductive Health Association (NFPRHA) to understand what they consider to be the wins and losses of 2023 when it comes to reproductive health, as well as what activity they expect to see in 2024.
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Their wins for 2023:
This year had the second-highest number of abortion protections enacted, according to Kimya Forouzan, principal policy associate for state issues at the Guttmacher Institute. This shows that “policymakers continue to be invested in protecting and expanding abortion access.” Data from Guttmacher also shows that abortion rates have increased in the states where care stayed legal after the overturning of Roe v. Wade, compared to 2020. This is especially true in the states bordering where there are restrictions to care.
“The goal for abortion policy should be to support those seeking care, and through a combination of proactive policy and the herculean efforts of providers and abortion funds, it is a win when anyone is able to access abortion care and make decisions about their bodies and futures,” Forouzan said.
Forouzan added that six states — Colorado, Maryland, Minnesota, New Mexico, Oregon and Ohio — have passed measures to legally protect contraception. In addition, Oregon, Vermont and Massachusetts have expanded coverage or funding for gender-affirming care.
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For Kim Diaz Scott, vice president of policy and communications at NFPRHA, a major win is the reintroduction of the Right to Contraception Act. This bill would protect the “right to obtain and voluntarily use birth control in federal law and affirm the right for family planning providers to support their patients with the contraceptive care and education they need without political or legal interference.”
Another major victory is the Food and Drug Administration’s approval of Opill, the first over-the-counter birth control pill in the U.S., Diaz Scott said.
“This decision will bring transformative change in contraceptive access and reproductive health and help reduce barriers for people of all ages who need more effective birth control options over the counter,” Diaz Scott stated. “While this was a groundbreaking advancement, we also need to make sure Opill is affordable and fully covered by insurance so that it is for all who need it.”
Their losses for 2023:
Fourteen states have total bans on abortion “with very limited exceptions,” and two of these total bans went into effect this year, according to Forouzan. This means that nearly 18 million women of reproductive age — as well as trans and nonbinary people — don’t have access to abortion care in their state. In addition, seven states are “restricting care at gestational limits that would have been blatantly unconstitutional under Roe,” Forouzan said. Three of these restrictions were enacted in 2023.
“Anyone denied abortion access in their state is forced to either overcome the enormous logistical and financial hurdles of traveling out-of-state, self-manage an abortion, or carry an unwanted pregnancy to term — three scenarios that are either most difficult or carry the greatest consequences for those marginalized by economic insecurity and structural racism,” Forouzan said.
She added that legislation to restrict or ban gender-affirming care has “increased dramatically this year,” with 19 states enacting 20 bans this year out of a total of 22 bans ever enacted.
According to Diaz Scott, another major loss is that because Congress failed to get increased funding for Title X, family planning providers are not able to meet the demand for their services. Title X ensures access to family planning and reproductive health services, particularly for low-income individuals.
“Highly qualified Title X-funded providers are a critical part of the health care infrastructure and under extreme budget constraints, some health centers have been forced to limit services and health center hours or freeze open positions,” Diaz Scott said. “These actions constrain access to care for people who rely on this program for care.”
Their expectations for 2024:
Both Forouzan and Diaz Scott said they expect further challenges in 2024. For example, Forouzan said she anticipates an increase in laws that restrict interstate travel for abortion. Diaz Scott added that there has been “a rise in false claims about birth control that reject the science on contraceptive methods and undermine its safety and efficacy.”
“The reality is that a growing number of states are attempting to restrict access to contraception – by defining abortion to include emergency contraception and IUDs, funding cuts to family planning, parental consent mandates and more,” Diaz Scott declared. “With this looming threat, we need to advance any opportunity to continue to protect and expand access to contraception.”
There will be some efforts to protect reproductive health, however, Forouzan noted. In the 2024 election, Maryland and New York have measures on the ballot to improve protections for reproductive health.
Photo: Fokusiert, Getty Images
