Reproductive & Sexual Health

Affordable family planning services are essential to health and well-being, yet it remains a challenge for millions of people to obtain. Of the approximately 38 million women in need of contraceptive care in the U.S. each year, 15.5 million are low-income adults and 4.5 million are uninsured. The Affordable Care Act (ACA) made important strides in improving coverage, with 90 million women ages 18-64 now having health insurance, including more than 33 million women of color. The percentage of women with coverage through the individual market has doubled from 2010 to 2016 and the share with Medicaid has risen by 5 percent. As federal lawmakers threaten those gains by trying to repeal the ACA, ushering in a new wave of restrictions on birth control, and slashing the Title X program, National Health Law Program is actively working with states to develop laws and policies to improve access to family planning in public and private health insurance.

Prompt access to high quality reproductive health care is important to ensuring healthy pregnancies, mothers, and babies. While the Affordable Care Act mandated maternity care as an essential health benefit, and Medicaid continues to provide coverage for almost half of all births, pregnant individuals still struggle to access adequate care. The National Health Law Program fights for prenatal care and delivery services and for seamless health coverage transitions for individuals who are pregnant or postpartum. We work with state advocates to support laws and policies, such as Medicaid coverage for doula care, which advance health equity and improve maternal health outcomes through culturally competent, patient-centered care.

Many women lack means and opportunity to make their own decisions about whether to continue a pregnancy. Limits on federal funding for abortion cause significant harm to low-income women. Both states and the federal government enact legislation and policies that impact abortion access, either by limiting or expanding access to abortion services. Even in absence of federal or state law obstacles, abortion is not always treated as a basic health care service.  At every level, the National Health Law Program works to protect women’s access to the full range of reproductive health services, including abortion in Medicaid and private insurance.

Health care refusals are laws, policies, and regulations that allow institutions and individual providers to use their religious beliefs to deny care to patients including health care services, information, and coverage that would otherwise be required under evidence-based, medical standards of care. These refusals have historically focused on abortion services, contraception, and sterilization.  Health care refusals harm women, particularly low-income women of color, people living with disabilities, and LGBTQ people who already struggle to access care. The harm refusals cause is further compounded by the prevalence of Catholic hospitals in the United States who do not provide the full range of reproductive and sexual health care. In the U.S., one in six hospital beds is in a Catholic hospital. The National Health Law Program develops strategies in partnership with state and federal advocates, providers, researchers, and policymakers, and provides technical and legal analysis to stakeholders to ensure that all persons receive the care, including sexual and reproductive health care, they need without corporate or government interference.

According to CDC research, women with disabilities are sexually active at the same rates as women without disabilities, and yet their sexual and reproductive health needs are not always met. People with disabilities often do not have access to the reproductive health care that they need due to barriers such as physical accessibility issues and a lack of culturally competent care. These barriers exist across disability type and can prevent people with disabilities from receiving information, screening, and treatment for sexual health, family planning, and other reproductive health care issues. The nearly one million women of childbearing age enrolled in Medicare or dually eligible for Medicare and Medicaid encounter specific reproductive health barriers as they navigate a Medicare system that is largely designed for older adults. The National Health Law Program advocates for reproductive health care that provides the full range of health care services, is fully accessible, and is provided in a culturally competent manner.

The National Health Law Program approaches our reproductive health work through an intersectional lens that takes into account histories of injustice, racism, and discrimination endured by women of color. In our understanding of reproductive justice, we are deeply indebted to the writing, work, and legacy of reproductive justice organizations. The reproductive justice lens is the right to have a child, the right to not have a child, and the right to parent with dignity.  While not a reproductive justice organization, the National Health Law Program strives to incorporate lessons of the reproductive justice movement in our work to empower all individuals to make their own informed decisions about their bodies, sexuality, and reproduction.

Medicaid is a cornerstone of reproductive and sexual health in the U.S. Medicaid finances almost half of all births and nearly three-quarters of all publicly funded family planning services nationwide. Nearly one-third of Black women of reproductive age are enrolled in Medicaid, over one-quarter of Latinas, and nearly one-fifth of Asian and Pacific Islander women. The National Health Law Program is on the front lines defending Medicaid from federal and state threats and advancing initiatives to improve Medicaid. We fight to uphold the integrity of Medicaid by protecting the rights of Medicaid enrollees, enforcing Medicaid laws through litigation, and advocating for the advancement of Medicaid policies to ensure health law meets the reproductive and sexual health needs of the people who rely on its coverage.

Medicaid is a vital health care life-line for millions of LGBTQ individuals and families in the United States. Despite progress, however, LGBTQ people continue to face myriad barriers to care, including stigma and discrimination when seeking health care services and medications, such as HIV therapy and sexual and reproductive health services. LGBTQ individuals who have low incomes and who are from communities of color disproportionately lack access to care and coverage, and experience negative health outcomes at higher rates than the general public.

To help combat these inequities, the National Health Law Program and our partners have created the “Medicaid as an LGBTQ Reproductive Justice Issue: A Primer,” an educational resource for advocates and policy makers with information about the importance of Medicaid for LGBTQ people. The primer is informed by the reproductive justice framework, which is rooted in the belief that all individuals and communities should have the resources and power they need to make their own decisions about their bodies, genders, sexualities, families, and lives.

Medi-Cal, California’s Medicaid program, is a cornerstone of reproductive and sexual health in the state. Under federal law, all states must cover certain low-income people, including pregnant women and very low-income parents, however the expansion of Medicaid under the Affordable Care Act means that Medi-Cal plays a major role in the financing of reproductive and sexual health care services for millions of low-income women in California. This toolkit provides background information on federal and California state law pertaining to access to family planning and abortion services. We have also included tools for advocates and clinics to use in their work.

The National Health Law Program’s Doula Medicaid Project seeks to improve health outcomes for pregnant Medicaid enrollees by ensuring that all pregnant individuals enrolled in Medicaid who want access to a doula, will have one.