2021 and Beyond: Key Federal Sexual and Reproductive Health Issues

Leah H. Keller, Guttmacher Institute Lauren Cross, Guttmacher Institute Zara Ahmed, Guttmacher Institute
Reproductive rights are under attack. Will you help us fight back with facts?

First published online:

Note (November 10, 2020): Please see the more recent version of this article, which has been updated to reflect the results of the November 2020 elections and can be found here.


As the COVID-19 pandemic tested the fragmented U.S. health care system in spring and summer 2020, sexual and reproductive health and rights were neglected or outright targeted by opponents of reproductive autonomy. Now, with attention turning to planning for the future, policymakers and other stakeholders must address these setbacks and support the work of providers and advocates whose innovation and resilience helped to mitigate the damage over the last few months. The focus cannot simply be on how to restore the health care system to its prepandemic status, but rather on how to redress long-standing injustices and bolster sexual and reproductive health and rights in 2021 and beyond.

Many of the people most directly harmed by these health care system challenges are simultaneously dealing with racism and other deeply entrenched societal inequities that have been exacerbated by the COVID-19 pandemic. In tackling these issues, stakeholders must recognize that people hold multiple identities and experience multifaceted hardships. As we look ahead to next year, it is important to remain focused on people and their communities, as policy solutions must serve their needs.

With this resource, we shine a spotlight on the communities and populations that will be most affected by important sexual and reproductive health policy decisions that lie ahead in 2021 and lay out recommendations to meet their needs, based on the latest evidence and rooted in values of equity and justice.

Who Will Be Impacted by Sexual and Reproductive Health Policy Decisions in 2021?

Anyone who uses public health insurance programs​
Anyone who uses contraception
  • Where things stand now: The Trump administration and an increasingly conservative judiciary have made it easier for employers and schools to deny insurance coverage for contraceptives and undermined the Title X national family planning program through the "domestic gag rule."
  • Why this is important: Forty-three million women in the United States are sexually active and do not want to become pregnant.
  • How to move forward: Close loopholes to the contraceptive coverage guarantee and repair the Title X program by reversing the gag rule and boosting funding for the program.
Anyone seeking an abortion
Anyone who needs maternal health care
  • Where things stand now: The Trump administration has expanded xenophobic policies in several ways, including through the public charge rule. The policy was designed to create fear and confusion in immigrant communities and has resulted in people being pushed out of publicly funded programs (e.g., Medicaid).
  • Why this is important: Immigrant women are less likely to have health insurance coverage and use sexual and reproductive health services than U.S.-born women, which may increase their risk of negative health outcomes.
  • How to move forward: Pass the HEAL for Immigrant Women and Families Act, eliminate the public charge rule, and prohibit the U.S. Department of Homeland Security from detaining pregnant or postpartum people and parents.
Adolescents and young adults
LGBTQ+ community
Black, Indigenous and other people of color
People around the world
  • Where things stand now: Millions of people depend on U.S. foreign assistance programs to access sexual and reproductive health services. But the Trump administration has tried to decrease funding for this work, pulled U.S. support from the World Health Organization (WHO) and the United Nations Population Fund (UNFPA), and put up barriers to the provision of comprehensive care, including for safe abortion services.
  • Why this is important: Across 132 low- and middle-income countries, more than 218 million women of reproductive age have an unmet need for contraception and more than 35 million unsafe abortions occur each year. 
  • How to move forward: Appropriate the full U.S. fair share of funding for international family planning and reproductive health programs ($1.66 billion per year), pass the Global Health, Empowerment and Rights (Global HER) Act to permanently repeal the "global gag rule," pass the Support UNFPA Funding Act to reinstate funding for UNFPA programs, repeal the Helms Amendment to end the ban on U.S. funding for safe abortion internationally and restore U.S. funding for WHO programs.