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
- Where things stand now: Conservative policymakers have repeatedly attempted to weaken Medicaid, although most states have expanded eligibility for full-benefit Medicaid coverage or family planning services.
- Why this is important: More than 20% of all women and nearly half of low-income women aged 15–44 rely on Medicaid and other public health insurance programs for coverage.
- How to move forward: Increase Medicaid eligibility in all states and affirm enrollees’ right to see the provider of their choice.
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
- Where things stand now: Six in 10 women live in states with policies that are hostile toward abortion rights and the federal Hyde Amendment blocks low-income people from accessing affordable abortion care.
- Why this is important: One in four women will have an abortion in their lifetime, yet many face substantial financial and logistical barriers to abortion care.
- How to move forward: Pass the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act to restore public insurance coverage of abortion and the Women’s Health Protection Act to ensure access to abortion across the country without medically unnecessary restrictions. Remove long-standing barriers that limit access to medication abortion, including through telehealth and self-managed abortion.
Anyone who needs maternal health care
- Where things stand now: Black and Indigenous women’s maternal mortality rates are two to three times the rate as those of White women, and four to five times as high among older age groups. The federal government has not offered a comprehensive response to the growing maternal health crisis, but nearly all states have maternal mortality review committees to understand and address the causes of preventable maternal deaths.
- Why it matters: The United States has the highest maternal mortality rate among developed countries, with dramatic racial disparities that are preventable and caused by systemic racism and provider bias.
- How to move forward: Pass the Black Maternal Health Momnibus Act, address racism as a public health crisis, increase funding for the federal maternal health service and surveillance projects, and expand Medicaid and Children’s Health Insurance Program coverage to at least 12 months postpartum.
- 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
- Where things stand now: Young people face confidentiality concerns and logistical barriers to obtaining sexual and reproductive health care, and the Trump administration has aggressively pushed for abstinence-only sex education.
- Why this is important: By age 25, 93% of people will have had sex, and the COVID-19 pandemic will have profound and likely lasting impacts on this generation’s sexual and reproductive health.
- How to move forward: Redirect abstinence-only funds to the Teen Pregnancy Prevention Program, the Personal Responsibility Education Program and comprehensive sex education programs. Support adolescents’ ability to access confidential and affordable health care, including abortion, and better support pregnant and parenting teens.
- Where things stand now: The Trump administration has weakened a key antidiscrimination policy in the Affordable Care Act (ACA) and made it easier for health care providers and institutions to refuse care to LGBTQ+ patients.
- Why this is important: LGBTQ+ people already face discrimination from health care providers and stigmatizing sex education. During the COVID-19 crisis, they have faced disproportionate delays and challenges in obtaining contraceptives and gender-affirming care.
- How to move forward: Fully restore the ACA’s antidiscrimination protections, reverse the refusal of care rule and ensure that all sex education is LGBTQ+ inclusive.
Black, Indigenous and other people of color
- Where things stand now: The U.S. government has a long history of dictating and coercing the reproductive health decisions of Black, Indigenous and other people of color that continues today through policies that threaten vital health services.
- Why this is important: The maternal mortality rate for Black women nationally is 3.2 times the rate for White women, and racist policies like the Hyde Amendment are designed to target people with low incomes—and, in particular, people of color—for harmful and discriminatory treatment.
- How to move forward: Eliminate the Hyde Amendment, increase Medicaid eligibility, acknowledge racism as a cause of heath disparities and address the disproportionate impact of the COVID-19 pandemic on communities 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.