Reproductive health care in the United States is facing an unprecedented crisis, one that is deeply rooted in the nation’s complex history and exacerbated by a recent wave of policy changes, legal rulings, and funding restrictions. These developments, according to sources including The Hill and commentary from medical professionals, are not isolated incidents but rather part of an ongoing, coordinated campaign that threatens access to contraception, abortion, and broader sexual health services for millions—especially those already marginalized by race, income, or geography.
To understand the current landscape, it’s crucial to recognize the historical underpinnings of reproductive health disparities in America. As detailed by medical students Kaitlynn Esemaya, Alexis Thompson, Annique McLune, and Anamaria Ancheta, the legacy of slavery and the American eugenics movement established race-based medicine and persistent stereotypes that continue to shape provider bias and patient mistrust. Black women, in particular, have been subjected to centuries of exploitation and mistreatment: in the antebellum South, enslaved women endured repeated gynecological experiments without anesthesia, their pain dismissed by the false belief that Black people do not feel pain like their White counterparts. This myth, rooted in the horrors of slavery, still influences medical practice today, with studies showing that some health care providers hold these erroneous beliefs, leading to inadequate pain management and delayed interventions.
The consequences of this legacy are stark. Black birthing people remain three to four times more likely to die from pregnancy-related causes than White women, a disparity that persists even as overall maternal mortality rates in the U.S. climb. The historical pattern of reproductive control continued well after emancipation, with the 1930s seeing federally supported birth control clinics used to suppress Black reproduction, and the 1980s and 1990s marked by coercive sterilization of low-income Black women through threats of withholding welfare benefits. These injustices have left a deep well of trauma and mistrust that is only deepening as new barriers arise.
Recent years have seen a dramatic escalation of these barriers, with the Supreme Court’s 2022 decision to overturn Roe v. Wade opening the door for states to impose severe restrictions on abortion access. As reported by The Hill, the Republican-led budget reconciliation bill passed in 2025 is projected to strip Medicaid coverage from millions and “defund” Planned Parenthood—a provider that, according to the Guttmacher Institute, delivers higher quality and more specialized contraceptive care than other federally qualified health centers or hospitals. The loss of Medicaid coverage and Planned Parenthood’s services is not something that other health providers can quickly or easily compensate for; Guttmacher’s research indicates that these institutions would need to increase their capacity by 56 percent and 28 percent, respectively, to fill the gap, a feat requiring significant time and investment.
The attack on reproductive health care extends beyond abortion. The Trump administration’s actions have included an attempt to destroy $9.7 million worth of contraceptives intended for women in low- and middle-income countries, and a systematic assault on the Title X family planning program. By withholding funding from providers that offer or refer for abortions—even when those services are funded separately—many clinics have been forced to close or curtail their services. This has disproportionately affected people of color, young people, and those living in poverty, according to the National Family Planning and Reproductive Health Association.
The cumulative effect is a “reproductive health care crisis in slow motion,” as Amy Friedrich-Karnik and Dr. Megan Kavanaugh of the Guttmacher Institute put it. In June 2025, the Supreme Court’s ruling in Medina v. Planned Parenthood South Atlantic upheld South Carolina’s power to prevent Planned Parenthood from receiving Medicaid reimbursement, setting a precedent that other states may soon follow. This, combined with the passage of H.R. 1—a federal law blocking Medicaid payments to organizations receiving over $800,000 in federal reimbursements if they provide abortion care—could force many Planned Parenthood clinics to close entirely, leaving millions without access to contraception, STI testing, Pap smears, HPV testing, and cancer screenings.
For those keeping score, the blows keep coming. Executive Order 14168 led to the removal of thousands of Centers for Disease Control and Prevention webpages on reproductive health care, making it even harder for patients and providers to access reliable information. Meanwhile, conservative lawmakers in some states are quietly working to further restrict access to contraception by reclassifying widely used methods such as emergency contraception as abortion. This maneuver allows them to claim they are not banning birth control—even as they lay the groundwork to do just that.
The human cost of these policies is not abstract. In February 2025, Adriana Smith, a 31-year-old Georgia woman, was declared brain dead after blood clots were found in her brain while she was nine weeks pregnant. Due to Georgia’s strict abortion laws, which ban the procedure after six weeks, Smith was kept on life support against her family’s wishes until the baby was born prematurely in June 2025. Her case, as reported by multiple sources, is a harrowing example of how restrictive laws can override patient autonomy and cause profound distress for families and health care providers alike.
Physicians and providers now face ethical dilemmas as they try to balance their commitment to autonomy, beneficence, non-maleficence, and justice with the constraints imposed by law. Many are calling for greater “structural competency”—an approach that recognizes the political, economic, and social forces shaping health outcomes. With more than 17 million Americans losing access to health care, including reproductive care, due to recent Medicaid cuts, the stakes could not be higher.
In response, advocacy organizations are stepping up. The American Medical Student Association offers resources, clinical training, and advocacy workshops to equip future physicians with tools to support reproductive health access. The American Academy of Family Physicians’ Advocacy Ambassadors Program helps connect medical professionals with policymakers, while the American Medical Women’s Association provides an advocacy platform and regular calls to action for its members. These efforts aim to fill the gaps left by shrinking public resources and to mobilize support for policies that protect and expand access to reproductive health care.
Yet, as Friedrich-Karnik and Kavanaugh warn, “an attack on one aspect of sexual and reproductive health care is an attack on all forms of sexual and reproductive health care.” The loss of insurance, trusted providers, and reliable information is not just a policy issue—it’s a matter of basic human rights and bodily autonomy.
As the nation grapples with the consequences of these changes, the need for urgent attention and action has never been clearer. The future of reproductive health care in America will depend on the willingness of policymakers, advocates, and the public to recognize what’s at stake—and to fight for a system that serves everyone, regardless of income, identity, or ZIP code.