In this Article, I explore how nearly continuous public rhetorical challenges to abortion in the political realm first led the public and the courts to turn away from a particular abortion procedure (intact dilation and extraction, also known as partial-birth abortion) which political agitators labeled as “barbaric” and then to view physicians who performed abortions not as legitimate professionals, but simply as “abortionists,” and sometimes as evil “Frankensteins.” “Abortionists” use no “medical judgment” and are unworthy of deference by state legislatures, Congress, or the courts when deciding how or when to perform an abortion. The concentration on the welfare of fetuses and the actions of physicians permitted the abortion debate to bypass discussion of both the rights and welfare of pregnant patients, including their right to health, and to virtually never mention that abortion restrictions primarily affect people in poverty who cannot afford to seek reproductive health care, including an abortion, by traveling to a nonrestrictive state. Understanding the power of extreme rhetoric, including the use of social media in political campaigns and the use and misuse of concrete terms such as murder, infanticide, brutality, and dismemberment, and abstract concepts such as “human dignity,” can help us plot a post-Dobbs way forward. Perhaps the demise of Roe can lead to a birth of a new rhetoric on abortion, one that concentrates on the right to health of everyone, including the right to make reproductive decisions, and requires moving abortion back into the realm of contemporary medicine, complete with a meaningful doctor-patient relationship protected by privacy and financed in a way that is accessible to all pregnant patients.

Recent advances in prenatal genetic testing have made testing for congenital disorders more accessible, with emerging technologies promising further expansion of available testing options. In particular, non-invasive prenatal testing (“NIPT”) has allowed women to identify more fetal disorders earlier in pregnancy than was possible only a decade ago. In addition to allowing women to prepare for the birth of a child with a disability, prenatal diagnoses give women the ability to terminate a pregnancy to avoid raising a child with a disability, a choice driven by myriad factors.

The state is increasingly criminalizing reproduction. While prosecutions of pregnant people for prenatal drug use began occurring several decades ago,1 this type of prosecution remained relatively rare for many years.2 But such prosecutions have increased dramatically—thousands have now occurred across the United States.3 In addition, the criminalization of reproduction is not limited to instances of prenatal drug use,4 but extends to a wide array of prosecutions in the reproductive space—including the criminalization of stillbirth,5 miscarriage,6 breastfeeding,7 home births,8 and c-section refusals.9 And, of course, recent changes in the Supreme Court have resulted in an almost certain change in the criminal regulation of abortion, as well.10 The criminalization of reproduction often occurs at an initial point of access to the health care system – at the hospital, the doctor’s office, the lactation consultant appointment, or the addiction treatment clinic. In this way, health care settings become gateways into the criminal justice system, and it is the attempt to access reproductive health care that results in criminal prosecution.11

Women with opioid use disorder (“OUD”) are more likely than other women to experience sexual assault, unintentional pregnancy, transactional sex and coercion regarding reproductive health care choices than women without OUD. Laws described as family friendly may be punitive rather than helpful to women and rarely apply to men. Laws regarding reproductive health and OUD are unevenly enforced and therefore biased against poor, minority women. As part of a larger study oriented toward strengthening systems of care related to the intersection of HIV and OUD, we conducted an analysis of state laws related to pregnant and postpartum women with OUD. Data on disparities in child removals and pregnant women’s use of evidence-based treatment for OUD by income and race were captured for the five states with the most restrictive laws in both categories. Laws that were purportedly designed to improve reproductive health outcomes for women with OUD and/or their children often have the opposite of the expressed intended outcome. There is a relationship between restrictive reproductive choice and coercive OUD treatment policy for women. Restrictive state regulations for pregnant women with OUD persist despite negative outcomes for maternal and child health. Altering coercive and/or criminalizing regulation and redefining ‘family friendly’ may improve outcomes for individuals and families.

As the United States’ largest public health insurance program, Medicaid has since 1965 played a crucial role in the struggle for equitable health care access. It has the potential to be a powerful instrument of reproductive justice, yet discriminatory policies that deny coverage for vital sexual, reproductive, or other health services, or exclude entire populations of people with low incomes from coverage altogether, constrain peoples’ health and reproductive futures. Resulting discrimination in Medicaid law and policy thwart the program’s ability to promote intergenerational health equity and reproductive justice for underserved communities.

This Article provides an account of why reproductive justice is a necessary framework for examining, reimagining, and reforming Medicaid coverage law and policy. Part I gives a brief history and overview of reproductive justice, which serves as “an open source code that people have used to pursue fresh critical thinking regarding power and powerlessness.” Part II argues that we should utilize that open source code in Medicaid coverage reform. Using some of the reproductive justice movement’s critiques as a starting point, it explores how reproductive oppression has shaped Medicaid coverage law, policy, and mainstream reproductive and health care reform movements’ proposals, and to what effect. It argues that examining Medicaid law, policy, and proposed reforms through this lens and in collaboration with the reproductive justice movement can enable health advocates and policymakers to more fully understand, disrupt, and dismantle reproductive injustices that drive health inequities. Ultimately, it can empower reformers to build a more equitable public health insurance safety net that brings us closer to reproductive justice for all.

In July 2020, a federal district court lifted the U.S. Food & Drug Administration’s (“FDA”) restriction requiring patients to pick up the first drug of a medication abortion—mifepristone—at a healthcare facility. Soon after, an ongoing experiment with remote care for abortion expanded, as telemedicine did in other areas, and virtual clinics began offering no-touch abortions. Growth of virtual care stalled in January 2021 when the Supreme Court stayed a district court’s order pending the appeals process. But in April 2022, persuaded by the evidence of remote abortion’s safety and efficacy, the FDA suspended enforcement of the in-person rule for the course of the pandemic. On December 16, 2021, the FDA lifted the requirement that patients pick up mifepristone at a healthcare facility, clearing the way for supervised mail delivery and pharmacy dispensation.

The expansion of virtual clinics, however, is not without significant limitations. First, questions remain about how to implement the new FDA regulation, specifically regarding certified pharmacies, and several FDA restrictions on mifepristone remain in place. Second, about half the country prohibits telehealth for abortion by either banning all abortion or by requiring the physical presence of a healthcare professional. Third, participation in telemedicine depends on various forms of privilege. Patients must have a stable internet connection or smartphone as well as an uncomplicated pregnancy, which, in part because of U.S. health disparities, is more likely for wealthier and white people. Even with the expansion of remote care, the need for clinical spaces will not disappear; in fact, it will come under increasing pressure.

This Article maps the emergence of virtual abortion care and analyzes the potential trajectory of medication abortion access, given that the Supreme Court has overturned constitutional protections for abortion. It considers the limits of telehealth for abortion—who telehealth can reach and who it cannot. Those living in states that permit abortion will have new options for ending early pregnancies. Those residing in states hostile to abortion will have to seek cross-border care, carry pregnancies to term, or find other avenues to end pregnancies. But the portability of abortion pills, when mailed by prescribers or dispensed by certified pharmacies, will test how closely states officials (or anyone else) can police or impede access to medication abortion.

The ability of pluripotent stem to develop into any of the cell types in the human body has meant that it was only a matter of time before scientists would try to transform them into human gametes. Up to now though it has not been possible to do so. Nevertheless a 2016 book written by Henry Greely speculated that in twenty to forty years most people in developed countries will cease reproduction through sex, using sex exclusively for pleasure, and instead will rely on reproduction through pluripotent stem cell-derived gametes. This paper will offer a different perspective. After describing the process through which human pluripotent stem cells might eventually be coaxed into gametes, it will show why the use of pluripotent stem cell-derived gametes for reproductive purposes would present significant safety, ethical, and regulatory challenges.

The United States has a long and controversial history with abortion that did not end with Roe v. Wade. Almost immediately thereafter, anti-choice politicians commenced a decades-long effort to restrict access to abortion, recently culminating in the Dobbs decision that overturned Roe. One successful attempt to restrict access immediately following Roe was the Hyde Amendment. With more Americans covered by federally funded health insurance than ever, the Hyde Amendment creates an insurmountable barrier to abortion care for those who lack other sources of financing.

Despite the impacts of the Hyde Amendment, support for discontinuing the amendment has been weak. For the first time in over forty years, the United States is in a position to change its abortion funding policy. Beyond ending Hyde, the EACH Act has been introduced in Congress to ensure permanent funding for abortion through all federally funded insurance programs. To secure funding for abortion and reduce barriers to access, advocates must press the federal government to pass legislation such as the EACH Act.

Abortion, though afforded certain legal protections, can be challenging to access in many areas of the United States, a problem exacerbated by the presence of Crisis Pregnancy Centers (CPCs). CPCs present themselves as clinics that provide a full spectrum of free pregnancy consultation services, but in fact are pro-life, anti-abortion organizations.1 From the outside, CPCs appear to be neutral health and welfare establishments, leading women *to believe they will receive unbiased guidance based on their best interests. In reality, CPCs recruit unsuspecting women into their facilities to deter them from accessing abortions, promoting only two options: parenthood or adoption.2 Women are lured into CPCs with the promise of free services which range from medical care to clothing and other items. At its most basic level, these deceptive practices violate the autonomy of women seeking reproductive care, perpetuating unjust limitation of access to quality medical care.