For decades – and especially since the Supreme Court overturned Roe v. Wade – providing abortion and reproductive healthcare has often been an exceedingly difficult task. Whether it is harassment and violence, TRAP lawsTargeted Regulation of Abortion Providers (TRAP) laws are policies that impose strict regulations specifically on abortion providers – and not on other similarly situated care providers – and that are unnecessary, and in some cases counterproductive, to ensuring patient health and safety. TRAP laws can include requiring abortion clinics to conform to standards for ambulatory surgical centers, mandating that clinics have transfer agreements with hospitals, placing onerous requirements on clinicians, and more. See more information at https://www.guttmacher.org/state-policy/explore/targeted-regulation-abortion-providers., cuts to funding, policies that have forced clinic closures, or bans on abortion care, the attacks on reproductive healthcare providers have been relentless – and in many cases, have succeeded in undermining the availability of care.The ability of clinics to provide high-quality care cannot be disentangled from the legal landscape of abortion access and availability: where abortion is mostly or entirely banned, clinics are often forced to close down entirely or, at the very least, to operate under incredible amounts of politically-motivated scrutiny that, of course, has negative implications for their operations. The most up-to-date information about state laws and policies on abortion is available at https://states.guttmacher.org/policies/. On top of that, issues such as provider shortages, atypical compliance policies and surveillance from state health officials, and low reimbursement rates make it difficult to provide care, even in the absence of state laws that make abortion illegal.

Despite these challenges, reproductive healthcare providers are often beacons in their communities, persistent in their determination to ensure access to care wherever they can and to deliver care that is of the highest quality. Now is the moment to double down on this commitment to providing excellent and equitable care. This issue brief highlights examples of reproductive healthcare providers that are innovating not only in how they respond to the healthcare needs of patients but also in how they work towards achieving health equity for entire communities. From addressing social needs and structural barriers to care, to diversifying the provider workforce, to investing in community partnerships, to championing comprehensive policy solutions, these providers are leading the way toward more equitable and just models of care.

Providing Whole-Person Care to Achieve Reproductive Health Equity

Healthcare providers of all kinds should strive to offer high-quality, culturally centered whole-person care that responds to people’s context and overall physical, mental, and social well-being. This includes addressing structural barriers that prevent access to care, such as financial or physical constraints, as well as working to understand and mitigate larger factors like institutional racism that impact both care delivery and patient experience. This also includes recognizing that people are experts in their own lives and needs, and co-creating care plans through effective communication and fostering trusting environments. Given the history of reproductive violence against women of color and disabled women, and the commitment of the reproductive health, rights, and justice movement to people’s dignity, it is especially critical to create trusted, respectful clinical care settings. Reproductive healthcare providers, unlike other “specialty” providers, are often the first line of healthcare for communities; they commonly provide a host of preventive and primary care services in addition to reproductive healthcare, often while under-resourced. In this respect, many reproductive healthcare providers are already at the forefront of providing comprehensive, whole-person care.

Maine Family Planning

For people living in Maine, one of the most rural states in the nation, there are unique challenges to reproductive healthcare access. Low-income, uninsured Mainers are less likely to seek needed medical services and have more trouble finding providers to see them.Maine Center for Disease Control & Prevention. “Rural Health in Maine,” https://www.maine.gov/dhhs/mecdc/public-health-systems/rhpc/rural-health.shtml. That’s where Maine Family Planning (MFP) comes in.Maine Family Planning. “Our Services,” https://mainefamilyplanning.org/our-services/. In addition to providing primary care, MFP provides affordable abortion services, gender-affirming healthcare, and has launched a broad outreach program, the Reproductive Empowerment Project (REP). In partnership with domestic violence programs, harm-reduction associations, and substance use disorder treatment centers, MFP is providing education and consultations on reproductive health, contraceptive methods, and STI/HIV prevention.Maine Family Planning. “Bringing Education & Contraception to Maine Organizations,” https://mainefamilyplanning.org/reproductive-empowerment-project-rep/. To address the challenge of accessing abortion care after the first trimester, Maine piloted an in-state referral system to allow clients to be seen with fewer delays and reduce logistical and financial difficulties of having to travel greater distances.Yves-Yvette Young, MPH; Alison Bates, ARNP, WHNP-BC; Donna Burkett, MD; Leah Coplon, CNM, MPH; Andrea Irwin, JD, et al. “Expanding access to later abortion care in Maine: Improving in-state clinic referral systems,” Later Abortion Initiative at Ibis Reproductive Health, 2021, https://laterabortion.org/sites/default/files/lai_expanding_access_maine.pdf. This approach aims to address a range of factors that help improve health and well-being across many dimensions of clients’ lives through comprehensive care and community partnerships.

New York City Department of Health Sexual Health Clinics

Addressing the long-standing problems impacting reproductive healthcare means that it’s time for innovative solutions to confront persistent structural inequities. Three New York City Department of Health clinics now offer free medication abortionsNYC Health. “Sexual Health Clinics,” https://www.nyc.gov/site/doh/services/sexual-health-clinics.page., the first city-run clinics in the nation to do so.Robbie Sequeira, “Abortion care access explore d at Morrisania Sexual Health Clinic, the first city-run clinic in the nation offering free abortion meds,” Bronx Times, February 20, 2023, https://www.bxtimes.com/morrisania-sexual-health-clinic-free-abortion-meds/. Abortion pills for people in their first trimester of pregnancy are available at clinics in the Bronx, Queens, and Manhattan, with additional locations to come. New York City also offers a first-of-its-kind phone line that refers callers to abortion care providers and can connect them to financial support for the procedure, transportation, and/or lodging.NYC.gov, “Mayor Adams, Health Commissioner Vasan Announce Opening of Abortion Access hub to Ensure NYC Remains Safe Haven for Abortion Care,” November 1, 2022, https://www.nyc.gov/office-of-the-mayor/news/801-22/mayor-adams-health-commissioner-vasan-opening-abortion-access-hub-ensure-nyc. These measures explicitly address the economic and logistical barriers that many people have in accessing abortion, helping to ensure that the city will continue to function as a safe haven for quality, affordable healthcare free from political interference and social stigma.

Employing and Supporting a Diverse Workforce that Can Drive Health Equity

Healthcare institutions have a crucial opportunity to exemplify best practices in diversifying and supporting a workforce primed to provide high-quality, respectful, trustworthy cultural congruent care. This includes employing and cultivating a workforce that is representative of the surrounding community and is trained, equipped, and supported to advance reproductive health equity. This also includes increasing diversity at the leadership level, which can strengthen an organization’s policies and practices. Given the history of abuse and exploitation of Black, Brown, and disabled women in reproductive and gynecological health and the systemic exclusion of providers of color from professionalized care, it is especially important that reproductive healthcare providers reflect their communities and patient populations. It is also vital to create and sustain workplaces and jobs where employees can be healthy, thrive, and help guide effective and equitable care while feeling safe themselves. This can include, for example, providing employees with paid leave, fair pay, excellent health coverage and benefits, and pathways to professional growth.

CHOICES for Reproductive Health

In the mid-South, CHOICES for Reproductive Health embodies best practices in cultivating a diverse workforce that is representative of the surrounding community in western Tennessee and Southern Illinois.CHOICES Center for Reproductive Health. “Abortions” https://yourchoices.org/abortions/. Informed by the history of Black midwives in the South, CHOICES initiated its Nurse-Midwifery Fellowship Program to introduce recently graduated nurse-midwives to a full-spectrum reproductive health model and ensure that fellows are equipped to practice in an inclusive, patient-centered manner.CHOICES Center for Reproductive Health. “Center of Excellence Nurse Midwifery Fellowship,” https://yourchoices.org/fellowship-for-black-midwives/. The fellowship increases the number of Black Midwives trained to offer both birth services and abortion care, grounded in principles of reproductive justice and with a focus on dismantling systems of reproductive oppression. These services are essential in a region where nearly twice the number of Black infants are dying compared to white infants.CHOICES Center for Reproductive Health. “Center of Excellence Nurse Midwifery Fellowship,” https://yourchoices.org/fellowship-for-black-midwives/. CHOICES works to center patients with the least access to affordable, inclusive, quality care, and it does so by exemplifying best practices in diversifying and supporting its provider workforce.

Partnering with People and Organizations in the Community You Serve

Effective and sustainable strategies and programs to achieve health equity require authentic partnership with those most affected by barriers to care. Especially in a landscape where the availability and legality of abortion and reproductive healthcare is confusing and chaotic – deliberately made so by political actors and anti-abortion extremists – provider organizations must strengthen engagement and build trust with their surrounding communities. This includes creating structures and opportunities to listen to people seeking reproductive healthcare, with the goal of trusting their lived experience and expertise and incorporating these learnings into policy and program development. Structures to support engagement include compensation for time and expertise, technical support for participation, accessibility of meetings, provision of meals and childcare support. Engaging with the community should be on-going rather than sporadic – from identifying priorities to developing and implementing solutions to evaluating and improving these initiatives. Lastly, creating meaningful partnerships involves recognizing and supporting community leaders and organizations with complementary missions or goals – from full-spectrum doulas and birth justice advocates to LGBTQ+ and intimate partner violence organizations, to mental health providers and many others – thereby cultivating a connected network of support for patients and people in the community.

Red River Women’s Clinic

For Red River Women’s Clinic (RRWC), building authentic partnerships has long been integral to their mission of providing high-quality abortion care. As the only abortion provider in North Dakota, RRWC understood that this not only meant better care for their patients but also helped demystify abortion for community leaders and members, many of whom were unfamiliar with what goes on inside a clinic. Whether elected officials, local media, or the mail carrier, RRWC recognized that they would each serve as ambassadors for the clinic and its services out in the community. They also worked to develop relationships with organizations like the North Dakota Women’s Network and CAWS North Dakota, the statewide sexual and domestic violence coalition. While Dobbs forced RRWC to leave North Dakota – exacerbating an already dire lack of access to maternal and reproductive health care in the stateFontenot, J, Lucas, R, Stoneburner, A, Brigance, C, Hubbard, K, Jones, E, Mishkin, K. Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity in North Dakota. March of Dimes, 2023, https://www.marchofdimes.org/peristats/reports/north-dakota/maternity-care-deserts. – they are now providing abortion care in Minnesota, with the same commitment to integrating themselves into and partnering with their surrounding community.

Planned Parenthood Hudson Peconic

Planned Parenthood Hudson Peconic (PPHC) recently launched a Community Advisory Board (CAB), with the goal of making abortion more accessible and more equitable. Composed of patients, community members, and community partners, the CAB focuses on identifying and better understanding the barriers people face when accessing abortion care and what resources may help mitigate those challenges. Topics for discussion include logistical concerns like transportation and childcare, stigma and misinformation about abortion care, patient experience, access to counselors or social workers, the cost of care, and more. Members of the CAB are compensated for their participation and meetings are held over Zoom to facilitate access. PPHC also intentionally sought diverse representation on the CAB in order to ensure a variety of experiences and perspectives, and to foster the creation of solutions that are grounded in equitable approaches to care.

Using Your Voice to Advance Policies that Support Reproductive Health Equity and Justice

Reproductive healthcare provider organizations have unique power and influence as policy leaders that can help shape better systems and direct resources to advance health equity and community well-being. Many providers have become adept at using that power out of necessity, because access to reproductive healthcare has long been politicized and attacked, and also using that power by deliberate choice, because they understand the role that policies play in shaping their patients’ lives and experiences. This includes using healthcare stakeholders’ status, credibility, and relationships to increase public understanding about the root causes of health inequity, including racism and all forms of discrimination, poverty, and other adverse social drivers of health. It also includes building intentional, cross-issue coalitions and advocacy strategies. Now more than ever, the harms resulting from bad policies are starkly visible, and our values of health equity and reproductive justice drive us to advocate for policy change that is responsive to the totality of what people need to be well and to thrive.

Feminist Women’s Health Center

“When we change our state laws, we change our whole state,” says the Feminist Women’s Health Center (FWHC) in Atlanta, Georgia.Feminist Women’s Health Center. “Legislative Advocacy Program” https://feministcenter.org/legislative-advocacy-program/. Recognizing the direct relationship between policy and the clinical services they provide – and more broadly, the challenges and concerns facing their clients – FWHC employs a full-time advocate at the state Capitol to educate policymakers on key issues, fight back against harmful bills, and champion the policy solutions that advance reproductive justice. They also know that there is power in movement-building and in engaging members of the public in the policy process, so they work to empower Georgians to advocate directly with their government. Whether through trainings on current laws relevant to reproductive justice and the legislative process, supporting people in talking to their elected officials, registering new voters, or canvassing in local communities, FWHC is building a network of engaged, informed advocates who will make a meaningful difference in changing state policies for the better.

The crisis wrought by the end of Roe – indeed the knowledge that Roe alone was never enough – presents an opportunity to envision the future of reproductive health, rights, and justice in new ways. And while the challenges are real, now is the time to invest in making that future our reality, to follow these examples on the path to achieving true health equity and justice.

The following staff of the National Partnership for Women & Families contributed to this report (in alphabetical order).

• Ashi Arora, Health Justice Policy Associate
• Shaina Goodman, Director of Reproductive Health and Rights
• Sinsi Hernández-Cancio, Vice President for Health Justice
• Josia Klein, Huber Reproductive Health Equity Legal Fellow 2022-2023
• Erin Mackay, Managing Director for Health Justice
• Carol Sakala, Senior Director of Maternal Health
• Jessi Leigh Swenson, Director of Congressional Relations for Health Justice

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