Tag: reproductive rights

Does Trump’s Call For Expanding IVF Access Have Any Real Legal Teeth?

Assistance with fertility care is an urgent need for many families across the United States. According to findings from the 2024 Kaiser Family Foundation(KFF) Women’s Health Survey, one in eight reproductive-age women said that they or their partner needed fertility services to help them become pregnant or prevent a miscarriage. Fifteen states require some private insurers to cover some fertility treatment, but significant gaps in coverage remain. Only one state Medicaid program covers any fertility treatment, and no Medicaid program covers artificial insemination or in vitro fertilization.

Following the Dobbs decision, the future of assisted reproductive technology (ART) has been in question. In February 2024, the Alabama Supreme Court issued a ruling declaring frozen embryos in that state to be “unborn children” for the purposes of civil liability under Alabama’s wrongful death statute. Following national outrage from the decision, in March 2024, Alabama passed a law that provides immunity from civil and criminal charges for in vitro fertilization (IVF) patients and providers, which helped restart IVF services. However, this law did not overturn the state Supreme Court’s decision, keeping the legal status of embryos as “children” under the wrongful death statute.

In response to the uproar over the Alabama case, Senate Republicans announced support for protecting nationwide access to IVF. During the 2024 presidential campaign, Donald Trump pledged to make IVF free. On February 18, 2025, President Trump signed an executive order aimed at expanding access to in vitro fertilization (IVF). Following that executive order, on October 16, 2025, the White House revealed plans to offer discounts on certain IVF medications through a new government website, TrumpRx.gov. The White House also stated that it would work to develop more options for employers to voluntarily assist with fertility and family formation costs for their employees and dependents.

Following the White House’s announcement, the American Society for Reproductive Medicine (ASRM) issued a statement noting that, although the initiative was presented as a breakthrough for affordability, “key details about its implementation, scope, and equity remain unresolved.” Regarding legal considerations, they noted that classifying fertility coverage as an “excepted benefit” could undermine consumer protections under the Affordable Care Act (ACA) and the Employee Retirement Income Security Act (ERISA). Additionally, the announcement did not address the issue that across the country states are still navigating an evolving legal landscape that is emerging from disputes about pre-embryos making their way to court.

Many patients lack access to fertility services mainly because of high costs and limited coverage from private insurance and Medicaid. This initiative has no impact on existing state coverage mandates. As stated in the American College of Obstetrics and Gynecologists’ response to increase access to comprehensive care, employer-sponsored insurance plans should be both affordable and universally available. Coverage of IVF benefits can vary significantly and may not fully cover the entire cost of an IVF cycle, which typically ranges from $15,000 to $20,000. Many individuals facing infertility may need more than one IVF cycle. The cost of medication is just one part of the IVF process; discounts on these medications do not significantly lower the total expenses, which usually include both procedural and lab fees. As noted by KFF, laws regarding IVF insurance coverage vary, often limiting benefits to those with an infertility diagnosis and excluding single people and same-sex couples, and they do not apply to self-funded employer plans. The White House announcement leaves important gaps unaddressed. It also omits the 16 million reproductive-age individuals enrolled in Medicaid, who, even with a discount through TrumpRX, would find these treatments prohibitively expensive.

Senate Republicans have had the opportunity to support legislation that would provide comprehensive coverage of IVF and other ART treatments. However, despite their declared support, they blocked the passage of the Right to IVF twice, first in June and then in September 2024, legislation that would establish a right to IVF and ART, and help lower the costs of IVF treatments through expanded coverage. Republicans have cited increased costs to medical plans as their main concern with the bill, even though in 2024,  97% of large employers voluntarily offered fertility benefits reported no significant increase in costs to their medical plans. Despite this, the Access toFertility Treatment and Care Act, which would require most private insurance plans, as well as plans offered by Federal Employees Health Benefits Program, Medicaid, TRICARE, ERISA, and VA to provide coverage for treatment of infertility without any insurance or copays, remains a partisan bill. While the discounts are a step in the right direction, they fall short of truly enabling families to access the care they need.

Tracing the History of Forced Sterilization within the United States

When many people hear the phrase “forced sterilization,” they rarely associate the practice with the United States, or if they do, they believe this was something the country did more than a century ago. Unfortunately, however, coerced and forced sterilizations have been occurring since the early 1900s and have seen their most recent iterations as “voluntary” procedures offered for a reduced prison sentence. Coerced sterilization occurs when financial or social incentives or intimidation tactics are employed to compel an individual to undergo the procedure. In comparison, forced sterilization happens when a person does not know she is undergoing the procedure, has no opportunity to provide consent, or gives consent under duress.

In 1907, Indiana
became the first state to successfully pass a mandatory forced sterilization
law, and California and Washington followed suit a few years later. Throughout
the first half of the twentieth century, the public generally supported
sterilization of the mentally handicapped. In 1927, the Supreme Court ruled in Buck v. Bell that forced sterilization
did not violate the Constitution. In his opinion in Buck, Justice Holmes explicitly argued for eugenics, which Nazi propaganda
then cited the opinion as a basis for Germany’s forced sterilization programs.

Public sentiment surrounding sterilization began to shift following the 1940s, but the trend changed when the Nixon administration dramatically increased Medicaid-funded sterilization of low-income Americans, specifically targeting people of color and those with HIV/AIDS. This funding, combined with a federal commitment to family planning and community health, led to widespread sterilization abuse in the United States from the late 1960s to the mid-1970s. For example, the North Carolina Eugenics Board sterilized 7,600 mentally handicapped women between the 1940s and 1970s. The increase of reproductive health clinics at this time overwhelmingly benefited middle-class white women, but minority working-class women faced stigma and a family planning model that lacked standardized consent protocols, which created an environment “ripe for coercion.”

The story of the Relf sisters, who were teenagers sterilized without consent in 1973 in Alabama, mobilized many women to address forced sterilization. As the case went to trial, it was found that the girls’ mother believed she was consenting to birth control for her daughters, but because she could not read, she mistakenly signed a sterilization release. In reaction to this story, African American and Native American women throughout the United States came forth with similar allegations, and, in Relf v. Weinberger, a federal district court judge estimated that 100,000 to 150,000 low-income women had been sterilized during the early seventies. The call to action grew as awareness of the practice increased, and health departments in major cities began revising their guidelines for sterilizations, which included reviewing the consent notice and fully informing patients of the permanence of the procedure. Some jurisdictions, like North Carolina, even established governmental entities to identify victims of forced sterilization and compensate them.

Despite this, forced sterilization still occurs today, although it is reframed as a voluntary option in exchange for a reduced prison sentence. In May 2017, a Tennessee judge signed a standing order allowing inmates in White County to receive jail credit if they underwent either a vasectomy for males or a Nexplanon implant for females. Thirty-two women and thirty-eight men underwent sterilization during the three months Judge Benningfield’s order was in effect. Though Tennessee later introduced a bill that would forbid judges from approving a reduced sentence if it is conditioned upon sterilization, other states are not responding with similar legislation. In February 2018, an Oklahoma woman, who was a prior drug addict, received a shorter sentence for a federal counterfeiting offense after undergoing surgery to prevent further pregnancies. The sentencing judge, Stephen Friot, defended his decision, saying that the Supreme Court “has yet to recognize a constitutional right to bring crack- or methamphetamine-addicted babies into this world.” Actions and sentiments like Judge Friot’s demonstrate how eugenics practices in the United States have evolved and continue to violate an individual’s bodily autonomy and human rights on the whole.