Proceedings of a Workshop—in Brief

Shaping Access to Reproductive Health Care Through Financing and Delivery Systems

Proceedings of a Workshop—in Brief

OVERVIEW

In June 2024, the Standing Committee on Reproductive Health, Equity, and Society of the National Academies of Sciences, Engineering, and Medicine (the National Academies) held a two-part, public webinar series to explore the ways in which health care financing and delivery systems influence access to reproductive health care.

During the two webinars, speakers examined how public and private financing, institutions, and systems shape equitable access to comprehensive reproductive health care at state and national levels. Panelists discussed topics including state-level Medicaid reimbursement rates for abortion care, inequities in financing for infertility care, statewide contraceptive access initiatives, and the role of the private sector in enabling access to care, as well as how different care delivery systems, such as the Indian Health Service, the Veterans Health Administration, and Catholic-owned health care, promote or restrict reproductive health services.

This Proceedings of a Workshop—in Brief is a high-level summary of the topics and discussions by participants from both webinars. The views contained in this Proceedings of a Workshop—in Brief are those of individual workshop participants. It should not be viewed as providing consensus conclusions or recommendations of the National Academies.

FRAMING REMARKS

Moderator Tracy A. Weitz, American University, provided opening remarks to frame the two-part discussion series. She noted that reproductive health services are “often isolated from more mainstream health services, and decisions about financial coverage are often controversial.” Given these circumstances, the ability of patients to access the services they need is significantly affected by decisions made about what type of care is covered by insurance providers, how extensive that coverage is, and what care is provided within health systems. “Millions of people find their reproductive decisions constrained by the inability to pay for or access care, and many health care providers find their ability to offer care constrained by decisions of payers and other stakeholders,” said Weitz.

WEBINAR PART I: FINANCING SHAPING ACCESS TO REPRODUCTIVE HEALTH CARE

Presentations during the first webinar, held June 7, 2024, focused on how reproductive health care services are covered through public and private financing systems. The panelists explored the relationship between financing decisions and equity in access to care as well as

evidence-based strategies to bolster access to comprehensive reproductive health care services.

Reimbursement and Access for Abortion Services Under Medicaid

Brittni Frederiksen, KFF, discussed Medicaid reimbursement for abortion care services and limitations on coverage. Medicaid coverage “directly affects whether people are able to afford and access abortion services and whether providers are willing to accept Medicaid coverage for abortion services.” Overall, Medicaid coverage for abortion care is very limited, Frederiksen explained, due to state-level abortion bans and Hyde Amendment restrictions. The Hyde Amendment is attached to annual appropriations bills in Congress and was first passed in 1976. It prohibits the use of federal funds for abortion, except in cases where the pregnancy is the result of rape or incest or when the life of the pregnant person is endangered and affects many federal programs in addition to Medicaid. In 19 states and Washington, DC, Medicaid coverage of abortion is restricted by the Hyde Amendment; 17 states use their own respective funds to pay for abortion services for Medicaid enrollees (meaning services can be provided beyond Hyde exceptions); and in 14 states, abortion is generally banned altogether. Even in circumstances where exceptions to the Hyde Amendment apply, abortions are often not covered “because there’s additional paperwork or certification needed, such as a police report,” said Frederiksen.

Frederiksen said that Medicaid coverage is crucial for many women. Across all states, “nearly half or more than half of women with low incomes have Medicaid coverage.” For anyone using abortion services in states where Medicaid reimbursement is restricted by the Hyde Amendment, the majority (82 percent) pay out of pocket (8 percent have other insurance, and 10 percent received care at no cost to the patient).¹ Patients unable to afford out-of-pocket costs may turn to financial assistance through an abortion fund. As a result, Frederiksen said, equity becomes an even greater concern because the state where a patient resides can dictate whether they are able to afford abortion care.

In terms of calculating how much Medicaid reimburses for different services associated with abortion care, Frederiksen noted that the available data present challenges. KFF found that state- and plan-level claims can offer a “reliable picture of utilization and payment for abortion under Medicaid.” The amounts Medicaid reimburses for different types of abortion services varies greatly depending on the state where the patient receives care. KFF found significant variation in the reimbursement amounts across states depending on the billing codes used. For example, in New Mexico, the reimbursement for medication abortion is $665, which includes $570 for the bundled “global code” and $93 for the medications. By comparison, Rhode Island only reimburses $162 for all the components of the service.² She added that reimbursement amounts do not necessarily reflect the complexity of the abortion care. For example, for procedural abortions, some states reimburse roughly the same amount for dilation and curettage (D&C) (used through approximately 13 weeks of pregnancy) and dilation and evacuation (D&E), although the latter involves more complex care.

Frederiksen highlighted states that have established strategies to increase Medicaid reimbursement for abortion services. California created a supplemental payment to compensate nonhospital clinics providing abortion services to patients who are beneficiaries of Medi-Cal (California’s implementation of Medicaid). In preparation for the outcome of a state-wide ballot initiative to repeal the state funding ban, Colorado has increased reimbursements for D&C, D&E, and medication abortion. Frederiksen cautioned that increases in state funding for reimbursements can be unreliable because “a revenue shortfall may result in future funding restrictions.”

Reproductive Justice and Financing Infertility Care

Kimberly Mutcherson, Rutgers Law School, discussed the connection between infertility, insurance coverage for treatments, and reproductive justice. Mutcherson explained that reproductive justice refers to “the right to have a child, the right to not have a child, and the right to parent your child in safe and sustainable communities.” Often omitted from discussion of reproductive justice is what it takes to become pregnant. She said that infertility, which affects one in five people in the

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United States, can be defined in “at least three ways”: (1) medical infertility, or the inability to become pregnant after 1 year of unprotected sex in the case of opposite sex partners; (2) social infertility, or when assisted reproduction is needed to become pregnant, for example, in the cases of “same sex couples [or] people who are single and who don’t have a sexual partner;” and (3) iatrogenic infertility, or when medical infertility occurs as a result of unrelated medical treatments. These definitions often determine what care is covered by public or private insurance and therefore can directly affect who is able to access fertility care. She noted that significant racial disparities exist in the United States in both infertility diagnoses and access to treatment. “Women of color, especially Black women and Indigenous women, have higher rates of infertility and much lower rates of access to fertility care,” said Mutcherson.

Mutcherson explained that there is a wide range of fertility treatment options from non-invasive treatments, like lifestyle changes and medications, to more complex treatments, like in vitro fertilization (IVF), and the costs can vary greatly. She added that a single cycle of IVF can cost upwards of $30,000 in the United States. Twenty-one states and Washington, DC, mandate coverage for fertility care, said Mutcherson, and each state has different rules regarding what treatments are covered and what types of payors are obligated to cover the care. She explained that “carve outs,” or when a specific service is not included in insurance coverage, mean that some employers are exempt from state mandates, such as carve outs for religious employers or carve outs for employers who have fewer than 50 employees.

Mutcherson examined how the language of mandates in several states affects access to treatment. In Arkansas, the wording of the insurance mandate presumes a married heterosexual couple is seeking treatment and “the patient and her spouse must have at least a 2-year history of unexplained infertility,” said Mutcherson, and the mandate does not allow for the use of donor sperm. She noted that California’s mandate carves out people who are insured by the state’s Medi-Cal plans, which sends “a very specific message about who they want to be having babies in their state.” On the other hand, New Jersey’s fertility care mandate is expansive, said Mutcherson. It includes coverage for various treatments and stipulates that treatment should not be denied or delayed based on relationship status or sexual orientation.

Role of Statewide Contraceptive Access Initiatives: An Example From South Carolina

Amal Khoury, East Tennessee State University, explained that public programs like Medicaid are critical to financing contraceptive care for women with low incomes, but there are challenges to ensuring adequate access. She said policy changes at the state levels can limit access by placing restrictions on patient eligibility, types of services covered, and provider reimbursement amounts. For example, “Ten states have not expanded their Medicaid programs under the Affordable Care Act,” Khoury noted. She explained that these states are mostly in the U.S. South, and, as a result, “large proportions of low-income Southern women remain uninsured.” Contraceptive care also varies in the private sector, and both insurance plans and employers can refuse to provide coverage for contraceptive care, she added. In many parts of the country, statewide contraceptive access initiatives have “stepped in to fill the gaps and help finance reproductive care for populations facing barriers to access.”

Khoury said that statewide access initiatives often involve several, multisectoral partners with the common goal of increasing equitable contraceptive access. “Over the past two decades, more than 30 statewide contraceptive access initiatives have been implemented across the country,” she said. Khoury focused her presentation on one such initiative in South Carolina, Choose Well,³ for which East Tennessee State University is an external evaluator. Choose Well was launched in 2017, and its clinical partners include local health departments, delivering hospitals, and federally qualified health centers (FQHCs) in 45 of the state’s 46 counties. Khoury said the initiative aims to expand contraceptive access and reduce cost barriers “by financing contraceptive infrastructure, offering free or low-cost birth control methods,” and providing training opportunities for clinicians and administrative staff at partner organizations.

East Tennessee State University’s evaluation examined the impact of Choose Well over a 6-year period, said Khoury. The evaluation found significant uptake following trainings. Khoury noted that more than 80 percent of staff who participated in a training session between

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2017 and 2019 reported intending to change something about their provision of contraceptive care as a result. The evaluation also showed a large jump in contraceptive provision at participating FQHCs; for example, in 2016, 37 percent of participating FQHCs offered on-site provision of intrauterine devices (IUDs) and, in 2022, that figure rose to 88 percent. Cautious that these increases did not reflect provider coercion, Khoury said the university also evaluated patient experience and found that more patients at participating FQHCs “reported person-centered contraceptive counseling” than patients at “matched comparison clinics.” These investments and changes at the clinic level appeared to have translated to changes in contraceptive use within the state Medicaid program at midline.

Khoury said that components of Choose Well are now sustained through a mix of funding sources, including funds allocated by the South Carolina legislature and the state’s Medicaid agency. Evaluation findings were essential to securing state funding. Khoury said that it is critical to expand and “strengthen contraceptive access initiatives, particularly in the current environment, where restrictions on reproductive health care services are increasingly challenged, and also to ensure rigorous evaluation of these initiatives in order to advance the evidence in support of current and future programs.”

Role of the Private Sector in Enabling Access to Abortion Care

Jen Stark, Business for Social Responsibility (BSR), explored how businesses are responding to limitations on access to reproductive care created by state-level abortion bans and restrictions. Stark noted that as the reproductive health care landscape changes, so does the range of considerations for private employers. She said that the ubiquity of employer-sponsored health insurance in the United States—it is “the largest source of coverage in the U.S., covering 153 million people younger than age 65 in 2023”—means decisions employers make about coverage directly affects access to care. Stark emphasized that state level abortion bans and restrictions have a negative impact on employers because they “don’t support workforce readiness or safety.” She said that restrictions “make the business environment chaotic,” noting that the significant variance in levels of access across states is a challenge for employers to contend with. Stark pointed out that this sentiment is common across the private sector and shared insight from an Oklahoma business owner, who referred to the state losing “economic development deals, talent, and doctors” because of restrictions.

Many companies expanded their reproductive health benefits following the overturn of Roe v. Wade, said Stark, for example some established “emergency funds administered by a third party” and others set up funds that “didn’t require employees to leave a paper trail to access.” However, this increased coverage is not always equitably applied, she stressed, noting that contract and part-time workers may not receive coverage. Currently, there are legislative threats to employer-sponsored coverage, said Stark, including laws that criminalize travel across state lines for abortion, gender-affirming care, and penalize individuals who help others access abortion information. Stark also explained that health care providers across different specialties may choose not to practice in restrictive states, which creates care deserts, and attracting talent has become more difficult for employers operating in restrictive states. “[Human resources] recruiters are getting lots of questions from talent prospects” regarding access to care, said Stark. She added that that “across all demographics, workers want to be in states where abortion is legal and accessible,” which she said is evident through ballot initiatives on abortion in states including Ohio, Kentucky, and Kansas.

To help address recruitment concerns, Stark said that employers should assess their benefits packages to remain competitive and that there are also opportunities for employers to use their influence to advance public policy measures. She referred to a new tool called the Reproductive & Maternal Health Compass as a “comprehensive performance standard meant to help employers better understand their benefits offerings” and determine if they are “meeting the moment.” Stark also highlighted the Don’t Ban Equality platform that has brought together more than 1,000 businesses of all sizes in the United States to “engage as peers on understanding abortion access as a material workforce issue.” The platform, she noted, calls on employers to mitigate the harm of restrictions on workers, advocate with office holders on the need to combat restrictions and support efforts to

codify access to care, and to align their political influence strategies with their stated commitments and goals.

WEBINAR PART II: DELIVERY SYSTEMS SHAPING ACCESS TO REPRODUCTIVE HEALTH CARE

The final webinar, held June 12, 2024, explored how different health systems affect access to reproductive care. Weitz noted that, “millions of people find their reproductive decisions constrained or enabled by the decisions that are made at a systems level, and many health care providers find their ability to offer care constrained by the systems in which they operate.”

Indian Health Service

Loretta Christensen, Indian Health Service (IHS), provided an overview of the maternal health inequities faced by American Indian and Alaska Native (AI/AN) populations and access to contraception and abortion within IHS. Christensen said that AI/AN women are two to four times more likely to die of pregnancy-related causes than white women, revealing stark inequities in outcomes. She emphasized that underlying chronic conditions, increased rates of interpersonal violence, barriers like limited health care access in rural areas, and “ongoing historical trauma due to colonization, forced migration, cultural erasure” contribute to these inequities. The scale of these challenges is large: the majority (93 percent) of pregnancy-related deaths among the AI/AN population are preventable, said Christensen. Almost 13 percent of AI/AN women who gave birth in 2020 lived in maternal care deserts, she added, and just under one-quarter of AI/AN women do not receive adequate prenatal care.

In response to these challenges, IHS has made efforts to expand access to reproductive care services and to provide a “wide spectrum of care” to patients served. Contraceptive options are widely available at IHS facilities, including at walk-in clinics, and emergency contraception is offered over the counter at every location with a pharmacy. She added that the Opill, a daily birth control medication, was recently added to the IHS formulary for over-the-counter availability. Pharmacies also offer “patient education, access to counseling, and any referrals” to patients seeking contraception.

IHS adheres to federal law regarding abortion access and Hyde Amendment restrictions. Christensen explained that, while the system respects tribal sovereignty regarding reproductive access on tribal lands, any facility receiving IHS funding must also adhere to Hyde Amendment restrictions when using the funds for abortion care services. Thus, abortion services are not offered through IHS.

Christensen shared some current IHS work focused on reproductive health. One example is the ObRED program, a “multidisciplinary training and simulation for the safe triage, stabilization, and transfer of pregnant persons and newborns at sites that don’t have obstetric services.” This kind of program is especially important in maternal care deserts to give staff the training and information necessary for safe deliveries. Christensen said IHS has “elevated Indigenous birthing practices in collaboration with our midwives and birth workers,” noting that this work is “particularly important in the Alaska health system in which we have community health workers . . . in over 150 village clinics that may have to deliver a baby at any time.”

Veterans Health Administration

Amanda Johnson, Office of Women’s Health, Veterans Health Administration (VHA), described the provision of reproductive health care in the VHA since the Dobbs v. Jackson Women’s Health Organization decision. Johnson said the VHA is the “largest integrated health care system in the country” and serves more than 700,000 women veterans. She noted that, compared to the U.S. population overall, women veterans are more likely to be in rural areas and to have a “significant mental health and trauma burden.”

Prior to the Dobbs decision, abortion and abortion counseling were not part of VHA medical benefits. Johnson said, following Dobbs, the VHA recognized that given the location of its beneficiaries those individuals may not be able to access abortion care through non-system providers and amended its regulations. As a result, the VHA provides abortion care and counseling in cases “when the pregnant person’s life or health would be endangered if carrying the pregnancy to term, and also in the case of rape or incest, and, because we are a federal agency and federal law supersedes state law, we are able to provide

abortion and pregnancy options counseling in every state across the nation, regardless of contrary state law.”

Transitioning from a health care system that did not provide abortion care to one that does in certain cases required significant changes, said Johnson. The VHA worked across its national locations to identify a wide range of needs, including medical equipment and medications, “enhanced security at our facilities” especially in states with bans in place, and training on “pregnancy options counseling and abortion,” she explained.

Johnson described some of the challenges and successes that occurred as the VHA built out its abortion care services. She said that despite “reassurance from the Department of Justice that any of our employees who were providing this care contrary to state law would be protected,” there remained the “chilling effect of punitive state laws.” For some specialized care, Johnson said the VHA relies on providers in the patients’ communities. However, “in some states, that’s just no longer available,” and the VHA incurs costs to help patients travel to states where they can access care. Johnson said the VHA’s ability to provide critical “wrap-around” services to patients, including primary care and mental health care, is enhanced by including more reproductive health services. Johnson noted the system has significant experience in “telemedicine supporting our rural veterans” and has been able to expand access to contraception through this method.

Telehealth and Federally Qualified Health Centers

Fabiola Carrión-De Liban, National Health Law Program, examined the role of telehealth and FQHCs in shaping access to reproductive health care services. She said that the use of telehealth to access care has grown in the wake of the COVID-19 pandemic. Carrión-De Liban said that the use of different telehealth modalities varies across populations and data from the U.S. Department of Health and Human Services indicates “the highest rates of telehealth visits were among those covered by Medicaid and Medicare, individuals who are Black, and those earning less than $25,000.” She added that the data showed Latine, Black, and Asian populations were more likely to use audio-only telehealth than their white counterparts. Carrión-De Liban explained that telehealth is one important tool for expanding “abortion access by eliminating or greatly reducing costs often associated with abortion” like transportation, lodging, or lost wages. She said that currently one in five abortions in the United States are conducted via telehealth using medication.

The National Health Law Program conducted a study in 2022 examining coverage of telehealth abortion care services in Alaska, Connecticut, Hawaii, Maine, Montana, and Oregon—all of which use state funds to cover abortion care through Medicaid. The study revealed progress in improving service delivery, said Carrión-De Liban, including expanding coverage to more telehealth modalities like synchronous video conferencing as well as asynchronous options and audio-only calls. She noted that the study also found the states had expanded reimbursements to different types of providers, beyond only physicians, to include “nurse midwives, physician assistants,” when those clinicians are allowed to provide abortion under state law.

These practices are promising, but some challenges remain, said Carrión-De Liban. Some of the states “don’t reimburse [telehealth services] at the same rate as in-person services,” she noted. Reimbursement rates varied for different service modalities, which, Carrión-De Liban noted, presents an equity concern because “BIPOC communities are more likely to use audio-only and asynchronous services.” Another National Health Law Program study reviewed the policies for asynchronous care in states that use state funds for abortion care under Medicaid and found that there were different limitations on coverage for some types of care. For example, “Alaska, New Mexico, New York, and Vermont limit coverage to asynchronous interactions between providers,” said Carrión-De Liban.

Carrión-De Liban also highlighted the role of FQHCs as “outpatient facilities that provide comprehensive primary care to underserved communities” and offer reproductive health services, including abortion care. FQHCs—which, as recipients of federal funds, must adhere to Hyde Amendment restrictions—are not prohibited from providing abortion care services, but legal and financial hurdles, like additional malpractice insurance costs, can create this effect. Carrión-De Liban noted that “of the 10,560 FQHC delivery sites in operation in March 2017, only one offered abortion services.” Given these compli-

cating factors, she said “it’s always better when states issue guidance that confirms that their Medicaid programs can reimburse FQHCs” for abortion services. To date, only California has issued such guidance.

Catholic Hospital Systems

Lori Freedman, University of California, San Francisco, explored how restrictions on reproductive care in Catholic hospitals impact patients and health care providers. Freedman explained that 4 of the 10 largest health systems in the country are Catholic. The number of Catholic hospitals has grown 28 percent between 2000 and 2020, while the number of non-Catholic hospitals has shrunk, she said. Catholic hospitals “must follow the ethical and religious directives for Catholic health care services that are written by the U.S. Conference of Catholic Bishops,” she explained. The directives discuss a wide variety of health services, including reproductive care. Freedman said abortion is not the only reproductive health service restricted or prohibited in the Catholic health system; “contraception is not allowed, direct sterilizations like tubal ligations and vasectomies are not allowed” among others.

Freedman emphasized that funding for Catholic hospitals is provided by “private insurance, public insurance, [and] government grants,” not by the Catholic church, and “less Medicaid, less charity care than average” is provided. Overall, patients who go to Catholic hospitals do not seek care in them for religious reasons, rather hospital choice is related to factors like reputation and insurance coverage, Freedman explained. She noted that a nationally representative survey conducted by her research team demonstrated that 37 percent of women did not know their primary hospital was Catholic and that “many people just don’t know—even if they know that the hospital is Catholic—that there are restrictions on care.” For example, 77 percent of people surveyed reported thinking birth control would be available at Catholic hospitals.

Based on interviews conducted between 2012 and 2022, Freedman reported that providers at Catholic hospitals “found they couldn’t treat miscarriage management in the way they were trained because of the very strict abortion prohibition. If there were any signs of fetal life, they had to stall, they had to wait for infection to set in,” to be able to proceed, she said, illustrating how abortion restrictions have implications for pregnancy loss care. Providers Freedman interviewed discussed how they worked around the abortion care restrictions in Catholic hospitals. These strategies, such as diverting patients to alternate hospitals, were “unlikely to be equitable . . . [and] prone to unfair distribution,” she said. Furthermore, following the Dobbs decision, additional factors have come into play, including criminalization of previously utilized means of expediting pregnancy loss and a lack of facilities providing abortion care where patients can be referred.

The restrictions on abortion in the Catholic health care system have served as examples for states seeking to ban abortion since the Dobbs decision, said Freedman. “Various leaders within Catholic health systems have informed some of the language in the health exemptions of states, saying that direct abortion is not medically necessary,” she explained. Freedman said this language is pervasive in the “dialogue around abortion in the United States and medical exemptions in states” that ban abortion. However, Freedman emphasized that the Catholic health system has “given the impression that medicine can exist without abortion, but it really hasn’t ever done so” because providers at Catholic hospitals have employed workarounds to help patients receive abortion care services.

DISCLAIMER This Proceedings of a Workshop—in Brief was prepared by Jamie Durana as a factual summary of what occurred at the workshop. The statements made are those of the rapporteur or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

COMMITTEE MEMBERS Claire Brindis (Chair), University of California, San Francisco; Andreia Alexander, Indiana University School of Medicine; Elizabeth Ananat, Barnard College, Columbia University, and National Bureau of Economic Research; Wanda Barfield (ex officio Member), Centers for Disease Control and Prevention; Bruce N. Calonge, Colorado School of Public Health; Alison N. Cernich (ex officio Member), Eunice Kennedy Shriver National Institute of Child Health and Human Development; Judy Chang, University of Pittsburgh School of Medicine; Ellen Wright Clayton, Vanderbilt University; Cat Dymond, Atlanta Birth Center; Michelle Bratcher Goodwin, Georgetown University School of Law; Barbara J. Grosz, Harvard University; Vincent Guilamo-Ramos, Johns Hopkins School of Nursing; Lisa Harris, University of Michigan; Justin R. Lappen, Cleveland Clinic and Case Western Reserve University School of Medicine; Monica McLemore, University of Washington School of Nursing and School of Public Health; Rebecca R. Richards-Kortum, Rice University; Sara Rosenbaum, George Washington University; Yvette Roubideaux, Colorado School of Public Health; Alina Salganicoff, KFF; Susan C. Scrimshaw, University of Illinois at Chicago; LeKara Simmons, AMAZE; Melissa Simon, Northwestern University; Lisa Simpson, AcademyHealth; Tracy A. Weitz, American University and Center for American Progress; Katherine L. Wisner, Northwestern University Feinberg School of Medicine.

*The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop—in Brief rests with the institution.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Shilpa Patel, Center for Health Care Strategies, and Jen Moore Conrow, Society for Family Planning. Leslie Sim, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

SPONSOR This workshop was supported by the National Academy of Sciences W.K. Kellogg Foundation Fund.

STAFF Julie Pavlin, Senior Board Director; Ashley Bear, Board Director; Natacha Blain, Senior Board Director; Priyanka Nalamada, Program Officer; Laura DeStefano, Director of Strategic Communications & Engagement; Melissa Laitner, Senior Program Officer, Special Assistant to the President; Adaeze Okoroajuzie, Senior Program Assistant; Kavita Shah Arora, Consultant.

For additional information regarding the workshop, visit http://www.nationalacademies.org/our-work/standing-committee-on-reproductive-health-equity-and-society.

SUGGESTED CITATION National Academies of Sciences, Engineering, and Medicine. 2024. Shaping access to reproductive health care through financing and delivery systems: Proceedings of a workshop—in brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/27937.

Health and Medicine Division Division of Behavioral and Social Sciences and Education National Academy of Medicine Policy and Global Affairs Copyright 2024 by the National Academy of Sciences. All rights reserved.