WRDI Watch

If you've followed WRDI for a while, you know we talk a lot about access.

Earlier this year, I wrote about the difference between having a right on paper and being able to exercise it in practice. Laws matter enormously. But so do courts, funding, providers, geography, and the systems that determine whether someone can actually use the rights they have.

And then this week, a story out of a Michigan high school made me think about access in a different context:

Lakeview High School in St. Clair Shores requires ninth-grade girls who miss swimming because of their periods to provide a note from a parent stating the length of their menstrual cycle before they can make up the missed days. Without the make-up, the missed swimming can impact their grade.

What?

Menstruation is a normal biological function, but it is also personal health information, especially for a teenage girl. Why should she have to disclose details about her period to receive the same opportunity to make up classwork?

If a boy misses gym because he's sick, does the school ask exactly what happened to his body? How high was his fever? How many times did he vomit? Or do we just need to know he had an excused absence?

The story raises important questions about privacy and equal treatment. But it also got me thinking about access in its most basic sense: what additional hurdles does someone have to clear just to participate?

That question runs through several reproductive-health developments we're following right now. They're very different stories. But together, they show four dimensions of access we think are worth watching: legal, physical, publicly funded, and state-protected.

— Julie

1. Legal access: Mifepristone is back in court

The legal and regulatory fight over mifepristone has entered another chapter.

On September 9, a three-judge panel of the Fifth Circuit heard Louisiana's challenge to the FDA rules that allow mifepristone to be prescribed through telehealth and delivered by mail. During oral arguments, judges questioned whether Louisiana had demonstrated the legal standing necessary to bring the case.

But the lawsuit is only part of this story.

The FDA is conducting its own safety review of mifepristone and the rules governing its use. The agency says that once the study is complete, it will determine whether changes to the current requirements are warranted. Another lawsuit challenging mifepristone access has been paused while that review proceeds.

For now, nothing has changed: mifepristone remains FDA-approved, and current federal rules allowing telehealth prescribing and mail delivery remain in place.

But both developments matter because what's at stake isn't simply whether mifepristone remains legal. It's how women can access it.

A nationwide return to an in-person requirement would have an obvious impact in states with abortion bans, where telehealth and mail delivery have become an important route of access. But the effects would extend to states where abortion remains legal. Women who can currently receive care through telehealth may instead have to find an in-person provider, secure an available appointment, travel to it, and potentially arrange time away from work or family responsibilities.

It's a particularly clear example of the distinction we're exploring throughout this issue: a medication can remain legal while becoming considerably harder to obtain.

We've been following the growing legal and regulatory pressure around medication abortion throughout the year.

2. Physical access: A new way to see contraceptive gaps

We've become accustomed to hearing about maternal-care deserts — communities where maternity services are limited or nonexistent.

New data released this month offer another way of looking at reproductive-health geography: contraceptive access gaps.

Power to Decide and the Guttmacher Institute have created new county-level maps comparing women's self-defined need for low- or no-cost contraception with the capacity of publicly funded clinics to provide it.

The findings are striking.

21.4 million women of reproductive age who need low- or no-cost contraception live in a county where the need exceeds available clinic capacity.

Of those women, nearly three-quarters live in counties where available services can meet no more than 25% of the estimated need. More than 1 million women live in counties without a single publicly funded health center offering contraceptive care, while 1.9 million live in counties without a center offering a full range of birth-control methods.

What the maps make clear is that access isn't binary.

A contraceptive method can be legal and covered by insurance. A clinic can technically exist in your county. But that doesn't necessarily mean the clinic has the capacity to see you, offers the method you want, provides sufficient privacy, or is practically reachable.

Related from WRDI:
New maps show where contraceptive access falls short

3. Publicly funded access: Title X priorities are changing

Physical access also depends on who provides the care. That makes what's happening within Title X, the federal family-planning program, particularly important.

Title X still funds contraception. In fact, HHS is preparing to award as much as $257 million for Title X family-planning services for fiscal year 2027, and federal law continues to require participating projects to offer a broad range of family-planning methods and services.

However, the priorities surrounding the program are changing.

This year, HHS created a new $4 million Infertility Training Center to help Title X-funded organizations expand infertility-related services. Federal guidance identifies areas including “body literacy,” fertility-awareness-based methods, infertility testing and treatment, and referrals to specialists.

At the same time, new conditions attached to Title X funding have prompted a lawsuit from 23 states, including disputes over requirements affecting contraception-related services.

None of this means contraception has disappeared from Title X. It hasn't.

But it does signal a changing federal emphasis within the country's reproductive-health safety net — one that is putting greater attention on infertility, fertility awareness and other reproductive-health priorities.

Why does that matter for access?

Because federal priorities don't only determine what programs exist. Over time, they can influence provider training, patient education, which services receive attention, and how publicly funded reproductive healthcare is delivered.

4. State-protected access: Virginia adds another layer

And then there is the state side of the equation.

Virginia's new Right to Contraception Act took effect July 1.

The law establishes a right to obtain and use contraception and protects providers' ability to provide it. It also limits the Commonwealth and local governments from enforcing laws or policies that prohibit or restrict the sale, provision or use of contraceptives — or make it more difficult for someone to help another person obtain them.

Virginia also enacted new insurance protections related to contraceptive coverage this year.

And voters will consider another layer in November: a proposed constitutional amendment addressing reproductive freedom that expressly includes contraception, along with abortion, prenatal care, childbirth, postpartum care, miscarriage management and fertility care.

That gives us a useful counterpoint to the other stories in this newsletter.

States don't only determine whether reproductive care is restricted. They can also determine how extensively access is protected — through statutes, insurance rules, provider protections and state constitutions.

Related from WRDI:
States move to strengthen reproductive rights protections

The Bigger Picture

There isn't one measure of reproductive-health access.

A service can be legal but difficult to obtain. It can be available but not practically reachable. Federal priorities can affect how care is delivered, while states can add protections of their own.

That's why at WRDI, we don't just track whether a right exists. We also look at what it actually takes for women to exercise it.

Coming Up at WRDI

Wisconsin readers!
On October 1, I'll be in Egg Harbor for an in-person conversation about women's rights in Wisconsin and what's at stake in the 2026 midterm elections.

Can't make it to Door County? We're also planning a virtual presentation on October 21 for those who want to join from anywhere.

RSVP for the October 1 event
Register for the October 21 virtual presentation — all registrants will receive a recording afterward, whether or not they attend live.

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