We are clearly at a critical point regarding the ability of individuals to control their reproduction free from intervention by the state and by third parties, an issue that is highly contested in our society. Among the topics we will discuss are: 1) the variable acceptability of contraception and abortion over the years, 2) eugenics, its association with sterilization and immigration policy, and its long shadow, 3) the evolution of reproductive genetic testing from prenatal diagnosis and risk counseling to preimplantation genetic testing and non-invasive genetic testing to mitochondrial replacement therapy and the prospect of germline gene editing; and 4) the growth of assisted reproductive technology from gamete donation to gestational surrogacy. The federal government has been involved both as a potential payer as well as a regulator of medical interventions. State governments, which traditionally have been primary regulators of health care, have become much more active in controlling access in recent years, and there is every reason to think that this trend will continue. Thus, we will look at what is going on in the “laboratory of the states” and will study the experience in Tennessee in some detail. We will also look at the actions of third parties, such as employers. In all these domains, we will consider disparities in access and burden as they have changed over time. We will also consider the broader influences of debates about the rights and roles of women, particularly those of color, of LGBTQIA+, as well as the influence of conscientious objection.
