Act on the Evidence: Policy Solutions to Protect and Advance Abortion and Contraception Access in the United States

As the United States contends with the consequences of the Dobbs decision and an emboldened opposition seeking to further dismantle sexual and reproductive rights and access, both providers and people seeking care face unprecedented threats. A growing, global anti-rights and anti-science climate buttressed by the spread of mis- and disinformation, is driving continued attempts to eliminate abortion access. Communities already harmed by unjust systems and policies are experiencing disproportionate impacts.

Rooted in the belief that sound policy starts with high-quality evidence, Guttmacher’s flagship research on abortion and contraception underscores the growing barriers to reproductive health care while pointing to policy solutions that can move us closer to reproductive health care access for all. This analysis draws on findings from leading Guttmacher research projects to identify recent trends in abortion and contraceptive access and offers policy recommendations informed by that evidence. While not exhaustive, these recommendations are intended to support advocates, communities, and policymakers working to advance rights-based, patient-centered approaches to sexual and reproductive health care in the United States. In a moment defined by entrenched inequities, rampant misinformation and political turbulence, the stakes for evidence-based policy have never been higher.

Changes in Abortion Provision Reflect a Complicated Legal Landscape

Due to harmful state and federal policies, access to abortion care continues to be fragmented across the United States. Currently, 12 states have enacted total abortion bans while a host of other harmful bans and restrictions further complicate patients’ ability to get the care they need. The fall of Roe has only deepened inequities in care and has prompted state policymakers supportive of abortion access to attempt to meet the needs of both their residents and those traveling from out of state. Guttmacher’s data on abortion incidence and patient demographics offer clear policy recommendations that can protect and expand access to abortion care.

Guttmacher’s Monthly Abortion Provision Study has produced timely estimates of clinician-provided abortions in states without total abortion bans and documents travel across state lines for abortion care. Our periodic surveys of US abortion providers have helped us understand changes in the provision of abortion care, including the role of brick-and-mortar abortion clinics.

Key findings:

• Medication abortion accounts for the majority of abortions provided in most US states without total abortion bans. Proportions of medication abortion provision were lowest in the District of Columbia (44%) and Ohio (46%), and highest in Wyoming (95%) and Montana (84%). These results expand on Guttmacher’s finding that medication abortions accounted for 63% of all clinician-provided abortions in 2023 in states without total abortion bans.
• In 2024, approximately 154,900 people crossed state lines for an abortion, representing 15% of all abortions provided in states without total bans. This is close to double the number who did so before the end of Roe (81,100 in 2020). Travel to states without total bans remains a critical pathway for people seeking an abortion, particularly for those living in states with total bans or other severe restrictions.
• In 2025, over 518,000 clinician-provided abortions occurred in the first six months of the year in states without total abortion bans: a 5% decrease compared to the same period in 2024. And while travel for care to states without abortion bans remains critical, Guttmacher data show this interstate travel declined by 8% during this same period. This is likely due to multiple factors, including the critical expansion of medication abortion access in states with total abortion bans through telehealth shield law provision. Other critical factors in these shifts likely include the newly enacted six-week abortion bans in Florida and other states, reduced support for abortion funds and community networks, and increased logistical and financial barriers to traveling for care.
• According to our analysis based on regular surveys of abortion providers, between 2020 and March 2024, the number of brick-and-mortar clinics offering abortion care in the United States declined by 5%, a net loss of 42 clinics. In March 2024, there were no clinics providing abortion care in the 14 states with total abortion bans in effect at that time.

Policy recommendations:

• Protect abortion rights at all levels. Nothing short of a reimagined national right to abortion is acceptable, with supporting policies to ensure all people can realize that right in practice. Congress should also enact bills to establish a baseline of abortion rights and states should adopt amendments to their state constitutions to secure abortion rights, like Michigan did via ballot measure.
• Protect the right to travel. Congress should reassert the constitutional right to travel to another state for the purposes of obtaining legal abortion care in that state.
• Strengthen and expand shield law protections. Many states have already enacted some level of shield law protections to minimize legal risk to health care providers, patients, and those who assist them in seeking certain types of legally protected sexual and reproductive health services. This typically includes protections for people traveling from out of state for abortion care and those helping them access these services. Where states have enacted these laws, policymakers should continue to strengthen and expand these protections, extending shield law protection to the telehealth provision of medication abortion to residents of ban states. Importantly, states should plan to revisit and reassess their shield laws as new avenues of attack emerge.
• Enact privacy protections for patients and providers. As states diverge in their legal climates for abortion care and as federal policymakers erode health data protections, both patients and providers have good reason to worry about their privacy and security. To safeguard provider privacy against legal attacks originating in abortion ban states, protective states such as California, New York and Massachusetts allow abortion providers’ names to be removed from prescription labels and replaced with those of their health care facilities. To protect patient privacy, Washington state enacted the My Health, My Data Act, which aims to ensure that consumers’ sensitive health information cannot be collected and shared without their consent. Federal policymakers should follow suit to protect the reproductive health care data collected by technology companies and tracking apps and to shield such data from law enforcement inquiries. States should also consider improving or removing mandated abortion reporting requirements and protecting patient location data.
• Invest in abortion access to meet patient need. Ensuring clinics and providers can meet the needs of patients traveling from abortion ban states requires state investments to support clinic infrastructure, training, and security, as well as practical support. To accommodate an influx of out-of-state patients after the Dobbs decision, New Mexico allocated $10 million to establish a reproductive health care clinic on the state’s border with Texas. Maryland enacted legislation that allows the state to use funds from fees collected under the Affordable Care Act to help pay for expanded abortion services. Federal and state legislation that provides investments in provider training, community support organizations, and wrap-around services such as childcare and travel, would go a long way toward protecting access to abortion care for in-state and out-of-state patients.
• Expand the pool of abortion providers. Protective states are seeing a rise in patients due to the proliferation of abortion bans, which create a need for more providers. State policymakers can address workforce shortages by permitting advance practice clinicians, such as nurse practitioners, physician assistants and other medical professionals to provide abortion care, as Connecticut did in 2022; currently, 24 states allow this practice.
• Strengthen and expand access to medication abortion. As the anti-abortion movement escalates its attacks on this common method of abortion care, policymakers should advance policies and programs that facilitate access to care. Recently, Illinois enacted legislation that requires public colleges to offer contraception and medication abortion to students, joining a handful of other states. Moreover, policymakers should repeal medically unnecessary state laws such as forced waiting periods, biased counseling, ultrasound requirements, and in-person dispensing requirements for medication abortion.

Cost is a Major Barrier for People Seeking Abortion Care

Guttmacher’s 2021–2022 Abortion Patient Survey demonstrates the importance of policies that reduce financial barriers to abortion care. The Hyde amendment bans public insurance programs like Medicaid from covering abortion care with federal funds, except in the instances of rape, incest and life endangerment. This policy disproportionately harms women of color and people with low incomes who are seeking abortion care, exacerbating inequities in access. Over the years, federal policymakers have imposed Hyde-like restrictions on other federal sources of coverage. More than half of states also enforce their own bans on state-funded public insurance coverage for abortion. Research demonstrates that discriminatory bans on abortion coverage impose financial barriers on seeking care and that other forms of financial assistance, often provided by abortion funds, are then needed to cover out-of-pocket expenses and indirect costs, such as travel. Unfortunately, escalating needs and a volatile fundraising landscape increasingly limit abortion funds’ ability to provide all the support that is required, making it an unsustainable model that cannot stand in for long-term policy solutions.

Key findings:

• 71% of patients who received care in states where Medicaid can be used to cover the costs of abortion paid $0 out of pocket for their pills or procedure in comparison with only 10% of all patients in states where Medicaid is prohibited from covering abortion.
• In states where Medicaid does not provide coverage beyond Hyde exceptions, two-thirds of respondents had to raise money for abortion care, for example, often delaying bills or expenses.
• In the same study, 31–33% of respondents indicated that they had to pay for travel, regardless of whether their states’ Medicaid funds covered or did not cover abortion care.

Policy recommendations:

• Pass the EACH Act to end the Hyde amendment. Congress should pass the EACH Act to ensure that all people who receive public health insurance or health care from federal government programs, such as TRICARE and the Veterans Administration, are guaranteed coverage for the full range of reproductive health services, including abortion care. The bill would also prohibit federal interference in private insurance coverage of abortion, including in the ACA Marketplace.
• Expand insurance coverage of abortion care. State policymakers should mandate coverage of abortion care in all health insurance plans, including public insurance, without cost-sharing. Many states only mandate Medicaid coverage of abortion care per the limitations imposed by the Hyde amendment. State policymakers have also enacted Hyde-like restrictions on private insurance plans and plans offered through state marketplaces. By contrast, states like Colorado, Illinois, and Delaware have taken recent steps to require that private insurers cover abortion and other SRH care.
• Create sustainable Medicaid reimbursement rates for providers. Patients can benefit from public insurance coverage for abortion only if providers are able to sustain care within the Medicaid system. State policymakers should work with providers, particularly independent providers, and advocates to establish reimbursement rates that support quality care. Reimbursement rates differ significantly by state and often do not reflect increasing costs or complexity of care, leading to inequities in access. Protective states like New Mexico, Illinois, and Maryland have significantly increased their reimbursement rates to support clinics serving both residents and those traveling from restrictive states.

Young People Face Unique Challenges in Accessing Abortion

Guttmacher’s 2021–2022 Abortion Patient Survey also documented the unique needs and obstacles young people face in accessing abortion care. Prior to Dobbs, policies such as parental involvement laws hindered access or placed abortion care out of reach for many young people. Now, anti-abortion policymakers have intensified their attacks on young people’s access to abortion services while drawing new lines of attack on the friends, families, and community support networks that help them obtain care.

Key findings:

• The majority of adolescent respondents identified as non-white (70%), and 23% identified as something other than heterosexual.
• 70% of adolescent respondents wanted to have their abortion sooner than they were able to get care. Multiple reasons accounted for these delays in care: 57% reported that they did not know they were pregnant; 19% reporting not knowing where to receive an abortion; and 16% reporting having to make travel arrangements.
• 54% of adolescents reported paying out of pocket for their abortion, at an average cost of $499, and reported that they had to delay bill payments or sell something to cover the cost of an abortion.
• Among adolescents 17 and younger, the majority (53%) lived in a state with a parental involvement law. When asked about the states where they received an abortion, 43% reported obtaining an abortion in a state with a parental involvement law. These data points indicate that some minors travelled out of state for care.

Policy recommendations:

• Support young peoples’ bodily autonomy and reproductive decision-making. It is imperative that lawmakers advance policies that respect the reproductive choices of young people. Policies that subject young people to mandated parental involvement can jeopardize the health and safety of pregnant young people by delaying access to time-sensitive care or increasing the risk of familial violence. Currently, 38 states require parental involvement in a minor’s decision to have an abortion. Such laws should be repealed and states should take proactive steps to support young people’s reproductive autonomy. In 2021, Illinois passed the Youth Health and Safety Act to ensure young people can make reproductive health care decisions free from government interference.
• Champion access to comprehensive sexual and reproductive health education. Data show a majority of young people who wanted to receive their abortion earlier did not know they were pregnant, pointing to the need for comprehensive sexuality education and access to information. Policymakers should advance policies that ensure sex education is medically accurate, LGBTQ+ inclusive, and culturally and age appropriate. While content requirements vary, 29 states and the District of Columbia require sex education to be taught in schools. Illinois recently enacted legislation to improve health education in public schools; federally, Congress should enact the Real Education and Access for Healthy Youth Act.
• Protect young people seeking care across state lines, and those supporting them. Policymakers should affirm every young person’s right to abortion care, as well as the rights of the people and community support networks that assist them in accessing care, and including their rights to share information and travel across state lines and localities. In 2023, Idaho passed the nation’s first abortion support ban, and in 2025, six other states introduced eight bills following this model. These bills target people who help minors travel to access legal abortion care without parental knowledge or consent, and must be defeated.

Restrictions on Publicly Funded Reproductive Health Care Limit Access to Contraception

Nearly all women of reproductive age use some method of contraception at some point in their lives. Guttmacher has spent decades tracking contraceptive use trends, conducting a Family Planning Clinic Census and studying the impact of public funds on access to contraception. Funding for public programs like Title X and policies that support insurance coverage help address cost barriers and allow more people to access birth control. And yet anti-abortion lawmakers continually underfund and threaten Title X while also enacting policies that will cause people to lose insurance coverage. Our Reproductive Health Impact Study has made clear that these types of restrictive policies on any one aspect of sexual and reproductive health care can have ripple effects and cause harmful impacts on people seeking care, as well as on providers and care delivery systems.

Key findings:

• In 2020, 18.8 million women of reproductive age were considered to have a likely need for publicly supported contraceptive services because they either had an income below 250% of the federal poverty level or were younger than 20 years old. In 2020, 7.2 million women received publicly supported family planning services.
• Title X served 2.8 million people in 2023, providing contraception, pregnancy testing and options counseling, and STI testing, among other essential health services. When the restrictive 2019 Title X Final Rule, or domestic gag rule, was in place, there was a dramatic decrease in the number of Title X clinics and patients served: there were 981 fewer clinics in the network in 2020 compared to 2018 and there was a 61% drop in the number of people served by Title X between those same years.
• Cost is a significant barrier to patients’ ability to access contraception and other reproductive health care—people often forego or postpone that care when experiencing cost barriers.
• Nearly one in four (23%) women rely on Medicaid to pay for contraceptive care, including over half (52%) of those with incomes below the poverty level.
• Policies that threaten to close clinics, such as the federal denial of Planned Parenthood Medicaid reimbursement, reduce access to care because other providers frequently do not have the capacity to serve a higher volume of patients. For example, if Planned Parenthood clinics shut down, federally qualified health centers (FQHCs) would have to increase their capacity to serve contraceptive patients by 56%, or an additional one million contraceptive clients annually.

Policy recommendations:

• Fully fund and strengthen Title X. For the past decade, the Title X program has received flat funding at $286.5 million annually; this has not kept up with inflation or come close to meeting the need for family planning services. Congress must provide robust funding for the program every year in annual appropriations, free from political interventions aimed at undermining sexual and reproductive health and rights. As a second line of defense, state policymakers should support state-funded access to sexual and reproductive health care services, including the full scope of contraceptive methods.  
• Require health insurance plans to cover contraception. Federal and state policies must require that all health insurance plans and programs cover the full range of contraceptive options, including over-the-counter (OTC) choices, without limitations. For example, Maine passed a law in 2025 that requires health plans to cover OTC contraception, and Illinois passed a law that includes requiring Medicaid to cover emergency contraception. Policymakers should enforce the contraceptive coverage requirement established in the Affordable Care Act (ACA) and ensure that all health plans and programs match the ACA’s guarantee of access to all methods without cost sharing.
• Ensure that all Medicaid enrollees can use their coverage at their provider of choice. Policymakers must resist all efforts to curtail Medicaid recipients’ ability to use their coverage at the reproductive health care provider of their choice, including Planned Parenthood clinics. They should also reinforce Medicaid policies stipulating that recipients can see their provider of choice and, where restrictions exist, states should provide funding that support clinics’ ability to serve all patients, as lawmakers did in Colorado.
• Protect the right to contraception. Policymakers at both the federal and state levels should pass “right to contraception” bills. Currently, 14 states and DC have laws or constitutional amendments that protect the right to contraception. Enacting policies that guarantee such rights could protect access to birth control options, independent of political shifts or legal rulings that further limit reproductive rights.

Attacks on Reproductive Health Care Limit Access to Person-Centered Contraceptive Care

Person-centered care integrates patients’ preferences, needs and values into clinical decisions. Applying this concept to contraceptive care prioritizes people’s preferences regarding which contraceptive methods align with their life circumstances and how they prefer to obtain these methods. In addition to making contraception more affordable, programs like Title X and providers like Planned Parenthood emphasize high quality, culturally competent, person-centered care. Yet, again, political attacks on those care systems threaten the quality of reproductive health care services. Given the diversity of contraceptive preferences, person-centered health policies must recognize that meaningful access looks different for different people and contexts, and must ensure patients have multiple options for accessing reproductive health care.

Key findings:

• Many women of reproductive age prefer to be able to choose among multiple sources of contraceptive care, including in-person from a health care provider, via telemedicine, at a pharmacy, or through innovative sources, such as vending machines or bike messengers. Publicly supported clinics are working to meet those needs, with 80% providing at least some services via telehealth.
• Women have varying preferences for the contraceptive method(s) they want to use, and yet a quarter (25.2%) of current and prospective users were not using their preferred method, whether because of side effects, sex-related reasons, logistical and knowledge barriers, safety concerns, or cost.
• Restrictive policies like the 2019 Title X Final Rule, or domestic gag rule, not only limit providers’ ability to offer comprehensive options counseling to pregnant patients, but also reduce their ability to provide patient-centered care. Such policies compromise patients’ access to their preferred method of care and their exercise of reproductive autonomy.

Policy recommendations:

• Ensure sexual and reproductive health care programs provide person-centered care. Policymakers should design new and existing SRH programs to support reproductive autonomy. At a minimum, this means providers must be able to give patients full information about their care options, including all forms of contraception and referrals to abortion care, without restrictions. All health plans and programs, including publicly funded health programs like Medicaid, must not only cover person-centered counseling on comprehensive sexual and reproductive health care, but must also cover all contraceptive methods and abortion care.
• Promote telehealth options for reproductive health care. Policymakers should increase access to high-quality telehealth care, including by ensuring adequate reimbursement rates for telehealth in Medicare and Medicaid. This would help many individuals access contraceptive and other SRH services in a way that meets their needs and circumstances.
• Expand options for obtaining contraception. Lawmakers should: pass policies that would allow patients to access contraceptive care from the provider of their choice, including through the mail or at the pharmacy; increase access to over-the-counter contraceptives; and require insurers to cover an extended supply of up to 12 months of contraception at a time, as 23 states and DC currently do. In 2025, states like Illinois, California and Rhode Island passed laws that expanded access in these ways. Notably, complete and fully funded implementation of such policies is necessary to provide access to these care options.