A Changed Landscape: Tracking Shrinking Contraceptive Access in the United States

Congress is doing this because they want to restrict contraception and ban abortion. We have proof.” Amy Friedrich-Karnik, Guttmacher’s Director of Federal Policy, revisited comments she made at a Senate press conference in June. At the time, federal lawmakers were weighing drastic cuts to Medicaid—the health insurance program that includes coverage of a robust package of contraceptive services—and many grantees of the Title X family planning program had seen their funding withheld. That proof came from a study Guttmacher began in 2016, tracking the impact of the most sweeping disruptions to US contraceptive access in 50 years, including the 2019 Title X “domestic gag rule,” the COVID-19 pandemic and the Dobbs v. Jackson Women’s Health Organization decision overturning federal abortion rights.  

Guttmacher’s Reproductive Health Impact Study (RHIS) zeroed in on four states: Arizona, Iowa, New Jersey and Wisconsin. It was particularly ambitious in scope, tracking patients’ experiences seeking contraceptive and related care over a seven-year period. That long time horizon allowed researchers to understand the impact of state and federal policy changes during the first Trump administration, which included a drastic reduction in the number of clinics receiving funding for services for low-income people.

Demonstrators gather in front of the US Supreme Court as Medina v. Planned Parenthood South Atlantic is heard in April 2025. (Photo by Tom Williams/Getty Images)

“Patients would say, ‘Last time I was here, it was free. Now here I am six months later, and what’s going on? I can’t even use contraception now because I can’t pay for it,’” said Megan Kavanaugh, a principal research scientist at Guttmacher, who led the study. One provider in Iowa quantified the impact, sharing that after losing Title X funding, their clinic went from offering patients a 100% discount on sexual and reproductive health care to just 40%. Kavanaugh’s team found that financial barriers often discouraged patients from seeking contraceptive care at all.  

Restrictive regulations also prevented providers from speaking to patients about the option to have an abortion. One provider in Wisconsin interviewed in the study said, “It's our job to educate women on all of their options, and when it comes to abortion, I feel like I’m swearing when I say it now. It's become a curse word in Wisconsin. […] We have to be very mindful of what we do so we don’t lose funding.”

One of the key takeaways from the study is that policies aimed at restricting one type of sexual and reproductive health care, such as abortion, end up creating barriers to additional types of care. “It’s a ripple effect. These restrictions will always trickle out to other aspects of people’s sexual and reproductive health because that’s the way we live our lives,” said Kavanaugh. “We can’t silo different pieces of health care.”