Reproductive Health Impact Study: New Jersey
The Reproductive Health Impact Study (RHIS) is a multiyear comprehensive research initiative analyzing the effects of federal and state policy changes on publicly funded family planning care in the United States. The study, which focuses on Arizona, Iowa, New Jersey and Wisconsin, documents the impact of these policies over the period 2017−2022 on family planning service delivery and on patients who rely on this care. New Jersey was selected as a focus state for the RHIS in 2019 because it has a long-established family planning network and policies that are generally supportive of sexual and reproductive health. For the New Jersey study, the Guttmacher Institute is working with the New Jersey Family Planning League and other in-state research and policy partners.
The RHIS was initially conceived in the aftermath of the 2016 election, in anticipation of federal and state efforts to change funding streams and service delivery for publicly funded family planning. As the study progressed, the RHIS team adapted ongoing study activities to document the impact of several events—notably, the 2019 changes to the federal Title X regulations (the Trump-Pence administration’s “domestic gag rule”) and the COVID-19 pandemic.
In March 2019, New Jersey was among 21 states that filed a lawsuit opposing the domestic gag rule. In early 2021, the Biden-Harris administration took the first step toward rescinding the domestic gag rule by signing a presidential memorandum directing the U.S. Department of Health and Human Services to review the rule and other restrictive Title X regulations and consider whether to suspend, revise or rescind them. In November 2021, the Biden-Harris administration’s Title X rule went into effect, restoring the crucial reproductive health care program to its previous state. The Biden-Harris rule revokes the 2019 Trump-Pence rule and updates regulations to focus on inclusion and health equity.
Ohio and 11 other states filed a lawsuit to block the Biden-Harris rule, which remains in effect while the case continues. New Jersey joined an amicus brief supporting the rule with 19 other states and the District of Columbia. In 2022, a federal court ruled in favor of the administration; the decision has been appealed. If the current rule is blocked, providers who left the Title X program as a result of the Trump-Pence gag rule might do so again. New Jersey is likely to appropriate state funds to cover family planning services if the Biden-Harris rule is blocked, as it did when the Trump-Pence rule was implemented.
Some of the key reproductive outcomes for New Jersey residents that are being tracked in the study appear below. Documenting changes to these outcomes over the study period helps identify the effects of changes related to publicly funded family planning care in the state.
The policy landscape in New Jersey
New Jersey has experienced significant policy shifts affecting sexual and reproductive health over the past 12 years. In 2010, Gov. Chris Christie (R) eliminated a state budget line that had funded family planning services for decades, and he withdrew the state’s waiver application to expand Medicaid coverage of these services. More recently, Gov. Phil Murphy (D) has prioritized family planning and reproductive health care, beginning when he signed his first bill in 2018, which restored state family planning funding. Since then, the state has expanded maternal care, including doula care, under Medicaid.
New Jersey increased family planning funding to $10.4 million for the 2020 fiscal year to account for the rising need and cost of services. New Jersey also expanded coverage of family planning services through a Medicaid state plan amendment. In 2019, the state launched Plan First, New Jersey’s expanded Medicaid family planning benefit program, which provides coverage of family planning services to individuals who have incomes up to 205% of the federal poverty level. The program covers patients of all genders, all FDA-approved contraceptive methods and the human papillomavirus vaccine. The Reproductive Freedom Act, which passed into law in 2022, explicitly ensures the right to reproductive decision making, expands insurance coverage for reproductive health care and prevents medically unnecessary restrictions on abortion care.
In response to the domestic gag rule, New Jersey’s two Planned Parenthood affiliates joined affiliates all over the country in leaving the Title X network in summer 2019. Prior to this exit, nearly 70% of New Jersey patients served through Title X received care at a Planned Parenthood clinic. After leaving the network, these clinics continued to offer comprehensive family planning services using emergency funds.
New Jersey responded to the consequences of the domestic gag rule by providing robust state funding for reproductive and sexual health services. In December 2019, the state legislature approved an additional $9.5 million for entities that lost Title X funding. State funding has also made it possible for all of New Jersey's family planning providers to continue offering comprehensive, unbiased family planning services, including nondirective counseling and referrals.
The New Jersey Family Planning League currently serves as the state’s Title X grantee and oversees the program.
In 2021, Gov. Murphy won a close reelection for a second term and the state legislature remained in Democratic control, so it continues to have a majority of legislators in support of reproductive rights and health. In 2022, the legislature passed a budget for FY2023 that committed $50 million for reproductive health care, including increased funds for family planning services.
Abortion is explicitly excluded from sexual and reproductive health care services that are part of the Title X program. Nevertheless, access to abortion is an important component of sexual and reproductive health and well-being, and restrictive abortion laws may affect people’s ability to access contraceptive services, as well as family planning providers’ capacity to provide contraceptive and other sexual and reproductive health care.
In July 2022, soon after the US Supreme Court overturned Roe v. Wade, New Jersey passed two laws that protect abortion rights. The first law prevents the governor from granting requests for the extradition of people in New Jersey who are charged with receiving or participating in reproductive health services in the state. The second law prevents a patient’s reproductive health medical records from being disclosed in legal proceedings without their consent and prohibits public employees from cooperating with interstate investigations brought against people for receiving or participating in reproductive health services, such as abortions, in New Jersey.
Publicly funded family planning in New Jersey
In 2018, 112 sites provided publicly supported contraceptive services in New Jersey. Of these, 48 sites received Title X funding and served more than 96,000 contraceptive patients. Twenty-two percent of these patients were served at federally qualified health centers, 68% at Planned Parenthood clinics and 8% at other sites. Fewer than 1% were served at either health department or hospital clinics.
In August 2019, 22 Planned Parenthood clinics in New Jersey that received Title X funding left the Title X program because of the domestic gag rule.
Exclusion of these clinics from Title X resulted in a decline in the program’s capacity. Between 2018 and 2020, the number of female contraceptive patients served by the Title X program in New Jersey, as reported in the 2020 Family Planning Annual Report, fell by 73%.1-3 This decline is attributed to clinics leaving the program because of the domestic gag rule and to the effects of the COVID-19 pandemic. Nationally, 63% of the decrease in Title X patients served during this time is attributed to the rule and 37% to the pandemic.
1. Fowler CI et al., Title X Family Planning Annual Report: 2019 National Summary, Washington, DC: Office of Population Affairs, U.S. Department of Health and Human Services (HHS), 2020, https://opa.hhs.gov/sites/default/files/2020-09/title-x-fpar-2019-natio….
2. Fowler CI et al., Title X Family Planning Annual Report: 2018 National Summary, Washington, DC: Office of Population Affairs, HHS, 2019, https://opa.hhs.gov/sites/default/files/2020-07/title-x-fpar-2018-natio….
Figure: Key reproductive health indicators
1. Kost K, Maddow-Zimet I and Kochhar S, Pregnancy Desires and Pregnancies at the State Level: Estimates for 2014, New York: Guttmacher Institute, 2018, https://www.guttmacher.org/report/pregnancy-desires-and-pregnancies-sta….
2. Douglas-Hall A, Li N and Kavanaugh ML, State-Level Estimates of Contraceptive Use in the United States, 2019, New York: Guttmacher Institute, 2020, https://www.guttmacher.org/report/state-level-estimates-contraceptive-u….
3. Reproductive Health Impact Study Abortion Provider Census, 2018.
4. National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. census populations with bridged race categories—vintage 2019 postcensal estimates of the resident population of the United States, 2020, http://www.cdc.gov/nchs/nvss/bridged_race.htm.
Figure: Changes in Title X−funded clinics
1. Reproductive Health Impact Study.
Figure: Change in Title X contraceptive patients
1. Fowler CI et al., Title X Family Planning Annual Report: 2018 National Summary, Washington, DC: Office of Population Affairs, U.S. Department of Health and Human Services (HHS), 2019, https://opa.hhs.gov/sites/default/files/2020-07/title-x-fpar-2018-natio….
2. Fowler CI et al., Title X Family Planning Annual Report: 2019 National Summary, Washington, DC: Office of Population Affairs, HHS, 2020, https://opa.hhs.gov/sites/default/files/2020-09/title-x-fpar-2019-natio….
This study was funded in part through a generous grant from the William and Flora Hewlett Foundation. The views expressed are those of the authors and do not necessarily reflect the positions and policies of the donor.