Some 20.2 million U.S. women were in need of publicly funded family planning services in 2014, an increase of 5%, or one million women, since 2010, according to “Contraceptive Needs and Services, 2014 Update,” by Dr. Jennifer Frost et al. Women were considered to be in need if they were sexually active, able to conceive and not trying to become pregnant and were either adults with a family income below 250% of the federal poverty level or were younger than 20 (regardless of income). Reflecting growing income disparities in the United States, the increase in need between 2010 and 2014 was disproportionately concentrated among poor and low-income women.

Implementation of the Affordable Care Act’s main coverage expansions in 2014 led to a significant decrease in the proportion of reproductive-age women who were uninsured. Dr. Frost notes that the number of women in need of publicly funded family planning services who were not covered by public or private insurance decreased by nearly 20% between 2013 and 2014, from 5.6 million to 4.5 million. Despite this positive development, nearly one in four women in need of publicly funded care (23%) remained uninsured in 2014.

“The Affordable Care Act has expanded access to health insurance for many women in need of contraceptive services, and we are seeing those changes reflected in patients’ insurance status,” says Kinsey Hasstedt, senior policy manager at the Guttmacher Institute. “Despite these gains, many women in need of publicly funded services remain uninsured. This makes the fact that funding for the Title X national family planning program has decreased by 10% since 2010, even as need for publicly funded care increased by 5%, simply unacceptable.”

Publicly funded family planning providers served 7.8 million women in 2014, helping prevent nearly two million unintended pregnancies. Of those pregnancies, an estimated 914,000 would have resulted in unplanned births and 678,000 in abortions. Without publicly funded contraceptive services, the U.S. rates of unintended pregnancy, unplanned birth and abortion would have each been 68% higher, and the teen pregnancy rate would have been 73% higher.

The report shows the critical role played by the federal Title X–funded family planning program. In 2014, the services provided at Title X–funded clinics alone helped U.S. women prevent 904,000 unintended pregnancies, 439,000 unplanned births and 326,000 abortions. Without these services, the rates of unintended pregnancy, unplanned birth and abortion would have been 33% higher, and the teen pregnancy rate would have been 30% higher.

“The services provided by Title X–funded clinics and other publicly funded family planning providers are essential to women’s health, and programs that support these providers should be funded accordingly,” says Hasstedt. “Regardless of income level or insurance status, every woman in the United States should have access to high-quality contraceptive care, both as a smart public health policy and as a fundamental right.”