Trump Administration Restrictions on Public Funding for Sexual and Reproductive Health Care Disrupted Contraceptive Access in Four US States

New study captures changes in care between 2018 and 2021

Read the full study here. 

New research published by the Guttmacher Institute found that family planning providers in the United States experienced changes, disruptions and challenges as a result of the Title X “domestic gag rule” and the COVID-19 pandemic, according to a new Guttmacher Institute study. The domestic gag rule refers to restrictions imposed by the Trump administration in 2019 on the Title X national family planning program. These restrictions, such as prohibiting referrals for abortion care, were rescinded by the Biden administration in 2021 but had lasting impacts. 

This analysis, part of Guttmacher’s larger Reproductive Health Impact Study, reports findings from two waves of surveys conducted with family planning clinic staff at 96 health care facilities in Arizona, Iowa, New Jersey and Wisconsin to capture changes in care between 2018 and 2021.  

“Clinics that both stayed in and left the Title X program were affected by the domestic gag rule,” says Alicia VandeVusse, senior research scientist at the Guttmacher Institute. “Ideologically motivated policies like the domestic gag rule restrict people’s bodily autonomy and interfere with providers’ ability to offer person-centered care.”  

The main changes family planning clinics reported were: 

  • Leaving the Title X program: Many of the publicly funded clinics in the four states studied in the sample (43%) left the Title X family planning program in 2018 because of the domestic gag rule. Clinics across the country left the program as well. From 2015–2018, Title X provided funds to almost 4,000 sites across the United States that served about 4 million patients annually. In 2020, following the implementation of the domestic gag rule, these numbers fell to 3,000 sites serving only 1.5 million patients.  

  • Decreases in patients seeking contraceptive care: The number of contraceptive patients served in publicly funded clinics in these four states declined between 2018 and 2021, from 95 to 57 patients per week among sites that left the Title X program. Clinics that stayed in the program also experienced a drop from 54 to 28 patients per week. 

  • Decreases in clinics providing comprehensive contraceptive and pregnancy counseling: The overall share of clinics that provided comprehensive contraceptive and pregnancy options counseling fell between 2018 and 2021, likely a result of the Trump administration’s gag rule. The share of clinics providing comprehensive contraceptive counseling fell from 98% in 2018 to 88% in 2021 and declined from 93% to 84% for pregnancy options counseling in that same time period. 

Family planning clinics also experienced numerous challenges as a result of both the domestic gag rule and the Covid-19 pandemic. In 2018, clinic staff mostly cited funding and billing issues, staffing concerns and patient volume as the primary challenges. In 20221, after the onset of the pandemic, staffing issues such as retention and morale were the primary difficulties reported. 

“From the domestic gag rule to the COVID-19 pandemic and the ongoing attacks on reproductive health and rights, family planning clinic staff have had to weather crisis upon crisis,” says VandeVusse. “Clinic staff and patients deserve so much better. Policymakers need to step up to ensure clinic staff have the support and funding they need to operate, as well as expand and protect everyone’s ability to access the full spectrum of reproductive health care.” 

Read the full study here. 


About the Reproductive Health Impact Study 

The Reproductive Health Impact Study analyzes the effects of federal and state policy changes on publicly funded family planning care in the United States. The study focuses on Arizona, Iowa, New Jersey and Wisconsin, and the Guttmacher Institute works with research, policy, grantee and provider partners in each state to document the impact of policies implemented from 2017 to 2022 on family planning service delivery and the patients who rely on this care. 

Emerging findings from this study are building a robust evidence base that demonstrates the disruptions to care stemming from ideologically motivated policy attacks on reproductive health services and the detrimental impacts of these attacks on patients and providers. The study findings also enhance the body of evidence regarding the impacts of the COVID-19 pandemic on sexual and reproductive health service provision.