New Iowa Study Adds to Body of Evidence that Trump “Domestic Gag Rule” Negatively Impacted Access to Contraception

Policy Shift Undermined Title X Program’s Mission to Provide High-Quality Family Planning Services for Low-Income Individuals

The Trump administration’s “domestic gag rule” (officially known as the 2019 Title X Final Rule), imposed in 2019, negatively impacted publicly funded family planning patients’ access to sexual and reproductive health care, including contraceptive use, according to a new Guttmacher analysis.  

“Measuring the impact of the 2019 Title X Final Rule on patients’ sexual and reproductive health care access and behavior in Iowa using a difference-in-difference approach,” by Megan Kavanaugh, Ellie Leong and Madeleine Haas, was recently published in Sexuality Research and Social Policy. This analysis is part of the Institute’s larger Reproductive Health Impact Study, a research initiative that analyzes the effects of federal and state policy changes on publicly funded family planning care in Arizona, Iowa, New Jersey and Wisconsin.  

For more than 50 years, Title X has served as the nation’s family planning program, supporting a network of grantees providing high-quality sexual and reproductive health care to millions of people, with a mandate to serve primarily low-income and adolescent patients. The domestic gag rule, issued by the Trump administration in March 2019 and fully implemented in August 2019, prohibited the distribution of these funds to health care centers that provided any abortion-related care or referrals, among other restrictions. As a result, some large health care providers opted to leave the Title X family planning program to continue providing the full range of reproductive health care.  

The study drew on data from 621 patients who sought publicly funded family planning care in Iowa between May 2018 and February 2019 and were contacted with follow-up surveys for two years. Patients who sought care at sites that left the Title X system following the domestic gag rule were less likely to have received recent contraceptive care than those who received care at sites that remained in the Title X system or were never in it.  

In a supplemental analysis aimed at disentangling effects of the gag rule from effects of the COVID-19 pandemic, the researchers also found evidence that the gag rule had negative impacts on patients’ contraceptive use, in terms of whether they used a provider-involved method, use of method that carries cost and in their satisfaction with the method used.  

“We found evidence that the Trump Title X gag rule disrupted patients’ access to health care and contraceptive use,” says Megan Kavanaugh, principal research scientist at the Guttmacher Institute. “These findings contribute to a robust body of evidence that policies that restrict access to sexual and reproductive health care—including contraception and abortion—directly harm people’s reproductive freedom and autonomy.” 

The gag rule had a severe impact. In 2020, an estimated 1.5 million fewer patients were served through the Title X program than in 2018. The Biden administration reversed the domestic gag rule in 2021. However, current Title X program funding is insufficient to meet patients’ needs and restore the level of services provided before the domestic gag rule went into effect. 

“The Trump administration’s domestic gag rule undermined the Title X program’s ability to fulfill its mission of ensuring access to a broad range of family planning services for low-income individuals,” says Kavanaugh. “As politically motivated attacks on reproductive rights continue, policymakers, advocates and public health professionals must work to mitigate the ongoing harmful effects of restrictive policies on patients and providers.” 

“All Iowans, regardless of income or geography, deserve access to quality and affordable reproductive health care,” says Allison Smith, executive director of Family Planning Council of Iowa. “But these data confirm what we see firsthand: Cuts to Title X funding make it increasingly difficult for Iowans to access critical family planning services.” 


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 significantly enhance the body of evidence regarding the impacts of the COVID-19 pandemic on sexual and reproductive health service provision. 

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