Guttmacher’s latest US-focused research explores critical topics such as the state of publicly funded family planning clinics post-Dobbs, the impact of insurance instability on access to reproductive health care, evolving attitudes towards pregnancy and recent federal recommendations for quality family planning care.

How Does Insurance Instability Impact Immigrants’ Access to Reproductive Health Care?

Published in Health Services Research, this paper seeks to assess how insurance instability impacts US-born individuals compared to foreign-born individuals, how this differs by race and ethnicity and if such instability affects access to sexual and reproductive health (SRH) care.

Key findings: 

• Insurance loss was more common among foreign-born individuals compared to US-born individuals, and this was particularly exacerbated for those from marginalized racial and ethnic backgrounds.
• Foreign-born people of color and foreign-born Hispanic respondents experienced insurance loss more often than their US-born counterparts.  
• Losing insurance was associated with a decrease in the likely use of SRH care and an increase in the likelihood of experiencing barriers to obtaining one’s preferred method of contraception.  

“Immigrants, specifically immigrants of color, face heightened challenges when seeking sexual and reproductive health care, such as knowledge and language barriers, systemic racism and xenophobia,” says Hannah Olson, Guttmacher senior research scientist and lead author. “In light of these increased barriers, ongoing threats to reproductive rights and continued hostility and violence towards immigrants, policymakers must continue to advocate for legislation that protects and advances sexual and reproductive rights for everyone, regardless of their immigration status.”

How Are Publicly Funded SRH Clinics Adapting After Dobbs?

Published in Sexual and Reproductive Health Matters, this qualitative study sought to better understand how Dobbs and shifting abortion policies have impacted publicly funded  SRH clinics across the United States.

Key findings: 

• Abortion restrictions and bans have caused upheaval in how publicly funded SRH clinics are functioning, regardless of the state’s abortion laws.
• Clinics in less restrictive states are making changes to clinic procedures to accommodate increased demand for abortion care.
• Clinics in more restrictive states are facing challenges providing abortion and related care.

How Do Different Measures of Pregnancy Attitudes Vary by Demographics and Across Time?

In a new study published in Contraception, Guttmacher researchers explored how attitudes about pregnancy varied across sociodemographic characteristics and whether overall attitudes are changing over time. Drawing on Survey of Women (SoW) data from Arizona, New Jersey and Wisconsin, the researchers examined pregnancy attitudes using three different outcome measures: How important is it to avoid becoming pregnant now, how does one feel about having a child sometime now or in the future and the Desire to Avoid Pregnancy (DAP) Scale.

Key findings:

• All three measures captured attitudes that were more open to pregnancy and childbearing among non-Hispanic Black and Hispanic respondents, compared to White respondents.  
• Those who had not given birth and those who had a high school education or less had lower odds of wanting to avoid pregnancy and lower DAP scores compared to those who had given birth or had college degrees or higher.
• The three measures were relatively consistent within age and race/ethnicity categories; however, DAP scores were the only measure that picked up differences across income categories. This suggests that the DAP scale may be more sensitive to detecting differences in attitudes within some sociodemographic subgroups.
• From 2019–2020 to 2022–2023, women across all three states reported an increased desire to avoid pregnancy or childbearing. Many factors may have impacted people’s attitudes during this time, such as the COVID-19 pandemic, inflation and the Dobbs decision.

Do SRH Patients’ Preferences Align With Federal Guidance on Quality Family Planning Care?

In 2024, the US Office of Population Affairs (OPA) updated its federal recommendations for quality family planning (QFP) services, outlining six guiding principles for the delivery of care: person-centered, evidence-based, inclusive, accessible, sex- and body-positive and trauma-informed. The recommendations also include three approaches to care to support these principles: quality counseling, informed consent and privacy, and confidentiality. A new Guttmacher qualitative study, published in BMC Women’s Health, examines how patients’ SRH preferences and experiences align with these updated principles.

Key findings:

• Participants’ preferences and experiences largely support the updated QFP principles, especially person-centeredness, inclusivity, accessibility, sex-positivity and confidentiality.  
• Evidence-based and trauma-informed care, quality counseling and informed consent were not explicitly mentioned, likely because they were not assessable by participants.  

“Our research offers compelling evidence that the new QFP principles—particularly person-centered care and accessibility—are essential components of high-quality reproductive health care,” says Alicia VandeVusse, Guttmacher senior research scientist and lead author. “Family planning clinics across the United States should adopt these guidelines to ensure that their patients receive the highest-quality care and are empowered to make their own decisions about their bodies and their futures.”