Robust public investment in sexual and reproductive health care is essential to ensuring that all people can access contraceptive methods that align with their needs and preferences. At the same time, harmful policy decisions can drastically undermine people’s access to person-centered contraceptive services. Both of these factors are evident in a new Contraceptive Access Maps project that shows widespread contraceptive access gaps across the United States for women* who rely on low‑ or no‑cost care.
New county‑level estimates from Guttmacher and Power to Decide assess the alignment between women’s likely need for low‑ or no‑cost contraceptive care and the availability of publicly funded brick‑and‑mortar clinics offering contraceptive services. These clinics include public health departments, Planned Parenthood health centers, federally qualified health centers (FQHCs), and independent organizations receiving federal, state or local funds, including Title X family planning grants and Medicaid reimbursements.
Counties where need exceeds availability are considered to have contraceptive access gaps. Today, 21.5 million women in the United States need low‑ or no‑cost contraceptive care, and nearly all of them live in counties where available services cannot meet the demand for care. Nearly 75% percent of women in need of this care live in counties that are unable to provide adequate contraception due to an extreme access gap. (An extreme access gap is defined as a county having below 25% alignment between the need for, and availability of, contraceptive care—but does not include counties with no publicly supported clinics.) Beyond such gaps, individuals may face other barriers to care, including lack of culturally competent providers, transportation challenges or concerns about the confidentiality of their health information. At the same time, robust public funding and proactive policies supporting brick-and-mortar contraception providers, including those who offer care via telehealth, could help bring more counties into alignment with patients’ needs and close persistent access gaps.
Lack of Access to Person-Centered Contraceptive Care Persists
Person-centered contraceptive care requires providers to identify and focus on each patient’s values, preferences, needs and desires when offering contraceptive counseling and services. This approach is also an essential component of high-quality sexual and reproductive health care. Achieving person-centered care requires that individuals, regardless of where they live, have access to providers who offer the full range of contraceptive methods. Yet, 84% of US women (18 million) in need of low- or no-cost contraception live in counties with either extreme gaps in access, or no access, to clinics offering the full range of contraceptive methods.
Furthermore, many women in live in places with no access to these services. More than 1 million women in need of low- or no-cost contraception live in a county without a single publicly funded health center offering any contraceptive care. When assessing access to clinics offering the full range of contraceptive methods, the number of women impacted nearly doubles, leaving almost 1.9 million women in counties without a single publicly funded clinic providing these comprehensive services.
Eighty percent of all US counties are considered to have either extreme gaps in access, or no access to any low-or no-cost contraceptive care. When the focus is on clinics providing the full range of contraceptive methods at low or no cost, 89% of counties show either that extreme gap in access, or no access.
Due to administrative burdens and low reimbursement rates, many clinics are unable to provide the full range of contraceptive methods, with potentially adverse effects on patients who cannot access their preferred methods. Without access to the full range of methods, women may use methods that do not meet their preferences, may use contraception intermittently or inconsistently, or may forego contraception entirely, which can increase the possibility of unintended pregnancy.
Geographic and Other Barriers Compound Existing Inequities
Analysis from the new Contraceptive Access Maps show that access gaps are widespread across all regions of the United States. States in the South and the Midwest carry the greatest burden of extreme contraceptive access gaps.
The South is home to the largest number of women (7.7 million) in need of low or no-cost contraception living in counties with extreme access gaps. At the same time, the Midwest has the highest proportion of women in need of this care living in counties with extreme access gaps, with 80% (3.6 million) facing such gaps in access to low- or no-cost contraceptive care. Furthermore, 610,020 Midwest women with a need for low- or no-cost contraception (14%) live in counties with no clinics providing this care, and 996,910 Midwest women (22%) live in counties with no clinics providing the full range of contraceptive methods at low or no cost.
At the same time, individuals living in the South and Midwest face some of the nation’s most severe abortion bans and restrictions, creating widespread barriers to reproductive health care across large sections of the United States. People of color, in particular, who make up a growing share of these regional populations, will continue to face significant challenges in accessing the full range of sexual and reproductive health care.
These data underscore that whether people live in rural communities or metropolitan areas, they all are at risk of losing access to clinics offering any contraceptive care or the full range of methods. Rural communities often have fewer providers, limited clinic hours, higher travel costs and longer distances to reach primary care, all of which pose obstacles to accessing contraceptive services and counseling. Many people in rural areas rely on primary care providers for family planning services, but many of these providers are not trained in IUD or implant placement. Communities in metropolitan areas face different but equally significant barriers: high patient demand, long waits, limited appointment availability, and transportation challenges. While telehealth can be an effective access point for contraceptive care, high-speed broadband internet continues to be unaffordable or inaccessible for many, and language and cultural barriers may impede people’s use of telehealth to access care.
Understanding geographic barriers and the landscape of publicly supported clinics is critical, but it doesn’t provide a complete picture of US contraceptive access. For example, women of color often face unique barriers in accessing contraceptive care, including distrust of the medical system based on past or ongoing bias and medical racism they or their family members have experienced. Several studies have found that provider racial bias impedes contraceptive counseling and patient autonomy, which undermines trust between patients and providers. These dynamics compound broader systemic discrimination, economic insecurity, and longstanding barriers to care, leaving people of color, immigrants, adolescents and those with low incomes bearing the brunt of these contraceptive access gaps.
A Restrictive Policy Landscape Shapes Contraceptive Access Gaps
Federal and state policies have eroded access to publicly funded clinics, severely curtailing the broader sexual and reproductive health care safety net. These policies have shaped where people and communities can and cannot access contraceptive care.
Attacks on Title X amplify the harm of contraceptive access gaps
As the only national program dedicated to providing reproductive health care to people with low incomes, Title X is an integral part of the publicly funded contraception network—including for young people who often face difficulties in accessing high quality care. Anti-abortion policymakers at the federal level have attacked the Title X program through a range of policies that hinder people’s ability to access contraceptive care, and with harms that vary by region and community.
The domestic gag rule imposed in 2019 under the first Trump administration disqualified clinics from participating in Title X if they offered abortion referrals or provided abortion services without federal dollars. Guttmacher research found the gag rule harmed both clinics that left Title X and those that stayed, reducing their ability to provide person‑centered care, and that the policy negatively impacted patients’ experiences seeking and accessing care. Between 2019 and 2020, Title X patient volume dropped from 3.1 million to 1.5 million and some states had no Title X clinics for nearly two years, exacerbating contraceptive access gaps. Although the domestic gag rule was reversed by the Biden administration in 2021, advocates fear similar restrictions under the current Trump administration.
Moreover, the Title X program has faced other administrative and budgetary challenges. The program has been flat level funded for the past decade and, in addition to freezing Title X funds last year for several months, the Trump administration has proposed new rules and guidance that threaten to undermine the program. These include proposals that would push people toward contraceptive methods that may not be their preferred option; erode long-lasting, high-quality, evidence-based standards of care and accountability; and facilitate federal grant-making decisions driven by ideology and politics.
Taken together, these efforts severely jeopardize the ability of Title X health centers to offer evidence-based and patient-centered care to the communities they serve.
Attacks on Medicaid block access to care
Medicaid plays a critical role in ensuring that people with low incomes can access health care, including contraception. Twenty-three percent of women in the United States rely on Medicaid to cover their contraceptive care. In states that have chosen to expand Medicaid eligibility for coverage of family planning and contraception beyond federal requirements, people with Medicaid coverage benefit even more. Research has demonstrated that people with low incomes in need of publicly funded family planning services who live in those states were more likely both to use contraception and to have their contraceptive preferences met than people living in states with more restrictive eligibility requirements.
Unfortunately, the passage and implementation of HR 1 (also known as the “One Big Beautiful Bill Act”), which imposes work requirements and other eligibility restrictions on Medicaid, threatens both funding streams for contraception providers and coverage for people in need of contraceptive care. Between 2.1 and 6 million women of reproductive age may lose Medicaid coverage due to the work requirements set to take effect in January 2027. Women of color and young adults who are disproportionately covered by Medicaid are likely to be most impacted by these cuts.
Already, HR 1 has negatively impacted both family planning providers and the patients that rely on these providers for care. HR 1 blocked Planned Parenthood health centers from being reimbursed by federal Medicaid for one year, causing nearly 30 clinics to close during the time the provision was in effect (July 2025‒June 2026). While spread across the United States, these closures occurred in places where contraceptive care was already hard to access and the gaps between the need for publicly funded care and the availability of services were already acute. As efforts to reimpose this “defunding” of Planned Parenthood continue, Guttmacher research is clear that if such efforts were successful, the gaps between the need for publicly funded contraceptive care and its availability would widen. For example, if all Planned Parenthood health centers were removed from the publicly funded contraceptive care network, 12.4 million women in need of publicly funded contraceptive care would be affected, representing 58% of the total number of US women likely to need this care.
Harmful state policies compound the effects of federal attacks
States have also enacted policies that have compromised and undermined contraception providers and targeted access for specific communities, including those with Medicaid coverage and young people, and which in turn contribute to contraceptive access gaps.
Anti‑abortion policymakers have sought for years to exclude abortion providers from their states’ Title X networks and from receiving Medicaid reimbursements. In 2025, they achieved part of this goal when, in Medina v. Planned Parenthood South Atlantic, the Supreme Court ruled against Medicaid enrollees trying to use the program’s “free choice of provider” provision to challenge state restrictions that prevented them from using their Medicaid coverage at Planned Parenthood health centers. That provision is supposed to allow those enrolled in Medicaid to seek care from any provider that is qualified and willing to participate in the program. Following the Court’s ruling, which upheld a South Carolina executive order, other states followed suit—including Nebraska and Oklahoma, which also issued executive orders blocking Medicaid enrollees from using their coverage at Planned Parenthood health centers. In contrast to these hostile efforts to defund providers and limit access, other states have responded by using state funds to stabilize reproductive health clinics.
Proactive Policies Are Needed to Close Contraceptive Access Gaps
The Contraceptive Access Maps reflect data from the provider landscape between 2020 through 2023, before some of the more recent health care restrictions were put in place. Given that the access landscape is likely worse today, we need proactive policies that invest in and support providers who offer contraceptive services to individuals with low incomes. Such policies should be designed to prevent more contraception providers from closing their doors, to prevent individuals from losing further access to local, person-centered care, and to prevent contraceptive access gaps from expanding. Policymakers must prioritize policies that center individuals’ needs and preferences, especially for individuals and communities who contend with systemic barriers and discrimination in accessing health care. While not exhaustive, the policy recommendations listed below are a starting point to narrow entrenched contraceptive access gaps and to help ensure that all people can obtain person-centered contraceptive services.
- Fully fund and strengthen Title X. For the twelfth consecutive year, Congress provided $286.5 million for the program in 2026, far below what is required to meet the need for publicly funded family planning services. Experts have estimated that Title X requires $1.38 billion annually to adequately meet patient need.
- Ensure Medicaid enrollees can use coverage with their provider of choice. State and federal policymakers must reinforce the principle that individuals enrolled in Medicaid should be able to use their coverage to see any willing and qualified provider they choose, including at Planned Parenthood clinics.
- Increase state funding for family planning services and consider innovative strategies for supporting reproductive health services, including those offered through Medicaid. State policymakers should provide funding that supports the ability of reproductive health providers to serve all patients and provide the full scope of contraceptive methods.
- Ensure sexual and reproductive health care programs provide person-centered care to support reproductive autonomy. As a starting point, providers must have the ability to offer patients complete, evidence-based information about all care options, including all forms of contraception and referrals for abortion care, without restrictions. All health plans and programs should cover all contraceptive methods and abortion care.
Methodology
Estimates of county-level contraceptive access are drawn from the Contraceptive Access Maps and reflect access based on the provider landscape during 2020‒2023. Briefly, estimates of county-level contraceptive access were calculated by dividing the estimated number of patients served by the publicly funded network present in the county by the estimated number of women in the county under age 20 and under 250% of the federal poverty level with a self-defined need for contraceptive services. These preliminary estimates were capped at 1.0, and a distance penalty was applied. The researchers examined varying thresholds of contraceptive access: <100% alignment between availability and need for low- or no cost clinic-based contraceptive care; <25% alignment; and no availability. Gaps were examined nationally and across the four US Census regions, focusing on numbers and percentages of counties falling within these alignment thresholds as well as numbers and percentages of women in need of low- or no-cost contraception living in counties within these thresholds, using data on county-level need for contraceptive services.
Footnotes
*This policy paper uses “women” because the data sources used in our analyses do not systematically provide additional detail on respondents’ sex or gender. Some rely on individuals’ self-identification as female or women. Other surveys base eligibility on respondents’ gender assigned at birth. We recognize that people across the gender spectrum may need or want to use contraception in their lifetimes.