Evidence You Can Use: Family Planning Funding Restrictions is designed to give advocates, service providers and policymakers the data and resources they need to engage in ongoing policy discussions in their states. It includes information on state laws and policies, a synthesis of the relevant research, information on states in which the issue has been debated in the past three years and links to state-specific data. The toolkit seeks to provide the evidence base for understanding the importance of publicly funded family planning services, the critical role of the safety-net provider network and the consequences of policies that would disqualify some types of providers from receiving public funding.

BACKGROUND

Modern contraception allows women and couples to control whether and when to have children. In doing so, it has had important public health consequences for women and families, and has improved women’s ability to reach their educational, social and economic goals. But in part because affordable contraceptive services are not equally available to all, many women and couples find it difficult to avoid pregnancies they do not want and to time those they do want. Research demonstrates that the family planning services provided by publicly funded family planning programs and providers benefit women, families and society by expanding contraceptive use, helping women to prevent unintended pregnancies, and improving maternal and child health. Health centers are considered part of the national safety-net family planning network if they provide contraceptive care to the general public using various federal, state and local funding streams to offer reduced-cost or free services. To be considered part of this network, sites must serve at least 10 contraceptive clients per year.

Over time, states have imposed a number of abortion-related restrictions on state family planning funds and on other publicly funded programs intended to provide services to low-income individuals. Often these laws prohibit family planning providers that use private funds to offer abortion from being eligible for state family planning dollars and other types of public funding. These restrictions can extend to entities affiliated with abortion providers, and some laws exclude all privately operated reproductive health–focused providers from receiving these funds. Other laws create tiered allocation systems for distributing various state-allocated funds that make it difficult or impossible for privately operated reproductive health–focused providers to receive funding.

Spurred by efforts at the federal level to prohibit Planned Parenthood affiliates from participating in federally funded programs, legislators in some states are attempting to bar providers that offer abortion and those affiliated with a provider that does so from receiving any public funds—including Title X grant funding and Medicaid reimbursements—that pass through the state treasury. Some states have gone so far as ending their joint state-federal Medicaid family planning expansion programs in favor of entirely state-funded “spin-off” programs, which cover many of the same services but exclude providers that offer abortion services.

STATE LAWS AND POLICIES

For a chart of current laws and policies in each state, see State Family Planning Funding Restrictions.

For information on state laws and policies related to other sexual and reproductive health and rights issues, see State Laws and Policies, issue-by-issue fact sheets updated monthly by the Guttmacher Institute’s policy analysts to reflect the most recent legislative, administrative and judicial actions.

RELEVANT DATA AND ANALYSIS

Benefits of Family Planning

Women’s ability to make their own decisions about childbearing benefits individuals, families and society.

Need for Publicly Funded Family Planning

Not all women and couples have the resources necessary to affordably obtain the methods of contraception that work best for them.

For many women, safety-net family planning centers are their entry point into the health care system.

Meeting the Need for Publicly Funded Family Planning

Medicaid, the Title X national family planning program, and state and local funds all help provide affordable contraceptive care to women who need it.

 

Public funding supports a diverse network of health centers in delivering high-quality family planning care to low-income and otherwise underserved individuals. Sites that offer reduced-cost or free contraceptive services and serve at least 10 contraceptive clients per year are known as safety-net family planning centers.

Impact of Publicly Funded Family Planning

The family planning services delivered by safety-net family planning centers confer major public health benefits.

Publicly supported family planning also yields considerable cost savings.

Protections Against Excluding Qualified Providers

Abortion opponents argue that qualified organizations should be excluded from participating in publicly funded programs if these providers use other funds to offer abortions or related services, such as abortion counseling or referral. They rely on an argument—which has been refuted in legal rulings—that doing so frees up resources that could then be used for abortion, and thus any funding to such organizations amounts to indirect government support for abortion.14

Impact of Funding Restrictions on Women’s Access to Care

Disqualifying reproductive health‒focused providers, particularly Planned Parenthood health centers, from receiving public funding would jeopardize many women’s ability to obtain publicly funded contraceptive care.

 

Compared with safety-net centers that provide family planning as part of a broader slate of primary health care services, Planned Parenthood and other centers that focus on reproductive health are more likely than others to facilitate women’s timely access to a wide range of contraceptive methods.21

RECENT STATE ACTION ON THIS ISSUE

States that have addressed this issue over the past three years are listed below.

EState enacted a relevant measure

V: State vetoed measure

A: State adopted measure in at least one chamber or filed application with the federal government

 

States that restrict or bar the allocation of state family planning funds to certain types of family planning or abortion providers

Arkansas (2015)

E

Arizona (2017)

E

Indiana (2016)

A

Iowa (2017)

E

Kentucky (2017)

E

Michigan (2017)

E

Missouri (2017)

E

North Carolina (2015)

E

South Carolina (2017)

E

Texas (2017)

A, E

Wisconsin (2015)

A

 

States attempting to bar abortion providers from receiving Medicaid reimbursement for family planning and other covered services

Alabama (2015)

E

Arizona (2016)

E

Arkansas (2015)

E

Florida (2016)

E

Iowa (2016)

A

Kansas (2016)

E

Kentucky (2016)

A

Louisiana (2015)

E

Mississippi (2016)

E

Oklahoma (2015)

A

Texas (2015, 2017)

E, A

 

States that have established a Medicaid spin-off program for family planning services that excludes abortion providers

Iowa (2017)

E

Missouri (2016)

E

 

States attempting to restrict access to funds beyond those for family planning services

Kansas (2016)

E

Kentucky (2016)

A

Michigan (2016)

A

Ohio (2016)

E

Texas (2015)

E

Utah (2015)

E

Virginia (2016, 2017)

V

Wisconsin (2016)

E

REFERENCES

1. Frost JJ, Frohwirth LF and Zolna MR, Contraceptive Needs and Services, 2014 Update, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/contraceptive-needs-and-services-2014-update.

2. Finer LB and Zolna MR, Declines in unintended pregnancy in the United States, 2008–2011, New England Journal of Medicine, 2016, 374(9):843–852, http://www.nejm.org/doi/full/10.1056/NEJMsa1506575.

3. Sonfield A, Hasstedt K and Gold RB, Moving Forward: Family Planning in the Era of Health Reform, New York: Guttmacher Institute, 2014, https://www.guttmacher.org/report/moving-forward-family-planning-era-health-reform.

4. Sonfield A et al., The Social and Economic Benefits of Women’s Ability to Determine Whether and When to Have Children, New York: Guttmacher Institute, 2013, https://www.guttmacher.org/report/social-and-economic-benefits-womens-ability-determine-whether-and-when-have-children.

5. Frost JJ and Lindberg LD, Reasons for using contraception: perspectives of U.S. women seeking care at specialized family planning clinics, Contraception, 2012, 87(4):465–472, http://www.guttmacher.org/pubs/journals/j.contraception.2012.08.012.pdf.

6. Kavanaugh ML and Anderson RM, Contraception and Beyond: The Health Benefits of Services Provided at Family Planning Centers, New York: Guttmacher Institute, 2013, https://www.guttmacher.org/report/contraception-and-beyond-health-benefits-services-provided-family-planning-centers.

7. Frost JJ, Gold RB and Bucek A, Specialized family planning clinics in the United States: why women choose them and their role in meeting women’s health care needs, Women’s Health Issues, 2012, 22(6):e519–515, https://www.guttmacher.org/article/2012/11/specialized-family-planning-clinics-united-states-why-women-choose-them-and-their.

8. Hasstedt K, Sonfield A and Gold RB, Public Funding for Family Planning and Abortion Services, FY 1980–2015, New York: Guttmacher Institute, 2017, https://www.guttmacher.org/report/public-funding-family-planning-abortion-services-fy-1980-2015.

9. Zolna MR and Frost JJ, Publicly Funded Family Planning Clinics in 2015: Patterns and Trends in Service Delivery Practices and Protocols, New York: Guttmacher Institute, 2016, https://www.guttmacher.org/report/publicly-funded-family-planning-clinic-survey-2015.

10. Hasstedt K, Why we cannot afford to undercut the Title X national family planning program, Guttmacher Policy Review, 2017, 20:20–23, https://www.guttmacher.org/gpr/2017/01/why-we-cannot-afford-undercut-title-x-national-family-planning-program.

11. Frost JJ et al., Publicly Funded Contraceptive Services at U.S. Clinics, 2015, New York: Guttmacher Institute, 2017, https://www.guttmacher.org/report/publicly-funded-contraceptive-services-us-clinics-2015.

12. Sonfield A, Beyond preventing unplanned pregnancy: the broader benefits of publicly funded family planning services, Guttmacher Policy Review, 2014, 17(4):2–6, https://www.guttmacher.org/gpr/2014/12/beyond-preventing-unplanned-pregnancy-broader-benefits-publicly-funded-family-planning.

13. Frost JJ et al., Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program, Milbank Quarterly, 2014, 92(4):667–720, https://www.guttmacher.org/article/2014/10/return-investment-fuller-assessment-benefits-and-cost-savings-us-publicly-funded.

14. Dreweke J, “Fungibility”: the argument at the center of a 40-year campaign to undermine reproductive health and rights, Guttmacher Policy Review, 2016, 19:53–60, https://www.guttmacher.org/gpr/2016/10/fungibility-argument-center-40-year-campaign-undermine-reproductive-health-and-rights.

15. 42 CFR 59.5.

16. Planned Parenthood of Central and Northern Arizona v. State of Arizona, 718 F.2d 938 (9th Cir. 1983).

17. 42 USC 1396a.

18. Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services, Letter to state Medicaid directors re: clarifying “free choice of provider” requirement in conjunction with state authority to take action against Medicaid providers, SMD #16-005, Apr. 19, 2016, https://www.medicaid.gov/federal-policy-guidance/downloads/SMD16005.pdf.

19. Frost JJ and Zolna MR, Response to inquiry concerning the impact on other safety-net family planning providers of “defunding” Planned Parenthood, memo to Senator Patty Murray, Senate Health, Education, Labor and Pensions Committee, New York: Guttmacher Institute, June 15, 2017, https://www.guttmacher.org/article/2017/06/guttmacher-murray-memo-june-2017.

20. Frost JJ and Zolna MR, Response to inquiry concerning the availability of publicly funded contraceptive care to U.S. women, memo to Senator Patty Murray, Senate Health, Education, Labor and Pensions Committee, New York: Guttmacher Institute, May 3, 2017, https://www.guttmacher.org/article/2017/05/guttmacher-murray-memo-2017.

21. Hasstedt K, Understanding Planned Parenthood’s critical role in the nation’s family planning safety net, Guttmacher Policy Review, 2017, 20:12–14a, https://www.guttmacher.org/gpr/2017/01/understanding-planned-parenthoods-critical-role-nations-family-planning-safety-net.