The Reproductive Health Impact Study (RHIS) is a multiyear comprehensive research initiative analyzing the effects of federal and state policy changes on publicly funded family planning care in the United States. The study, which focuses on Arizona, Iowa, New Jersey and Wisconsin, documents the impact of these policies over the period 2017−2022 on family planning service delivery and on patients who rely on this care. Wisconsin was selected as a focus state in 2019, following confirmation of significant shifts in Title X funding among state grantees. For the Wisconsin study, the Guttmacher Institute is working with the University of Wisconsin-Madison Collaborative for Reproductive Equity (UW Core) and other in-state research and policy partners.
The RHIS was initially conceived in the aftermath of the 2016 election, in anticipation of federal and state efforts to change funding streams and service delivery for publicly funded family planning. As the study progressed, the RHIS team adapted ongoing study activities to document the impact of several events—notably, the 2019 changes to the federal Title X regulations (the Trump administration’s “domestic gag rule”) and the COVID-19 pandemic.
In early 2021, the Biden administration took the first step toward rescinding the domestic gag rule by issuing a presidential memorandum directing the U.S. Department of Health and Human Services (HHS) to review the rule and other restrictive Title X regulations and consider whether to suspend, revise or rescind them. In mid-April 2021, the Biden-Harris administration published a notice that signaled its intention to restore Title X to its pre-Trump regulatory framework with certain updates. The rule then opened for comments for 30 days; the Trump-era regulations remain in effect for now.
Some of the key reproductive outcomes for Wisconsin residents that are being tracked in the study appear below. Documenting changes to these outcomes over the study period helps identify the effects of changes related to publicly funded family planning care in the state.
The policy landscape in Wisconsin
Wisconsin’s governor supports sexual and reproductive health and rights, but the state legislature is largely hostile to these rights. The state has a mix of supportive and hostile policies related to sexual and reproductive health. Supportive policies include Wisconsin’s BadgerCare, which extends Medicaid family planning services to patients with incomes up to 306% of the federal poverty level, and protections for patient confidentiality in health care generally.
Hostile policies include a state law that preceded the Title X domestic gag rule and is essentially Wisconsin’s own version of the policy. Passed in 2015, the law requires the Wisconsin Department of Health Services (DHS) to apply for every Title X funding opportunity, starting in 2018. The law also requires the state to prioritize the distribution of funds to public entities, such as local health departments. Independent agencies are eligible for leftover money, but no funds may go to agencies that provide or are affiliated with organizations, such as Planned Parenthood, that provide abortion services.
When the law was passed in 2015, Planned Parenthood of Wisconsin had long been the state’s sole Title X grantee. In 2018, Wisconsin DHS applied for Title X funds as required under this law and received a portion of the award, as did Planned Parenthood of Wisconsin. In March 2019, the Trump administration shifted all Title X funding away from Planned Parenthood of Wisconsin to Wisconsin DHS. Today, Wisconsin DHS serves as the state’s only Title X grantee.
In March 2019, Wisconsin was among 21 states that filed a lawsuit opposing the Title X domestic gag rule.
Publicly funded family planning in Wisconsin
In 2018, 146 sites provided publicly supported contraceptive services in Wisconsin. Of these, 59 sites received Title X funding and served more than 40,000 contraceptive patients. Ten percent of these patients were served at health department clinics, 65% at Planned Parenthood clinics and 25% at other sites.
In March 2019, 17 clinics in Wisconsin that received Title X funding, including all nine Title X−funded Planned Parenthood clinics and eight other women’s health clinics, were excluded from the program as a result of the state law described above. By 2020, three additional sites had closed or left the network for other reasons.
Exclusion of these 17 clinics from Title X resulted in a decline in the program’s capacity. Between 2018 and 2019, the number of female contraceptive patients served in Wisconsin fell by more than 50%.1,2
COVID-19 and reproductive health in Wisconsin
The COVID-19 pandemic has led to significant interruptions in patients’ ability to access family planning—particularly for those who rely on publicly funded clinics. Guttmacher researchers found that 33% of U.S. women participating in a national study in April–May 2020 had faced delays or had been unable to get contraceptive or other care because of the pandemic. Initial RHIS data on the impact of the COVID-19 pandemic on individuals’ ability to access contraceptive methods and sexual and reproductive care in Wisconsin demonstrate the ongoing challenges of the pandemic at the state level.