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-Pence administration’s “domestic gag rule”) and the COVID-19 pandemic.

In March 2019, Wisconsin was among 21 states that filed a lawsuit opposing the Title X domestic gag rule. In early 2021, the Biden-Harris 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 to review the rule and other restrictive Title X regulations and consider whether to suspend, revise or rescind them. In November 2021, the Biden-Harris administration’s Title X rule went into effect, restoring the crucial reproductive health care program to its previous state. The Biden-Harris rule revokes the 2019 Trump-Pence rule and updates Title X regulations to focus on inclusion and health equity.

Ohio and 11 other states filed a lawsuit to block the Biden-Harris rule, which remains in effect while the case continues. Wisconsin joined an amicus brief supporting the rule with 19 other states and the District of Columbia. In 2022, a federal court ruled in favor of the administration; the decision has been appealed. If the current rule is blocked, providers who left the Title X program as a result of the Trump-Pence gag rule might do so again.

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.

RHIS studies and resources

Disruptions and Opportunities in Sexual and Reproductive Health Care: How COVID-19 Impacted Service Provision in Three US States

This study describes the shifts family planning providers in Arizona, Iowa and Wisconsin made to continue providing sexual and reproductive health care during the COVID-19 pandemic. Clinics implemented COVID-19 safety protocols, shifted service delivery methods and staffing to meet patient needs, and expanded telehealth services. These innovations could increase access to sexual and reproductive health care for many patients, but standards must be established to ensure that the focus remains on patients’ needs and preferences.

Read the study and news release (November 2022)

The impact of policy changes from the perspective of providers of family planning care in the US: results from a qualitative study

This study—conducted in three RHIS states between May 2020 and May 2021—examines access to contraception and other sexual and reproductive health care among almost 1,500 patients at more than 50 publicly funded clinics in Arizona, Iowa and Wisconsin. It finds that the COVID-19 pandemic has prevented or delayed as many as half of family planning patients from getting birth control or related sexual and reproductive health care—and that those who experienced financial hardship were particularly affected.
Read the study and news release (July 2022)

Financial instability and delays in access to sexual and reproductive health care due to COVID-19

This study—conducted in three RHIS states between May 2020 and May 2021—examines access to contraception and other sexual and reproductive health care among almost 1,500 patients at more than 50 publicly funded clinics in Arizona, Iowa and Wisconsin. It finds that the COVID-19 pandemic has prevented or delayed as many as half of family planning patients from getting birth control or related sexual and reproductive health care—and that those who experienced financial hardship were particularly affected.
Read the study, read the news release and download the social media graphic (February 2022)

The policy landscape in Wisconsin

Wisconsin’s governor, Tony Evers (D), supports sexual and reproductive health care 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-Pence 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.

Abortion is explicitly excluded from sexual and reproductive health care services that are part of the Title X program. Nevertheless, access to abortion is an important component of sexual and reproductive health and well-being, and restrictive abortion laws may affect people’s ability to access contraceptive services, as well as family planning providers’ capacity to provide contraceptive and other sexual and reproductive health care. Clinics in Wisconsin stopped providing abortion care after the US Supreme Court overturned Roe v. Wade in June 2022 because the enforcement status of the state’s pre-Roe ban on abortion is unclear. A legal challenge to this ban is pending in state court. 

In the 2022 midterm elections, Gov. Evers was reelected, and the Republican-led state legislature failed to gain enough seats for a supermajority that would be able to override the governor’s vetoes. Because the governor and state legislative majority have opposing views on Title X, the mixture of supportive and hostile policies on reproductive rights is likely to continue.

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 2020, the number of female contraceptive patients served by the Title X program in Wisconsin, as indicated in the 2020 Family Planning Annual Report, fell by more than 80%.^1,2,3 This decline is attributed to clinics leaving the program because of the domestic gag rule and to the effects of the COVID-19 pandemic. Nationally, 63% of the decrease in Title X patients served during this time is attributed to the rule and 37% to the pandemic.

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 at the beginning of the pandemic in spring 2020, 33% of U.S. women faced delays or were unable to get contraceptive or other care because of the pandemic. This proportion decreased to 19% in a second Guttmacher study conducted in summer 2021. 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—especially for people who have experienced financial instability as a result of COVID-19.