The Reproductive Health Impact Study (RHIS) is a multiyear comprehensive research initiative that analyzed the effects of federal and state policy changes on US publicly funded family planning care from 2017 to 2024. The Guttmacher Institute worked with research and policy partners in four states—Arizona, Iowa, New Jersey and Wisconsin—to document the impact of these policies on family planning service delivery and the patients who rely on this care.

The RHIS was 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 several relevant events—notably, the 2019 changes to the federal Title X regulations (the Trump-Pence administration’s “domestic gag rule”), the COVID-19 pandemic and the US Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in 2022 overturning Roe v. Wade.

How Do Policy Changes Affect US Publicly Funded Family Planning Care?

The RHIS demonstrates that restrictions on sexual and reproductive health care and rights undermine people’s reproductive autonomy through negative outcomes at the patient, provider and system levels. Additional and unexpected disruptions to the landscape during the study period, such as the COVID-19 pandemic and the Dobbs decision, exacerbated the harms of restrictive policies.

Primary Takeaway 

• All types of sexual and reproductive health care are inextricably linked, and restrictions on sexual and reproductive health care have broader implications.

Additional Key Takeaways 

• Programs and policies that support person-centered care and focus on sexual and reproductive health equity are key to ensuring reproductive autonomy for all patients.
• Cost is a significant barrier to patients’ ability to access care and achieve reproductive autonomy.
• Person-centered contraceptive care is essential because contraceptive preferences vary.
• Publicly funded family planning programs, including Title X, are critical to making contraceptive services affordable.
• Policy restrictions on sexual and reproductive health care compound existing inequities, particularly for Black people and other people of color, LGBTQ+ individuals and people with low incomes.

The Guttmacher Institute has published numerous research articles, reports and policy analyses using RHIS data. A complete list of RHIS-related publications is available. Overall RHIS findings and their implications for policy are documented in a summary analysis.

Implications

The RHIS findings indicate that policy restrictions on sexual and reproductive health care impede access to care and compound existing inequities in health care access. Federal, state and local policies should promote meaningful access to sexual and reproductive health care, provision of person-centered care and support reproductive autonomy. Policymakers should take the following steps to build sexual and reproductive health equity:

• Fully fund and strengthen the Title X national family planning program
• Ensure that sexual and reproductive health care programs provide person-centered care
• Remove restrictions that silo abortion care
• Require all health insurance plans and programs to provide comprehensive coverage for all contraceptive options
• Ensure that patients have multiple options for accessing reproductive health care

Study Design

• The RHIS used original in-depth quantitative and qualitative research, including longitudinal studies, and a wide range of secondary data sources to create a robust set of scientifically innovative, policy-relevant findings. The project objective was to illuminate the effects of policy change on publicly funded family planning from several different angles:
• Overall landscape: Identify how delivery networks changed in composition and capacity as funding streams and programmatic guidance shifted
• Clinics: Quantify changes to the number and types of safety-net health centers available to women and to the number of women who visited these sites for contraceptive services
• Clinic staff: Describe the perspectives and experiences of clinic staff as they navigated the changing policy landscape while providing high-quality services to patients in their communities
• Patients: Highlight the perspectives and experiences of family planning patients as they navigated barriers to access within a changing family planning service delivery system
• Reproductive health indicators: Monitor shifts in key reproductive health indicators at the state level

State Fact Sheets

Choose a state:

Study States and Partners

RHIS researchers and policy experts worked in close collaboration with stakeholders in each study state.

We are grateful for the expertise shared by the following colleagues:

• Affirm
• Planned Parenthood of Arizona
• Planned Parenthood North Central States
• Family Planning Council of Iowa
• University of Wisconsin-Madison Collaborative for Reproductive Equity (UW CORE)
• New Jersey Family Planning League
• Other key stakeholders in each state

Key Guttmacher Institute Staff

Research:

• Jennifer Frost
• Megan Kavanaugh
• Alicia VandeVusse

Policy:

• Amy Friedrich-Karnik

Communications:

• Emma Stoskopf-Ehrlich

Acknowledgments

The Reproductive Health Impact Study was funded in part through a generous grant from the William and Flora Hewlett Foundation. The views expressed are those of the authors and do not necessarily reflect the positions and policies of the donor.