Most women in the US aren’t accessing family planning services, even as abortion restrictions grow

Most women in the United States haven’t received birth control prescriptions or other family planning services in recent years, a new report suggests, even as abortion restrictions have grown.

Family planning – including birth control, emergency contraception, sterilization and counseling for these services – is an important part of health care, according to the US Centers for Disease Control and Prevention.

These visits are sometimes the only interaction women have with the health care system, and inadequate access can lead to poor health outcomes. Some research also suggests that family planning services help prevent more than 1.5 million unintended pregnancies in the US each year.

But in 2022 and 2023, only about a third of women of reproductive age – 35.7% – had received family planning services in the previous 12 months, according to survey data published in a report by the CDC on Wednesday.

It was during this time, in June 2022, that the US Supreme Court’s Dobbs decision revoked the federal right to an abortion.

Alabama is one of more than a dozen states that have banned nearly all abortions since the Dobbs decision. The new state law meant the West Alabama Women’s Center – now known as WAWC Healthcare – would have to pivot, and Executive Director Robin Marty knew that if her center had to stop providing abortions, she wanted to shift the focus to family planning services.

“When we were doing abortion, we learned that a lot of the patients who were coming in to us were coming in because they had gotten pregnant because they couldn’t access any form of birth control,” Marty said.

“When you’re someone who supports a person’s decision to have bodily autonomy, when you believe that a person should be able to decide when and if they want to have a child, then you support that at every point in their reproductive lives.”

WAWC is one of 76 independent abortion clinics across the country that have had to close or stop providing abortion care since the Dobbs decision in 2022, according to a new report from the Abortion Care Network. Now, 14 states have no clinics providing abortion care.

The vast majority of the patients WAWC serves are uninsured, and it was just as difficult for them to get contraception as it was to get abortions, Marty said.

And the new CDC report shows vast inequities among women who receive family planning services, particularly by race and income.

Nearly 40% of White women had received any family planning services in the year before they were surveyed, compared with about 35% of Black women and 32% of Hispanic women, according to the survey data from 2022 and 2023. About 27% of White women said they had gotten some form of birth control in the previous year, compared with 21% of Black women and 20% of Hispanic women.

The rate of women accessing family planning services increased with family income and with higher levels of education, the report shows.

Changes to survey methods make it difficult to compare how likely women are to use family planning services now to earlier years, according to the CDC. But other recent research has found that women in states with the most restrictive abortion laws have also become less likely to access prescription birth control, and there are some indications that rates of emergency contraception use and sterilization may have increased compared with pre-Dobbs years.

Overall, a birth control prescription or other contraception method was the most commonly accessed family planning service, with about 24% of women ages 15 to 49 reporting that they had received it, according to the new CDC report. Nearly 4% received emergency contraception, and about 3% received counseling for sterilization, along with 1.6% of women who said they had the operation in the previous 12 months.

Efforts to expand access to family planning services continue.

Opill, the first nonprescription daily oral contraceptive approved by the US Food and Drug Administration, became available in the US this spring.

Growing awareness and interest “underscores the need for access to safe and effective daily birth control,” said Schmelter, who is also president of Perrigo’s Consumer Self-Care Americas, which manages the company’s over-the-counter store brand products.

And in October, the Biden administration proposed a new rule that would require private insurance plans to cover over-the-counter contraception without a prescription at no cost.

But there are also threats.

Title X is a federal program that helps provide funding for family planning and other preventative health care services. Regulations issued by the Trump administration in 2019 – aimed at separating abortion and family planning services – slashed the number of clinics eligible to participate and the number of people the program reached.

A recent analysis from KFF suggests that the program still hasn’t recovered since the Biden administration reversed the Trump-era regulations – at least 1.1 million fewer people were served by Title X in 2023 than before the regulations took effect – and the program remains vulnerable to more regulation under a second Trump term.

“We know that we’re still under surveillance in a lot of the same ways as we were when we were an abortion clinic,” Marty said.

But she’s proud of the way her clinic has been able to build trust in the community: It now serves more than a thousand people each month, up from just a couple dozen when it made the change about two years ago. And growth in fundraising donations and grants means the clinic can budget and plan for at least twice as many months as it’s used to.

“We’re just going to try to continue to help people make the healthiest decisions that they can and support them in any way that we can with their reproductive lives,” Marty said.