Access to affordable birth control is being chipped away through a series of incremental policy changes, legal rulings and funding restrictions that are quietly but effectively dismantling the reproductive health care safety net.
While seemingly piecemeal, these actions are part of a coordinated conservative attack on contraceptive access specifically and bodily autonomy more broadly, led by the same anti-abortion forces that helped overturn Roe v. Wade.
Access to contraception has long been a target of conservative lawmakers, but the Trump administration is especially hostile to all forms of sexual and reproductive health care. Look no further than the State Department’s plan to literally burn $9.7 million worth of contraception meant for women in low-income and middle-income countries to realize the war is well underway.
The most recent blow came with the passage of the Republicans’ budget reconciliation bill, which is projected to strip Medicaid coverage from millions of Americans and “defund” Planned Parenthood. Medicaid and Planned Parenthood enable millions to get birth control. For decades, the Guttmacher Institute — where we serve as director of federal policy and principal research scientist — has tracked the effect of public funding on access to contraceptive services, and the critical role that Planned Parenthood plays in helping to deliver that care.
Our research refutes the claim made by conservative lawmakers that federally qualified health centers and hospitals could easily replace Planned Parenthood’s role. These organizations would have to increase their capacity by 56 percent and 28 percent respectively, which would take significant time and investment.
In addition, evidence highlights the higher quality and more specialized contraceptive care provided at Planned Parenthoods as compared to these more generalized sites. The idea that other providers — critically important as they are — can simply “pick up the slack” both in terms of patient load and quality contraceptive care is a dangerous myth perpetrated by policymakers whose top priority is assaulting Planned Parenthood.
The Trump administration’s attack on the Title X family planning program is another front in the war on contraception. By withholding funding from providers that offer or refer for abortions — even though those services are funded separately — they have forced many clinics to close or scale back services. The National Family Planning and Reproductive Health Association has documented how these changes have disrupted care for millions, disproportionately affecting people of color, young people and those living in poverty.
And it’s not just Congress and the Trump administration attacking access. In June, the Supreme Court delivered a blow in Medina v. Planned Parenthood South Atlantic, effectively blocking Medicaid recipients in South Carolina from seeking care at Planned Parenthood and setting a dangerous precedent for other states to follow. Both that ruling and the defund provision passed by Congress mean that many Planned Parenthood clinics would no longer get reimbursed for the care they provide to Medicaid patients, which could force many to close entirely. This could leave Americans who relied on their services without access to care, even those who may be fortunate enough to maintain their Medicaid coverage after all the cuts have taken effect.
Conservative lawmakers in some states are quietly working to further restrict access to contraception — for example, by reclassifying as abortion widely used methods of birth control such as emergency contraception. This allows anti-abortion legislators to claim they are not banning birth control — even as they lay the groundwork to do exactly that.
Abortion and contraception are both critical components of bodily autonomy — which is why both are the target of constant attacks.
These attacks form a coordinated assault on access to reproductive health care. When people lose insurance, they lose the ability to pay for contraception and their relationship with a trusted health care provider who can support them in accessing the best birth control method for them. When clinics lose Title X funding, they may shut down entirely, leaving communities without access to birth control, testing for sexually transmitted infections or cancer screenings. And when providers such as Planned Parenthood are excluded from Medicaid, patients lose trusted sources of care.
It is abundantly clear that an attack on one aspect of sexual and reproductive health care is an attack on all forms of sexual and reproductive health care. We cannot afford to ignore these attacks simply because they are happening quietly or piecemeal. The cumulative effect is a reproductive health care crisis in slow motion — one that demands urgent attention and action.
Policymakers, advocates and the public must recognize what’s at stake and fight to protect and expand access to affordable birth control for everyone, regardless of income, identity or ZIP code.
Amy Friedrich-Karnik is director of federal policy at the Guttmacher Institute, where Dr. Megan Kavanaugh is a principal research scientist.