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Access to Contraceptives & Restrictive State Policies

By: Kalani Phillips, MPH, CPH

After the overturning of Roe v. Wade (1973) in June 2022, the right to abortion is no longer protected under the U.S. Constitution. As a result, states now have the flexibility to allow, limit, or ban access to abortion care. Currently, more than half of states have already banned or are limiting access to abortion.

Though the U.S. Constitution protects the right to buy and use contraceptives including condoms, birth control pills, and other contraceptive products, studies have found that restrictive state policies have disrupted individual access to sexual and reproductive health care. This has affected individuals’ ability to afford and use their preferred contraceptive method(s), furthering the decline in access to reproductive care. Considering that contraceptive access is covered by the U.S. Constitution, more should be done to protect, increase, and ensure equitable access to preferred contraceptive methods.

In Iowa, restrictive state policies have undoubtedly led to decreased access to reproductive healthcare. For example, after Iowa opted to leave the federal Medicaid family planning program in 2017 and began running a state-run program, they excluded clinics associated with abortion care from funding. Researchers from the Guttmacher Institute conducted a 2 year study and found that patients who sought care at sites that were potentially impacted by Iowa’s decision to leave the federal Medicaid program reported higher rates of shifting to a different site, receiving little to no care at all, switching to using a free contraceptive method, or switching to using no contraceptive method, as compared to patients who sought care at sites not impacted by the policy changes.

In addition, patients who stated they had not recently received contraceptive care increased from 32% to 62%, nearly doubling. Patients not using any contraceptives also increased from 9% to 15%. And the use of contraceptives requiring a provider, such as birth control pills or IUDs for insertion, decreased along with patient satisfaction with their current contraceptive method(s) throughout the study period. Patients also reported experiencing many barriers to access, including cost and quality-related barriers. Furthermore, the researchers state that participants in the study reported these restrictive policies caused reduced hours and lower provider ability at clinics, in addition to decreased subsidies to help offset the costs of care and methods. This caused patients to delay or not get care at all, which can result in unintended pregnancies.

While this research predates the Dobbs v. Jackson Women’s Health Organization (2022) decision, it highlights how anti-abortion policies can lead to disruptions in access to necessary reproductive care, even contraceptives. The fight for abortion access is not over. New policies to protect and expand access to abortion are being created. For instance, states with existing rights to abortion have already expanded access through the creation of additional laws or policies. These states include California, Oregon, Washington, Minnesota, Illinois, New York, Vermont, New Jersey, Connecticut, and Hawaii.

Moreover, changes to state constitutions to make access to contraceptives and abortion legal are ongoing. In California, residents will be able to add abortion rights to the state constitution during the midterm elections this November with California Proposition 1. Currently, the California Constitution guarantees everyone the fundamental right to privacy in their personal reproductive decisions, including the fundamental right to choose whether or not to have an abortion, and the fundamental right to choose whether or not to use contraceptives. The new proposition, however, would simply amend the existing state constitution to specifically include these fundamental rights (access to abortion and access to contraceptives), and prohibit the state from denying or interfering with an individual’s reproductive freedom in their most intimate decisions.

Although the fight for abortion access is an ongoing uphill battle, it seems individual states are doing what they can in order to ensure access to reproductive care. As some states will continue to enforce restrictive policies and limit or ban access to abortions, it seems other states like California will continue to expand their reproductive healthcare options and protections statewide.


  1. Reproductive Health Impact Study. (n.d.). [Institute]. GUTTMACHER INSTITUTE.

  2. Archie, A. (2022, June 28). Californians can vote to add abortion to the state’s constitutional rights [News]. NPR.

  3. Proposition 1. (2022). Legislative Analyst’s Office (LAO).

  4. Jones, K. (2022, July 25). Expanding Access and Protections in States Where Abortion Is Legal. CAP.

  5. After Roe Fell: Abortion Laws by State. (n.d.). Center for Reproductive Rights.

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