New Maps Expose Gaps in U.S. Birth Control Access

More than 21 million women of reproductive age in the United States who need low- or no-cost contraception live in a county where access to publicly funded services falls short of demand, according to a new analysis released Wednesday by two reproductive policy organizations. The findings, produced by Power to Decide and the Guttmacher Institute and shared exclusively with NPR, offer the most detailed county-by-county picture yet of the geographic disparities in contraceptive access — and suggest the situation may already be worse than the data show.

The analysis found that 21.4 million women in need of subsidized birth control live in a county with a “contraceptive access gap,” meaning the need for publicly funded services exceeds their availability. Of those, nearly 75% — about 15.7 million women — live in a county with an “extreme access gap,” where available services meet 25% or less of the need. More than 1 million women live in a county without a single publicly funded health center offering any contraceptive care at all.

A New Way of Measuring Access

The maps represent a methodological overhaul of Power to Decide’s earlier “contraceptive desert” framework, first created in 2017. Rather than relying on a fixed clinic-to-population threshold, the new approach measures the alignment between the capacity of publicly funded clinics and the number of women who say they need contraception but likely require public funding to afford it.

“Access to contraception shouldn’t depend on your zip code — but for too many, it still does,” Rachel Fey, Power to Decide’s vice president of policy and strategic partnerships, said in the announcement. “Now we can see exactly where the gaps are — and fight harder to close them.”

The researchers drew on more than 7,000 health centers tracked through Power to Decide’s Bedsider Clinic Finder, matched against county-specific caseload data and self-identified need estimates from the Guttmacher Institute, and adjusted for travel distance using federal network-adequacy standards. The need estimates draw on the National Survey of Family Growth, which asks women whether they would want to use contraception if cost were not a barrier.

“Measuring access to affordable contraception is a key public health priority, providing insights into whether or not people are able to exercise their right to sexual and reproductive autonomy,” said Megan Kavanaugh, a principal research scientist at Guttmacher.

Arizona as a Case Study

The analysis highlights Maricopa County, Arizona, as an example of an extreme gap. The county has 29 publicly funded family planning clinics and nearly 300,000 women in need of subsidized birth control, yet researchers estimate that only 8% of the need is being met. Arizona is also notable because every county has at least one publicly funded clinic providing family planning services — yet all of them still demonstrate an access gap.

The findings do not surprise Wendy Redford, chief clinical officer of Wesley Community & Health Center in Phoenix, which provides free contraception through Title X, a federal family planning grant program.

“If you don’t have high resources — namely insurance and even Medicaid — accessing care is incredibly difficult because doors are shut on you,” Redford said. She added that her clinic asks patients at every visit whether they want to become pregnant in the next year and how it can help them avoid it. “If you’ve got three kids and you don’t want four kids because you’re already splitting everything three ways … how can we help you keep your family on a more financially stable path? This can change a woman’s life.”

Data Lag and a Tighter Funding Picture

The maps are based on data from 2020 to 2023, and researchers caution the picture on the ground is likely more severe today. Planned Parenthood clinics have closed over the past year amid Medicaid defunding, and pending provisions of the One Big Beautiful Bill Act, including Medicaid work requirements, are expected to drive further closures.

Title X funding has been flat for more than a decade, sitting at roughly $286 million for years despite inflation, and its appropriation for next year is less than $300 million. Power to Decide is advocating for funding of at least $700 million.

“We need to be funding Title X at $700 million at least to even come close to meeting the need that we know is out there,” Fey said.

Because both the data and methodology changed, the new maps cannot be compared with earlier versions to determine whether access has improved or worsened over time. This year’s analysis will serve as a new baseline. The maps also have limits: they cover only publicly funded, brick-and-mortar clinics and do not account for over-the-counter methods, pharmacy provision, or telehealth.

What to Watch

Power to Decide says it plans to update the maps as new policies take effect, using them to press for more family planning funding. Fey argues the issue is not inherently partisan, noting that Title X has drawn support across Republican administrations dating back to President Nixon.

“This is not actually a partisan issue outside the Beltway,” she said. “Americans use and want contraception.”

Beyond funding, Redford points to education and awareness as persistent barriers. Sex education is not mandated in Arizona schools, she noted, and fear in some communities — including among immigrants — keeps people from seeking care. A general lack of awareness that subsidized birth control is available regardless of insurance compounds the problem.

“One of the really hard parts is like getting the butts in the seats,” she said. “Getting the people to come in, outreaching them — ‘We’re here, we have this.’”