Act on the Evidence: Policy Solutions to Protect and Advance Abortion and Contraception Access in the United States – Guttmacher Institute

Report on U.S. Sexual and Reproductive Health and Alignment with Sustainable Development Goals

This report analyzes recent trends in sexual and reproductive health (SRH) access in the United States, evaluating current challenges and policy solutions through the framework of the Sustainable Development Goals (SDGs). The data indicates that recent legal and policy shifts present significant obstacles to achieving SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities). The following analysis draws on evidence-based research to offer policy recommendations aimed at aligning U.S. domestic policy with these international commitments to health, equality, and justice.

Analysis of Abortion Access and its Impact on SDG 3 and SDG 5

Fragmented legal landscapes across the United States have created profound inequities in abortion access, directly undermining progress toward SDG 3, which ensures healthy lives, and SDG 5, which calls for gender equality and universal access to reproductive rights. The dismantling of established legal protections has disproportionately affected marginalized communities, hindering the nation’s ability to meet key targets for universal health coverage and reproductive autonomy.

Key Findings on Abortion Provision

• Medication abortion constitutes the majority of abortions in most states without total bans, accounting for 63% of all clinician-provided abortions in 2023 in these states.
• Interstate travel for abortion care has nearly doubled since the end of Roe v. Wade. In 2024, approximately 154,900 individuals (15% of all abortions in non-ban states) crossed state lines for care, compared to 81,100 in 2020.
• A 5% decrease in clinician-provided abortions was observed in the first six months of 2025 in states without total bans compared to the same period in 2024. Interstate travel for care also declined by 8%, potentially due to expanded telehealth access, new state-level restrictions, and increased logistical and financial barriers.
• The number of brick-and-mortar clinics providing abortion care in the United States declined by 5% between 2020 and March 2024, representing a net loss of 42 clinics.

Policy Recommendations for Achieving Universal Access

1. Protect Abortion Rights at All Levels: To align with SDG 5.6, establish a national right to abortion and support state-level constitutional amendments to ensure all individuals can realize this right in practice.
2. Protect the Right to Travel: Uphold the constitutional right to travel between states for the purpose of obtaining legal abortion care, a critical measure for mitigating geographic inequalities in health access (SDG 10).
3. Strengthen and Expand Shield Law Protections: Enhance state-level shield laws to protect providers, patients, and facilitators from legal risks, including extending protections to the telehealth provision of medication abortion.
4. Enact Privacy Protections for Patients and Providers: Implement federal and state policies to safeguard reproductive health data from law enforcement inquiries and misuse, thereby protecting the privacy and security of both patients and providers.
5. Invest in Abortion Access Infrastructure: Allocate state and federal funds to support clinic infrastructure, provider training, and practical support services to meet the needs of both in-state and out-of-state patients, advancing the goal of universal health access (SDG 3).
6. Expand the Pool of Abortion Providers: Authorize advanced practice clinicians, such as nurse practitioners and physician assistants, to provide abortion care to address workforce shortages and increase service capacity.
7. Strengthen and Expand Access to Medication Abortion: Repeal medically unnecessary restrictions on medication abortion, such as forced waiting periods and in-person dispensing requirements, and support initiatives that expand access, such as provision on public college campuses.

Economic Barriers to Care: A Challenge to SDG 10 (Reduced Inequalities)

Financial barriers are a primary driver of inequality in abortion access, directly contravening SDG 10, which aims to reduce inequality within and among countries. Policies restricting public insurance coverage for abortion disproportionately harm people with low incomes and women of color, exacerbating existing social and economic disparities.

Key Findings on Financial Burdens

• In states where Medicaid covers abortion costs, 71% of patients paid $0 out-of-pocket, compared to only 10% of patients in states where Medicaid coverage is prohibited.
• In states without Medicaid coverage for abortion, two-thirds of respondents had to raise money for their care, often by delaying payment of other essential bills.
• A significant portion of patients (31–33%) incurred travel costs, regardless of their state’s Medicaid coverage policy, adding to the financial burden of care.

Policy Recommendations for Economic Equity

1. End Restrictions on Federal Insurance Coverage: Pass federal legislation, such as the EACH Act, to ensure public health insurance programs cover the full spectrum of reproductive health services, including abortion, thereby reducing financial barriers for low-income individuals (SDG 10.2).
2. Expand State-Level Insurance Coverage: Mandate that all state-regulated health insurance plans, including public and private options, cover abortion care without cost-sharing to ensure equitable access.
3. Create Sustainable Medicaid Reimbursement Rates: Establish Medicaid reimbursement rates that reflect the true cost and complexity of providing quality abortion care, ensuring the financial sustainability of providers and clinics serving vulnerable populations.

Addressing the Needs of Young People to Advance SDG Targets

Adolescents face distinct and significant obstacles in accessing abortion care, including legal restrictions and lack of information. These barriers impede progress on SDG 3 and SDG 5 by jeopardizing the health, safety, and bodily autonomy of young people.

Key Findings on Adolescent Access

• A majority of adolescent abortion patients (70%) identified as non-white, and 70% reported wanting to have their abortion sooner than they were able.
• Reasons for delays in care among adolescents included not knowing they were pregnant (57%), not knowing where to obtain an abortion (19%), and needing to make travel arrangements (16%).
• Over half (54%) of adolescents paid for their abortion out-of-pocket, at an average cost of $499.
• A majority of adolescents aged 17 and younger (53%) lived in a state with a parental involvement law, a policy that can delay or prevent access to time-sensitive care.

Policy Recommendations for Youth Empowerment

1. Support Young People’s Bodily Autonomy: Repeal mandated parental involvement laws that can delay care and jeopardize the health and safety of young people, and enact policies that affirm their right to make independent reproductive health decisions.
2. Champion Comprehensive Sexuality Education: Implement policies requiring medically accurate, LGBTQ+ inclusive, and age-appropriate sex education in schools to ensure young people have the information needed to protect their health, a key component of SDG 3.7.
3. Protect Young People Seeking Care Across State Lines: Defeat and challenge policies that criminalize individuals who assist minors in traveling to access legal abortion care, thereby protecting support networks essential for youth well-being.

Contraceptive Access as a Cornerstone of SDG 3.7

Universal access to contraception is a specific target (3.7) of SDG 3. Political and financial attacks on publicly funded family planning programs and providers limit access to person-centered contraceptive care, undermining public health and reproductive autonomy.

Key Findings on Contraceptive Services and Funding

• In 2020, an estimated 18.8 million women in the U.S. were in likely need of publicly supported contraceptive services.
• The Title X program, a key source of public funding, served 2.8 million people in 2023. However, restrictive rules imposed in 2019 led to a 61% drop in the number of people served by the program.
• Nearly one in four women (23%) rely on Medicaid for contraceptive care. Efforts to exclude certain providers, such as Planned Parenthood, from Medicaid reimbursement would severely reduce access, as other providers lack the capacity to absorb the patient volume.

Key Findings on Person-Centered Contraceptive Care

• Individuals express a preference for multiple access points for contraceptive care, including telehealth, pharmacies, and other innovative delivery models.
• A quarter (25.2%) of current and prospective contraceptive users were not using their preferred method due to barriers such as side effects, cost, or lack of knowledge.
• Restrictive policies compromise providers’ ability to offer comprehensive, patient-centered counseling, thereby limiting reproductive autonomy.

Policy Recommendations for Strengthening Contraceptive Access

1. Fully Fund and Strengthen Title X: Provide robust and consistent federal funding for the Title X program to meet the national need for family planning services, free from political interference.
2. Require Comprehensive Insurance Coverage for Contraception: Enforce and expand federal and state policies requiring all health insurance plans to cover the full range of contraceptive methods, including over-the-counter options, without cost-sharing.
3. Ensure Freedom of Choice for Medicaid Enrollees: Protect the right of Medicaid recipients to receive care from the provider of their choice and resist efforts to exclude qualified reproductive health providers from the program.
4. Protect the Right to Contraception: Enact federal and state laws that explicitly protect the right to contraception to safeguard access from political or legal challenges.
5. Promote Person-Centered Care Models: Design and fund SRH programs that prioritize reproductive autonomy, ensuring providers can offer full information on all options and that health plans cover person-centered counseling.
6. Expand Telehealth and Innovative Access Options: Increase access to high-quality telehealth for SRH services and pass policies that allow for multi-month dispensing of contraception and expanded access through pharmacies.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

The entire article is centered on sexual and reproductive health care, which is a core component of SDG 3. It discusses access to abortion and contraception, the quality of care, financial barriers to health services, and the importance of health information. The article’s focus on ensuring everyone can access necessary reproductive health services directly aligns with the goal of promoting health and well-being for all at all ages.

SDG 5: Gender Equality

The article addresses issues that are fundamental to gender equality. Access to sexual and reproductive health care, including abortion and contraception, is critical for women’s and girls’ autonomy, enabling them to make decisions about their own bodies, health, and life paths. The article highlights how restrictions on these services disproportionately affect women and girls, undermining their rights and reinforcing gender-based inequalities.

SDG 10: Reduced Inequalities

The article repeatedly emphasizes how barriers to reproductive health care exacerbate existing inequalities. It points out that communities “already harmed by unjust systems and policies are experiencing disproportionate impacts.” Specifically, it mentions that policies like the Hyde amendment “disproportionately harms women of color and people with low incomes,” and that young people and those with limited financial resources face unique and significant challenges in accessing care. This directly connects to the goal of reducing inequality within and among countries.

SDG 16: Peace, Justice and Strong Institutions

The discussion revolves around the legal and policy landscape governing reproductive rights in the United States. The article analyzes the impact of the Dobbs Supreme Court decision, the enactment of state-level abortion bans, and the role of legislation (e.g., shield laws, the EACH Act) in either restricting or protecting access to care. This focus on laws, policies, and the need for just and effective institutions to uphold rights is central to SDG 16.

SDG 4: Quality Education

The article explicitly connects the lack of education to negative health outcomes, particularly for young people. It notes that a primary reason for delays in abortion care among adolescents was that they “did not know they were pregnant.” In response, it recommends championing “access to comprehensive sexual and reproductive health education” that is medically accurate and inclusive, which aligns with the goal of ensuring inclusive and equitable quality education.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

1. Target 3.7: “By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.” The article’s core focus is on the barriers and facilitators to accessing abortion and contraceptive services, which are central components of sexual and reproductive health care. It calls for policies to expand access to medication abortion, contraception, and family planning services through programs like Title X.
2. Target 3.8: “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” The article extensively discusses cost as a “major barrier” to care. It analyzes the impact of insurance coverage (or lack thereof) through Medicaid and the Hyde amendment, highlighting how financial burdens prevent people from accessing essential health services. Recommendations to pass the EACH Act and expand insurance coverage directly support this target.

SDG 5: Gender Equality

1. Target 5.6: “Ensure universal access to sexual and reproductive health and reproductive rights…” This target is directly addressed throughout the article. The discussion of the fall of Roe, the fight for a “national right to abortion,” and the need to protect the right to contraception are all centered on ensuring universal access to reproductive health and upholding reproductive rights as a cornerstone of gender equality.

SDG 10: Reduced Inequalities

1. Target 10.2: “By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, …race, …or economic or other status.” The article highlights how restrictive policies disproportionately harm specific groups, including “women of color and people with low incomes” and adolescents. By advocating for policies that remove these discriminatory barriers, the article supports the goal of promoting inclusion and equal access for all.
2. Target 10.3: “Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices…” The article explicitly calls for the elimination of discriminatory policies. The recommendation to “end the Hyde amendment” is a prime example, as the article identifies it as a policy that exacerbates inequities. Repealing parental involvement laws is another recommendation aimed at eliminating a discriminatory practice affecting young people.

SDG 16: Peace, Justice and Strong Institutions

1. Target 16.b: “Promote and enforce non-discriminatory laws and policies for sustainable development.” The article’s policy recommendations focus on creating a legal framework that is non-discriminatory and protective of reproductive rights. This includes enacting shield laws, privacy protections, and a federal “right to contraception,” all of which are examples of promoting and enforcing non-discriminatory laws and policies.

SDG 4: Quality Education

1. Target 4.7: “By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for… human rights, gender equality and promotion of a culture of peace and non-violence…” The recommendation to “Champion access to comprehensive sexual and reproductive health education” that is “medically accurate, LGBTQ+ inclusive, and culturally and age appropriate” directly contributes to this target by ensuring young people have the knowledge necessary for healthy lifestyles and understanding their human rights.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

For SDG 3 (Good Health and Well-being)

• Indicator for Target 3.7: The article provides several quantitative measures of access to reproductive health services. These include:
  • The proportion of abortions provided via medication (“medication abortions accounted for 63% of all clinician-provided abortions in 2023”).
  • The number of people traveling for care (“approximately 154,900 people crossed state lines for an abortion”).
  • The number of available clinics (“a net loss of 42 clinics”).
  • The number of people served by public programs like Title X (“Title X served 2.8 million people in 2023”).
• Indicator for Target 3.8: The article implies indicators related to financial barriers to care:
  • The proportion of patients with out-of-pocket costs for abortion (“71% of patients who received care in states where Medicaid can be used… paid $0 out of pocket in comparison with only 10% of all patients in states where Medicaid is prohibited”).
  • The average out-of-pocket cost for care (“adolescents reported paying out of pocket for their abortion, at an average cost of $499”).

For SDG 5 (Gender Equality)

• Indicator for Target 5.6: Progress can be measured by tracking the legal and policy landscape, as detailed in the article:
  • The number of states with laws restricting or banning abortion (“12 states have enacted total abortion bans”).
  • The number of states with laws requiring parental involvement for minors (“38 states require parental involvement”).
  • The proportion of individuals unable to use their preferred contraceptive method (“a quarter (25.2%) of current and prospective users were not using their preferred method”).

For SDG 10 (Reduced Inequalities)

• Indicator for Target 10.2/10.3: The article implies the need for disaggregated data to measure inequalities:
  • Demographic data of patients accessing care, broken down by race and income level (The article notes the Hyde amendment “disproportionately harms women of color and people with low incomes”).
  • Data on access to care for adolescents versus adults (The article has a dedicated section on the “unique challenges” young people face).

For SDG 16 (Peace, Justice and Strong Institutions)

• Indicator for Target 16.b: The existence and enforcement of specific laws and policies can serve as indicators:
  • The number of states that have enacted shield laws to protect providers and patients.
  • The existence of federal laws like the Hyde amendment versus protective laws like the proposed EACH Act.
  • The number of states with constitutional amendments or laws protecting the right to contraception (“14 states and DC have laws… that protect the right to contraception”).

For SDG 4 (Quality Education)

• Indicator for Target 4.7: The article provides a direct indicator for measuring access to sexual health education:
  • The number of states that mandate sex education in schools (“29 states and the District of Columbia require sex education to be taught in schools”).

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

Source: guttmacher.org