Report on the Impact of Reproductive Health Restrictions on Family Planning and Sustainable Development Goals

1.0 Introduction

This report analyzes the significant impacts of evolving reproductive health care legislation on family planning decisions and public health outcomes in North Carolina. Following the U.S. Supreme Court’s Dobbs decision in June 2022, which altered the landscape of abortion access, observable shifts in behavior and heightened public anxiety have emerged. These trends directly challenge the progress toward several United Nations Sustainable Development Goals (SDGs), particularly those concerning health, gender equality, and economic stability.

2.0 Changes in Family Planning and Reproductive Intentions

2.1 Postponement of Childbearing Due to Legislative Uncertainty

A growing number of individuals are reportedly postponing or forgoing plans to have children due to fears surrounding restricted access to reproductive health services. A case study of North Carolina resident Jaycee Foran illustrates this trend. Despite being prepared financially and logistically for a second child, she and her husband have decided against expanding their family in the current legal climate. Their decision is rooted in the fear of not being able to access necessary medical care, including abortion, in the event of pregnancy complications. This personal choice reflects a broader societal concern that directly impacts demographic trends and undermines SDG 3 (Good Health and Well-being) by creating significant psychological distress around pregnancy.

Ms. Foran’s first pregnancy involved the discovery of fetal anomalies consistent with Noonan syndrome, forcing the couple to confront the state’s gestational limits on abortion. The experience of navigating medical uncertainty under legal time pressure has made them unwilling to face a similar situation under even stricter laws.

2.2 Increased Fear and Anxiety Among Pregnant Individuals

Obstetrician-gynecologists and maternal-fetal medicine specialists in North Carolina report a substantial increase in fear and anxiety among patients regarding pregnancy. This emotional toll is a direct consequence of the legal restrictions and the uncertainty they create. This environment is detrimental to maternal mental health, a key component of SDG 3.

3.0 Shifts in Contraceptive and Sterilization Practices

In response to restricted abortion access, there has been a notable shift toward more permanent and long-acting forms of contraception. This trend indicates a public desire to exert control over fertility in an environment of perceived instability, directly linking to SDG 5 (Gender Equality), which includes the right to make autonomous decisions about one’s body and reproductive life.

3.1 Increased Demand for Long-Acting Reversible Contraception (LARC)

Health care providers have observed a rising preference for long-acting reversible contraception, such as IUDs and implants. Key data points include:

• A study published in the Journal of Women’s Health found nearly a quarter of surveyed clinics nationally reported increased requests for LARC post-Dobbs.
• Analysis within the UNC Health system revealed a 13 percent increase in LARC use in the year after North Carolina’s new abortion restrictions took effect.
• Planned Parenthood South Atlantic saw a 33 percent increase in monthly average requests for LARC appointments across its four-state region following the 2024 election.

This shift is compounded by pre-existing barriers, as data from Power to Decide indicates that 635,140 women in North Carolina already live in “contraceptive deserts,” areas with inadequate access to a full range of methods. This disparity hinders progress on SDG 10 (Reduced Inequalities).

3.2 Rise in Permanent Contraception (Sterilization)

A more drastic trend is the increased demand for permanent sterilization procedures. Medical professionals report a spike in requests from a diverse demographic, including young adults who do not want children and, surprisingly, individuals at low risk of pregnancy (e.g., those in same-sex partnerships or who identify as asexual) who fear a potential inability to access abortion after an assault. This demonstrates an extreme level of fear that compromises bodily autonomy and challenges the principles of SDG 3 and SDG 5.

1. UNC Health data showed a 25 percent increase in permanent contraception procedures in the year following the Dobbs decision.
2. National research confirms this trend, with one study finding a 3 percent monthly rise in surgical sterilizations in states where abortion was banned.

4.0 Policy Landscape and Systemic Barriers to Health

4.1 Impact of Legal Rulings on Health Service Access

The legal framework continues to create uncertainty. The Supreme Court ruling in Medina v. Planned Parenthood South Atlantic enables states to exclude Planned Parenthood from Medicaid reimbursement for non-abortion services like contraception and STI testing. This policy disproportionately affects low-income populations, directly undermining SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities) by creating financial barriers to essential health care.

4.2 Contradictory Effects on National Birth Rates

While a stated goal of some policymakers is to reverse declining birth rates, experts suggest that restrictive reproductive health policies may have the opposite effect. Factors contributing to low birth rates include:

• The high cost of child-rearing.
• Lack of paid parental leave.
• An ongoing maternal health crisis and the growth of maternity care deserts.

Restricting abortion access adds another layer of anxiety that may lead individuals to have fewer children. This complex dynamic illustrates how policies that fail to address systemic barriers to family-building are inconsistent with sustainable population goals and overall well-being (SDG 3, SDG 8: Decent Work and Economic Growth).

5.0 Conclusion: A Setback for Sustainable Development

The restriction of reproductive health services in North Carolina has generated cascading effects that extend beyond abortion access. The documented increase in patient anxiety, the shift toward irreversible contraception, and the erection of new barriers for vulnerable populations represent significant setbacks for public health and human rights. These outcomes are in direct conflict with the core principles of the Sustainable Development Goals.

Achieving SDG 3 (Good Health and Well-being) and SDG 5 (Gender Equality) requires ensuring universal access to sexual and reproductive health-care services and upholding reproductive rights. The current policy environment in North Carolina moves away from these targets, creating a climate of fear that impacts individual decisions, family structures, and the overall health of the community.

Relevant Sustainable Development Goals (SDGs)

• SDG 3: Good Health and Well-being

  The article directly addresses public health by focusing on reproductive health care, access to services like abortion and contraception, and the psychological impact (fear and anxiety) on women considering pregnancy. It discusses the maternal health crisis and the availability of healthcare services, which are central to SDG 3.

• SDG 5: Gender Equality

  The issues discussed are intrinsically linked to gender equality. The article highlights how legal restrictions on reproductive health disproportionately affect women, limiting their autonomy over their bodies, their family planning decisions, and their ability to participate fully in society. Access to reproductive health is a key component of empowering women and achieving gender equality.

• SDG 10: Reduced Inequalities

  The article touches upon inequalities in access to healthcare. It mentions “contraceptive deserts,” which points to geographic inequality. It also discusses how potential changes to Medicaid funding for providers like Planned Parenthood could jeopardize access for low-income women, highlighting socioeconomic inequality in the healthcare system.

Specific SDG Targets

1. SDG 3: Good Health and Well-being

   • Target 3.7: Ensure universal access to sexual and reproductive health-care services.

     This target is central to the article. The entire piece revolves around the diminishing access to reproductive health services, specifically abortion, following the Dobbs decision and North Carolina’s subsequent 12-week ban. The article details how this landscape creates fear and influences women’s decisions about contraception and family size, directly relating to the availability of family planning services and information.

   • Target 3.8: Achieve universal health coverage, including financial risk protection and access to quality essential health-care services.

     This target is relevant to the discussion of Medicaid funding. The article notes that a Supreme Court ruling “paves the way for states to exclude Planned Parenthood from receiving payment from the Medicaid program, jeopardizing access for some low-income women.” This directly concerns financial risk protection and access to essential services for a vulnerable population.

2. SDG 5: Gender Equality

   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights.

     This target is addressed through the personal stories and expert opinions in the article. Jaycee Foran’s decision to forgo a second child due to fear over lack of access to care is a clear example of reproductive rights being impacted. The increase in women seeking permanent sterilization is described as a way to “take control of their own fertility” in a landscape where their reproductive rights are perceived as being under threat.

3. SDG 10: Reduced Inequalities

   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices.

     The article discusses laws and policies, such as the 12-week abortion ban in North Carolina, that create unequal health outcomes for women. The mention of “635,140 women in North Carolina live in areas that can be classified as ‘contraceptive deserts'” also points to an inequality of outcome based on geographic location, which this target aims to address.

Indicators for Measuring Progress

1. For Target 3.7 & 5.6 (Universal access to sexual and reproductive health-care services and rights)

   • Fertility Rate:

     The article explicitly mentions this indicator, stating the U.S. fertility rate reached a record low and providing the specific rate for North Carolina: “55.8 births per 1,000 women of reproductive age in 2023.” This is used as a metric to discuss trends in family planning.

   • Rate of Use of Long-Acting Reversible Contraception (LARC):

     The article implies this as an indicator by providing specific data: “a 13 percent increase in use of long-acting reversible forms of contraception in the year after North Carolina’s increased abortion restrictions took effect.”

   • Rate of Sterilization Procedures:

     This is used as a direct measure of changing family planning behaviors. The article states there was “a 25 percent increase in permanent contraception among UNC Health patients in the year after the Dobbs decision.”

   • Laws and Regulations on Abortion Access:

     The existence and nature of laws are a key indicator. The article specifies the current law: “North Carolina bans most abortions after 12 weeks of pregnancy, with exceptions.”

2. For Target 3.8 & 10.3 (Universal health coverage and reduced inequalities)

   • Proportion of Population with Access to Subsidized Health Services:

     This is implied through the discussion of Medicaid. The article provides a specific figure: “roughly 14 percent of Planned Parenthood patients in North Carolina have accessed family planning services using Medicaid,” indicating the portion of this patient group vulnerable to policy changes.

   • Geographic Access to Contraceptive Services:

     The article provides a direct indicator of geographic inequality by citing data on “contraceptive deserts,” stating that “635,140 women in North Carolina live in areas that can be classified as ‘contraceptive deserts.'”

SDGs, Targets, and Indicators Analysis

Source: northcarolinahealthnews.org