New maps show where contraceptive access falls short

Birth control remains legal across the United States. But new data show that for millions of women, getting it may depend heavily on where they live.

New county-level maps from Power to Decide and the Guttmacher Institute compare the need for low- or no-cost contraception with the capacity of publicly funded health centers to provide it.

The result: 21.4 million women of reproductive age who need low- or no-cost contraception live in a county where the need exceeds available services.

Researchers call these areas contraceptive access gaps. And in many communities, the gap is significant.

What the new maps show

The Contraceptive Access Maps look at access in two ways: whether publicly funded health centers can meet the need for any contraceptive care, and whether women have access to centers offering the full range of birth-control methods.

Among the 21.4 million women living in counties with an access gap:

• Nearly three-quarters live in counties where available services can meet no more than 25% of the estimated need.
• More than 1 million live in counties without a single publicly funded health center offering contraceptive care.
• 1.9 million live in counties without a health center offering the full range of birth-control methods.

The maps draw on data from more than 7,000 publicly funded health centers and compare estimated clinic capacity with women’s self-defined need for contraception. The underlying data come from 2020–2023, so the maps may not reflect more recent changes in provider availability.

In other words, an access gap doesn't simply mean there isn't a clinic nearby. It means the estimated need for publicly funded contraceptive care in a county is greater than the capacity available to provide it.

Why it matters

We've become increasingly familiar with the idea of maternal-care deserts — places where women may have to travel significant distances to obtain maternity care because hospitals and obstetric providers aren't available nearby.

The new contraceptive maps show another geographic divide in reproductive healthcare. And they illustrate something important: access isn't binary.

A woman may live in a state where contraception is legal. She may even live in a county with a clinic that provides birth control. But that doesn't necessarily mean the clinic has enough capacity to meet local demand, or offers the contraceptive method she needs.

And even a county that appears to have enough clinic capacity can have other barriers the maps don't fully capture, including appointment availability, clinic hours, transportation, language access, and privacy.

Geography is increasingly part of the story

At WRDI, we track women's rights state by state because laws and policies increasingly produce very different experiences depending on where a woman lives.

Reproductive healthcare makes that especially visible.

Abortion access now varies dramatically across state lines. Medicaid eligibility and coverage differ by state. Maternity-care shortages leave some communities far from obstetric services.

The new contraceptive data add another layer: even when a service is legal nationwide, the infrastructure needed to provide it is not evenly distributed.

That distinction matters because contraception is ongoing healthcare. Women may need appointments to begin or change a method, obtain an IUD or implant, receive an injection, manage side effects, or find an alternative when a method isn't working for them.

A different way to measure access

The new maps are designed around a straightforward question: Can the publicly funded healthcare system in a community meet the contraceptive needs of the women who rely on it?

Researchers estimate women's self-identified need for low- or no-cost contraception and compare it with the number of patients local clinics are estimated to be able to serve.

They also distinguish between clinics providing some contraceptive services and those offering the full range of methods. That's important because access to “birth control” isn't necessarily access to the birth control a woman wants or needs.

A clinic that provides condoms and oral contraceptives, for example, does not offer the same range of options as one that also provides IUDs and implants.

The bigger picture

Earlier this year, WRDI looked at the question: If birth control is still legal, why is access changing?

That reporting focused on federal funding, Title X, insurance coverage and other policy changes that can affect contraceptive care even without a nationwide restriction on contraception itself.

The new maps provide another part of the answer.

Policy determines whether care is permitted and funded. Infrastructure helps determine whether women can actually get it.

Increasingly, understanding women's reproductive rights requires looking at both.

Resources

Power to Decide and the Guttmacher Institute Launch New Interactive Resource Revealing the Gaps in Contraceptive Access Across the United States - News Release
Contraceptive Access Maps - Power to Decide
New maps reveal massive gaps in access to affordable birth control across the U.S - NPR
Birth Control Is Still Legal. So Why Is Access Changing? - Women's Rights Data Initiative