WASHINGTON, D.C. – Only 16 states and the District of Columbia broadly protect access to contraceptives through policy choices, while 16 actively restrict access, according to a first-of-its-kind scorecard released today by the Population Reference Bureau (PRB). The 18 remaining states have a combination of restrictive and protective policies when it comes to contraceptive access. The full interactive scorecard, along with a breakdown of each state’s score and a federal policy overview, can be found at the button below.
State of Access: A Contraceptive Policy Scorecard evaluates state policies across nine key areas that shape contraceptive access for residents. Based on their scores across these nine areas, states are classified as “Protective”, “Restrictive” or “Some Protections and/or Some Restrictions”. This patchwork of policies creates a tiered system where reproductive health care access depends on where someone lives.
The scorecard comes at a critical time. The new “One Big Beautiful Bill Act” is set to slash Medicaid funding by over $1 trillion and about 17 million Americans are projected to lose health care coverage over the next decade. In addition, nine states have trigger laws that automatically terminate Medicaid expansion if federal funding decreases and three others have laws requiring them to revisit expansion. In June, the Supreme Court ruled in Medina v. Planned Parenthood that patients cannot sue when states block Medicaid funding to qualified contraceptive providers. These developments directly threaten access for millions of Americans who depend on Medicaid, which is the largest public payer for family planning services in the United States.
“Broad access to contraceptive care is essential to helping people live with more freedom, health, and possibility,” said Jennifer Sciubba, President and CEO of PRB. “At a time when federal policies protecting contraceptive access are crumbling, understanding state-level policies has never been more important. This new scorecard reveals the spectrum of contraceptive access in our country–from states where birth control is free and easy to obtain, to states where it’s prohibitively expensive and restricted. Where you live shouldn’t determine your access to contraceptives, yet that is the reality for millions of Americans.”
Key Insights
- The states with the most protective policies are California, Washington, Connecticut, New York, New Mexico, Maryland, and Oregon. California and Washington are the states with the most protective policies across the nine key areas. All protective states adopted Medicaid expansion through the Affordable Care Act (ACA).
- Kansas, Mississippi, Florida, Alabama and Wyoming are the top states in the Restrictive category. Kansas scored lowest of all states, with a mix of restrictive policies and significant policy gaps. None of the states in this category has expanded Medicaid under the ACA.
- The 18 states that fall in the middle category span the political spectrum from liberal strongholds like Massachusetts to red states like West Virginia.
- Some state policies create particular barriers for young people and those with low income. 10 states restrict most minors from independently accessing contraceptive services, 31 do not require emergency rooms to provide emergency contraception and 10 have not expanded Medicaid under the ACA.
The nine state policy areas evaluated for the scorecard are:
- Medicaid Expansion: Expands Medicaid coverage under the ACA to residents under age 65 with low income.Family Planning Medicaid Expansion: Expands Medicaid coverage of family planning services to more residents with low income.Contraceptive Coverage: Requires insurers to cover contraceptives without cost-sharing.
- Extended Supply of Contraceptives: Requires public and private insurers to cover an extended 12-month supply of contraceptives.
- Emergency Contraception: Requires emergency rooms to provide access to emergency contraception or restricts access to emergency contraception in state family planning programs or contraceptive coverage mandates.
- Prescriptive Authority: Permits advanced practice registered nurses and pharmacists to prescribe contraceptives independently from physicians.
- Sex Education: Measures whether sex education or abstinence-plus education are mandated in schools, including whether it is medically accurate and whether parental consent is required.
- Refusal Clauses: Permits providers or facilities to deny contraceptive services for moral or religious reasons.
- Minor Consent: Permits minors to independently access contraceptive services.
“The scorecard shows that states have tremendous power to shape contraceptive access through legislative decisions,” said Christine Power, senior policy advisor at PRB and co-author of the scorecard. “Decisions on whether to expand Medicaid, require insurance coverage, or allow teens confidential access to contraceptive care all directly impact residents’ health and well-being. We know that access to contraception has wide-ranging economic mobility and health benefits, including improving maternal and infant health outcomes and reducing rates of unintended teen pregnancy.”
The scorecard also summarizes additional threats to contraceptive access at the federal level. In 2025, executive orders have rolled back reproductive health protections, Title X funding has been frozen for many grantees, and the ACA contraceptive mandate faces continued legal challenges. When taken together with the Medicaid cuts passed in Congress and the Supreme Court ruling in Medina v. Planned Parenthood, this weakened federal foundation makes state-level protections more crucial than ever.
“As the federal landscape for sexual and reproductive health and rights becomes increasingly uncertain, understanding state-level policies is more important than ever,” said Cathryn Streifel, senior program director at PRB and co-author of the scorecard. “This scorecard gives advocates and policymakers the comprehensive data they need to identify policy gaps and make evidence-based decisions that will advance reproductive health equity in their communities and across the country.”