The study quantifies the benefits of programs that fund contraception for low-income Americans
Citlalli Chávez-Nava
A high-quality clinical trial led by UCLA finds that reducing the costs of contraception results in 16% fewer unintended pregnancies and 12% fewer abortions among low-income women after two years.
Published by the National Bureau of Economic Research, the study offers the first experimental evidence evaluating the importance of financial access to contraception for a broad population of women in the United States, helping settle questions of long-standing academic and policy interest.
“According to our findings, eliminating financial barriers allowed women to choose more effective contraception methods and reduced undesired pregnancies and abortions,” said Martha Bailey, professor of economics and director of the California Center for Population Research, and the study’s lead author.
In the U.S., the rate of unintended pregnancy is more than five times higher among women in poverty than women with incomes at least two times the poverty level. The study suggests that the high cost of reliable contraception is an important contributor.
The findings are particularly relevant for policy discussions surrounding ongoing cuts to the Title X program, a federal program that subsidizes contraceptive and other reproductive health care for millions of low-income Americans. Earlier this year, the Administration froze millions of dollars in Title X grants, affecting providers in numerous states including California.
Removing all contraceptive costs through M-CARES study
The findings were based on the Michigan Contraceptive Access, Research, and Evaluation Study (M-CARES) which recruited low-income women at Title X medical providers between 2018-2023. During this period, randomly assigned participants were given vouchers that made any method of contraception free or sharply discounted. The goal of the M-CARES study was to remove cost barriers for all methods available at Title X providers and to follow ensuing changes in the choice of contraception and pregnancy outcomes over time.
Based on data analysis over a two-year period, the study found:
- A significant reduction in pregnancies and abortions: Subsidizing contraception resulted in significantly fewer pregnancies and abortions within two years.
- A reduction in pregnancies of 16%.
- A reduction in abortions of 12%.
- Removing all financial barriers led to a shift to more effective contraceptive methods that persisted over 26 months.
- Increased the likelihood of buying contraception by 69%.
- Raised the efficacy of chosen methods by 44%.
- Raised use of Long-Acting Reversible Contraceptives (LARCs)— IUDs and implants—by 217%.
“It’s important to note that the effects of the study last well beyond the availability of the subsidies. The effects of increasing affordability extend over a two-year period and likely beyond,” said Bailey.
Furthermore, unlike previous academic studies, the M-CARES survey findings include high-quality administrative microdata offering a more comprehensive view of contraceptive use.
“Most studies have only been able to document changes in childbirth. Because we had administrative records, we were able to see changes in pregnancies and abortions, which are severely underreported in surveys,” added Bailey.
Timely findings for the 2026 Congressional budget adoption
In March of this year, the Trump Administration announced a freeze of close to $35 million in funding to Title X grantees. This freeze left California, among seven other states, without Title X funding. And there is a strong possibility this program will continue to face cuts or complete elimination for the upcoming 2026 federal fiscal year.
Bailey thinks that further disruptions to Title X grantees will be devastating for low-income women, worsening not just their health, but their social and economic outcomes as well as resources for their children.
“Generalizing our survey findings, we see that keeping Title X sliding scale costs as they stand now, results in significantly higher rates of unintended pregnancy among low-income women and causes more abortions nationally than if contraception were completely free,” said Bailey.
Instead, Bailey says the M-CARES evaluation provides evidence that federal Title X dollars help U.S. families and expanding the program would also have benefits.
“The Title X program is a cost-effective way to empower parents to choose their families according to their own desires,” she said. “Preserving Title X and expanding its generosity would strengthen the reproductive health safety net.”
Read full study, here.