Over the past decade in the United States, contraception has become a political issue rather than a public health prevention strategy, despite evidence that easier access to contraception reduces unintended pregnancy,1 thereby improving women’s and children’s health. Only 5% of unintended pregnancies occur among the two thirds of US women at risk of unintended pregnancy who practice contraception consistently and correctly.2 In 2006 alone, publicly funded contraception averted an estimated 1.94 million unintended pregnancies, which translated into about 860 000 unintended births, 810 000 abortions, and 270 000 miscarriages.3 Contraceptive services are cost effective. Every $1 (£0.62; €0.77) spent on public funding for family planning saves $3.74 in pregnancy related costs, with annual savings of $19.3bn.4 Protection against unintended pregnancy, particularly in adolescents, leads to gains in education, employment, and wealth in the longer term.5 Contraception also prevents unintended pregnancy in the 18% of women who experience sexual violence and lack control over when and with whom they have sex.6

Nevertheless, in the US, at federal …