Giving Compass' Take:

• Research from the Tara Health Foundation describes the state of reproductive healthcare in the U.S. and provides investment strategies for improvement. 

• Which of these strategies aligns with your values and resources? 

• Learn about the history and future of reproductive health and rights


This investment case and the underlying research and analysis has been supported by the Reproductive Health Investors Alliance with the overall mission of increasing the total amount of philanthropy and impact investment directed toward high-impact opportunities that increase American women’s ability to manage their fertility in a safe and dignified manner.

The objectives of this investment case are to a) develop a detailed landscape analysis to identify where and for whom access challenges are most acute; b) promote a systems view of the actors and issues that affect access to high quality contraception and abortion services; and c) identify a set of investment strategies to address the challenges and issues surfaced.

This investment case was written as a call to action to philanthropies, high net worth individuals and impact investors

While the current political climate has increased the intensity of threats to family planning and abortion services, the unintended pregnancy rate decreased substantially between 2008 and 2011, reaching its lowest rate since 1981.

Access challenges are increasingly concentrated in specific states and among specific demographic groups, but a comprehensive understanding of the key actors and issues that affect access allows for more targeted and impactful investments.

By opening up this investment case to a diverse community of both active and prospective RH funders, we hope to partner with likeminded investors to protect the encouraging progress that has been made while directing attention to those states and populations where burden is increasingly concentrated.

To inform this work, we started with a comprehensive Literature Review, leveraging the remarkable research and analysis by established organizations like ANSIRH, the Guttmacher Institute, Ibis Reproductive Health, and the Kaiser Family Foundation.

Where possible, we supplemented our Literature Review with original analysis of the CDC’s 2013-2015 National Survey for Family Growth.

We validated our key insights through interviews with 20 Reproductive Health, Rights, and Justice Subject Matter Experts.

This investment case is unique for its: a) original data analysis of raw survey data not yet available in public reports, b) systems view of the many actors, programs and process that affect access to contraception and abortion services, and c) actionable nature, providing prospective investors with myriad investment opportunities and robust evaluation criteria to identify their preferred way to get involved.

We developed a novel “state scorecard” methodology for our geography-focused analysis, identifying 10 indicators that measure statelevel support for RH, unintended pregnancy and abortion access, to identify those states with the greatest RH access challenges.

While the results of this analysis may surprise RH practitioners, the purpose of the state scorecard was less about directing investors to one state over another; instead we hope to demonstrate a potential methodology for arriving at a specific state or regional focus.

Our original analysis of CDC data identified specific demographic groups (18-19 year olds, Black and Hispanic women, and low-income women) that lag behind the national average in their rates of contraceptive use, the efficacy of contraceptives used and timing of abortion. The drivers behind these discrepancies are complex, but include provider bias, issues of self-identity, and systemic discrimination.

The “value chain” of actors and issues affecting access to contraception and abortion services stretches across the areas of R&D, regulatory, pricing, reimbursement, service provision, and care-seeking & patient experience.

The issues affecting contraception we identified to be of highest acuity include ongoing state level efforts to “defund” Planned Parenthood, provider bias and a history of reproductive oppression that affect the patient experience for Black, Hispanic, and low-income women, and provider bias and issues of self-identification that impact adolescents contraceptive care-seeking and use.

The issues affecting abortion we identified to be of highest acuity include low reimbursement rates that affect provider financial sustainability, federal REMS regulations that impede access to medication abortions, and the many state-level TRAP laws that regulate abortion providers in ways not linked to patient safety, resulting in licensure delays and refusals.

Through our Literature Review and Subject Matter Expert interviews, we identified 40 example investment opportunities, which we matched to five challenge-specific investment strategies that surfaced in our landscape analysis and systems map development.

The five challenge-specific investment strategies are: a) research and development, b) legislation & litigation, c) pricing & reimbursement, d) service provision, and e) care-seeking by underserved populations.

We have also included a sixth strategy, which focuses on financial tools (e.g. ETFs, social impact bonds) which can be leveraged for RH impact.

The opportunities have been evaluated against eight investment criteria intended to assist investors in determining which individual opportunities are best matched to their specific organizational priorities and investment capabilities.