To provide a socio-spatial analysis of the allocation of Title X funding, the federal
government's only program dedicated to reproductive healthcare; to systematically
assess whether access to publicly-funded reproductive health resources are distributed
in an equitable way across the US; to utilize an innovative measure of potential access
that incorporates both spatial and aspatial variables to ascertain the size, scope,
and demographic characteristics of geographies of concentrated disadvantage, which
we refer to as “contraception deserts.”
We employed methods that incorporated geographic information systems (GIS) and statistical/spatial
analysis. We used the integrated two-step floating catchment area (I2SFCA) method,
which incorporates both spatial (eg, distance, rurality/urbanicity) and aspatial (eg,
poverty) variables, to more accurately develop a measure of potential access to Title
X–funded clinics (FY2019). To map contraception deserts and to determine the demographic
profile of these spaces of inequity, we used US Census data (at the tract level) and
Title X–clinic location data from the Office of Population Affairs.
GIS mapping techniques illustrate that significant proportions of the US can be characterized
as contraception deserts, though with a great deal of variability in size across them.
However, historically marginalized racial groups and those experiencing poverty are
disproportionately represented in contraception deserts.
Given the various ways Title X can be implemented across states, results reveal that
contraception deserts are prevalent but not inevitable. Speaking to policy implication,
the results show that with strategic siting decisions, state-level Title X networks
can mitigate inequitable access to federal resources.