Differences in Family Planning Services by Rural–urban Geography: Survey of Title X–Supported Clinics In Great Plains and Midwestern States
4800916.pdf

Authors

Summer L. Martins, University of Minnesota Katherine A. Starr, Oakland University Wendy L. Hellerstedt, University of Minnesota Melissa L. Gilliam, University of Chicago
CONTEXT

Understanding the nature of rural–urban variation in U.S. family planning services would help address disparities in unmet contraceptive need.

METHODS

In 2012, some 558 Title X–supported clinics in 16 Great Plains and Midwestern states were surveyed. Rural–urban commuting area (RUCA) codes were used to categorize clinic locations as urban, large rural city, small rural town or isolated small rural town. Bivariate analyses examined key domains of service provision by RUCA category and clinic type.

RESULTS

The proportion of clinics offering walk-in appointments was lower in isolated small rural towns (47%) than in the other RUCA categories (67–73%). Results were similar for sites that do not specialize in family planning or reproductive health, but no variation was seen among specialty clinics. Overall, availability of evening or weekend appointments varied in a linear fashion, falling from 73% in urban areas to 29% in isolated small rural towns. On-site provision of most hormonal methods was most common in urban areas and least common in isolated small rural towns, while provision of nonhormonal methods was similar across RUCA categories. Sixty percent of clinics provided IUDs or implants. For clinics that did not, the only barriers that varied geographically were low IUD demand and lack of trained IUD providers; these barriers were most common in isolated rural towns (42% and 70%, respectively).

CONCLUSIONS

While important characteristics, such as clinics’ specialization (or lack thereof), are linked to the provision of family planning services, geographic disparities exist.

Perspectives on Sexual and Reproductive Health, 2016, 48(1):9–16, doi:10.1363/48e7116

Author's Affiliations

Summer L. Martins is a doctoral student, and Wendy L. Hellerstedt is associate professor, both in the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. Katherine A. Starr is assistant professor, Department of Obstetrics and Gynecology, William Beaumont School of Medicine, Oakland University, Rochester, MI. Melissa L. Gilliam is chief of the Section of Family Planning and Contraceptive Research; director of the Fellowship in Family Planning; and professor of obstetrics, gynecology and pediatrics, Division of Biological Sciences, University of Chicago.

Disclaimer

The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.
Volume 48, Issue 1
March 2016
|
Pages 9 - 16

First published online:

DOI: https://doi.org/10.1363/48e7116
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