Affordable but inaccessible? Contraception deserts in the US States

Context: This article focuses on whether, and the extent to which, the resources made available by Title X—the only federal policy aimed specifically at reproductive health care—are equitably accessible. Here, equitable means that barriers to accessing services are lowest for those people who need them most. Methods: The authors use geographic information systems (GIS) and statistical/spatial analysis (specifically the integrated two-step floating catchment area [I2SFCA] method) to study the spatial and nonspatial accessibility of Title X clinics in 2018. Findings: The authors find that contraception deserts vary across the states, with between 17% and 53% of the state population living in a desert. Furthermore, they find that low-income people and people of color are more likely to live in certain types of contraception deserts. Conclusions: The analyses reveal not only a wide range of sizes and shapes of contraception deserts across the US states but also a range of severity of inequity.