Prevalent, but not inevitable: Contraception deserts & the expansion of inequality in reproductive healthcare across US states

• In Event: Designing Inequality Through Federalism? The Role of Policy Framing & Design for Inequalities in Access and Participation

Abstract

·      Family planning clinics funded through Title X of the Public Health Services Act have been providing critical access to a broad range of family planning and preventative health services for more than 50 years (U.S. Department of Health & Human Services, 2025). Title X service grant recipients provide a broad range of medically approved family planning services, regardless of one’s ability to pay or insurance status. Funded federally but implemented by states, the landscape of Title X-funded family planning services has evolved drastically in recent years with the political battles over reproductive healthcare. The story of Title X elucidates the heterogeneous effects of these ongoing battles on the health and well-being of communities, particularly for low-income women and women of color. In this paper, we provide a socio-spatial analysis of Title X clinic locations to ascertain geographies of concentrated disadvantage, which we call ‘contraception deserts’ (Kreitzer et al., 2021; Smith et al., 2022). We use the integrated two-step floating catchment area (I2SFCA) method, which considers both spatial and non-spatial variables, to measure potential access to Title X clinics across all 50 US states in 2024. We find wide variation across states in the size, scope, and demographic profiles of contraception deserts, attributable to the variation in how states implement Title X. Systematically, historically marginalized groups and those experiencing poverty are disproportionately represented within contraception deserts. Our results show that strategic Title X siting decisions by states can mitigate inequitable access to federal resources.

Authors

• Kellen A. Kane, University of Texas at Austin
  Presenting Author

• Tracee Morgan Saunders, Pennsylvania State University
  Non-Presenting Co-Author

• Candis Smith
  Non-Presenting Co-Author