Abstract
Objectives
In the United States, Title X facilities are understood to be an effective starting point for improving teenagers’ reproductive health outcomes, including unintended pregnancy. We investigate geographic accessibility of Title X facilities and the relationship between geographic accessibility of Title X facilities and teenage birth rates in the state of North Carolina (NC).
Methods
Vehicular travel time from each ZCTA to its nearest Title X facility was calculated using a geographic information system and summarized as the indicator of geographic accessibility. We used bivariate and multiple spatial lag regressions to evaluate the relationship between ZCTA-level teenage birth rates (n = 754) in 2016 and geographic accessibility to a Title X facility, as well as socioeconomic and demographic factors.
Results
Nearly 60% of teenage women lived 30 min or less from a Title X funded facility, while approximately 12% of women lived 60 min or more from the nearest facility. In the regression models, percent non-Hispanic White, percent Hispanic, percent in Poverty, percent not enrolled in school, and population density were associated with teenage birth rates; however, geographic accessibility was only associated in the bivariate model.
Conclusions
Our findings show that geographic accessibility of Title X facilities is lower in NC than in other states. However, our results suggest that geographic accessibility is not related to teenage birth rates. Overall, these findings may indicate that publicly funded family planning facilities are underutilized by proximal populations or factors other than proximity act as a barrier to utilization.
This is a preview of subscription content, log in via an institution to check access.
Notes
The subject population of women who experienced poverty status in the past 12 months was aggregated for women from ages 15 to 24 due to the age groups used in the ACS data.
Because counts by sex and age were not available at the block level from the 2016 ACS, counts from the 2010 U.S. Census were used to calculate the ZCTA population weighted centroids.
References
Avery, M. (2017). SCHS Statistical Brief No. 47 (July 2017): Decline in teen births in North Carolina, 1996–2015. Raleigh.
Bell, B. S., Hoskins, R. E., Pickle, L. W., & Wartenberg, D. (2006). Current practices in spatial analysis of cancer data: Mapping health statistics to inform policymakers and the public. International Journal of Health Geographics,5(1), 49. https://doi.org/10.1186/1476-072X-5-49.
Bishai, D. M., Mercer, D., & Tapales, A. (2005). Can government policies help adolescents avoid risky behavior? Preventive Medicine,40(2), 197–202. https://doi.org/10.1016/j.ypmed.2004.05.021.
Blake, B. J., & Bentov, L. (2001). Geographical mapping of unmarried teen births and selected sociodemographic variables. Public Health Nursing,18(1), 33–39. https://doi.org/10.1046/j.1525-1446.2001.00033.x.
Brittain, A. W., Williams, J. R., Zapata, L. B., Moskosky, S. B., & Weik, T. S. (2015). Confidentiality in family planning services for young people: A systematic review. American Journal of Preventive Medicine,49(2), S85–S92. https://doi.org/10.1016/j.amepre.2015.04.001.
Finer, L. B. (2010). Unintended pregnancy among U.S. adolescents: accounting for sexual activity. Journal of Adolescent Health,47, 312–314. https://doi.org/10.1016/j.jadohealth.2010.02.002.
Fowler, C. ., Gable, J., Wang, J., & Lasater, B. (2017). Family planning annual report: 2016 National Summary. Retrieved from https://www.hhs.gov/opa/sites/default/files/title-x-fpar-2016-national.pdf.
Goldthwaite, L. M., Duca, L., Johnson, R. K., Ostendorf, D., & Sheeder, J. (2015). Adverse birth outcomes in Colorado: Assessing the impact of a statewide initiative to prevent unintended pregnancy. American Journal of Public Health,105(9), e60–e66. https://doi.org/10.2105/AJPH.2015.302711.
Goodman, D. C., Klerman, L. V., Johnson, K. A., Chang, C. H., & Marth, N. (2007). Geographic access to family planning facilities and the risk of unintended and teenage pregnancy. Maternal and Child Health Journal,11(2), 145–152. https://doi.org/10.1007/s10995-006-0151-6.
Guttmacher Institute. (2016a). State facts on publicly funded family planning services: North Carolina. New York. Retrieved from https://www.guttmacher.org/statecenter/family-planning/index.html.
Institute, G. (2016). Unintended pregnancy in the United States. Fact Sheet. New York: Guttmacher Institute.
Hughes, M. E., Furstenberg, F. F., & Teitler, J. O. (1995). The impact of an increase in family planning services on the teenage population of Philadelphia. Family Planning Perspectives,27(2), 60–78. https://doi.org/10.2307/2135906.
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., et al. (2018). Youth Risk Behavior Surveillance: United States, 2017. Morbidity and Mortality Weekly Report Surveillance Summaries,67(8), 1–114. https://doi.org/10.15585/mmwr.ss6708a1.
Lightfoot, A. F., Taboada, A., Taggart, T., Tran, T., & Burtaine, A. (2015). ‘I learned to be okay with talking about sex and safety’: Assessing the efficacy of a theatre-based HIV prevention approach for adolescents in North Carolina. Sex Education,15(4), 348–363. https://doi.org/10.1080/14681811.2015.1025947.
Lindberg, L., Santelli, J., & Desai, S. (2016). Understanding the decline in adolescent fertility in the United States, 2007–2012. Journal of Adolescent Health,59(5), 577–583. https://doi.org/10.1016/j.jadohealth.2016.06.024.
Manlove, J. (1998). The influence of high school dropout and school disengagement on the risk of school-age pregnancy. Journal of Research on Adolescence,8(2), 187–220.
Manson, S., Schroeder, J., RVan Riper, D., & Ruggles, S. (2018). IPUMS National Historical Geographic Information System. Minneapolis: University of Minnesota.
Martin, J. A., Hamilton, B. E., Osterman, M. J. K., & Driscoll, A. K. (2019). Births : Final data for 2018. National Vital Statistics Reports, 68(13). Retrieved from https://stacks.cdc.gov/view/cdc/82909
Penchansky, R., & Thomas, J. W. (1981). The concept of access: Definition and relationship to consumer satisfaction. Medical Care,19(2), 127–140. https://doi.org/10.2307/3764310.
Penman-Aguilar, A., Carter, M., Snead, M. C., & Kourtis, A. P. (2013). Socioeconomic disadvantage as a social determinant of teen childbearing in the U.S. Public Health Reports,128, 5–22. https://doi.org/10.1177/00333549131282S102.
Santelli, J. S., Lindberg, L. D., Finer, L. B., & Singh, S. (2007). Explaining recent declines in adolescent pregnancy in the United States: The contribution of abstinence and improved contraceptive use. American Journal of Public Health,97(1), 150–156. https://doi.org/10.2105/AJPH.2006.089169.
Sedgh, G., Finer, L. B., Bankole, A., Eilers, M. A., & Singh, S. (2015). Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. Journal of Adolescent Health,56(2), 223–230. https://doi.org/10.1016/j.jadohealth.2014.09.007.
Sonfield, A., Hasstedt, K., Kavanaugh, M. L., & Anderson, R. (2013). The social and economic benefits of women’s ability to determine whether and when to have children. New York: Guttmacher Institute.
U.S. Department of Health and Human Services Office of Population Affairs. (2017). Title X Family Planning Directory. Retrieved from https://www.hhs.gov/opa/sites/default/files/Title-X-Directory-November-2017.pdf
Ventura, S. J., Hamilton, B. E., & Mathews, T. J. (2014). National and state patterns of teen births in the United States, 1940–2013. National Vital Statistics Reports (Vol. 63). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_04.pdf
Wisniewski, M. M., & O’Connell, H. A. (2018). Clinic access and teenage birth rates: Racial/ethnic and spatial disparities in Houston, TX. Social Science and Medicine,201, 87–94. https://doi.org/10.1016/j.socscimed.2018.02.009.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Bennett, C.A., Delamater, P.L. Travel Time to Title X Facilities and Teenage Birth Rates in North Carolina. Matern Child Health J 24, 953–959 (2020). https://doi.org/10.1007/s10995-020-02908-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-020-02908-4