Travel Time to Title X Facilities and Teenage Birth Rates in North Carolina

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.

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Notes

  1. 1.

    Notably, Title X funding cannot go to any facility that provides abortion services (U.S. Department of Health and Human Services Office of Population Affairs 2017). This has led some to question the adequacy of this and similar publicly available services (Goodman et al., 2007).

  2. 2.

    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.

  3. 3.

    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.

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Correspondence to Paul L. Delamater.

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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

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Keywords

  • Teenage births
  • Geographic accessibility
  • Contraceptives
  • Family planning
  • GIS