Introduction
Publicly funded family planning clinics provide preventive health services to low-income
populations in the U.S. In recent years, several states, including Ohio, have restricted
public funds for organizations that provide or refer patients to abortion care, often
resulting in clinic closures. This research evaluates the effects of such closures
on preventive service use and access to care among female adults in Ohio.
Methods
With data from the 2010 to 2015 Ohio Behavioral Risk Factor Surveillance System, trends
in health service use were assessed for female respondents aged 18–45 years with household
incomes <$50,000. Clinic locations were combined with restricted-access survey ZIP
codes to compute respondents’ driving times to the nearest family planning clinic.
The association between changes in driving time and the use of routine preventive
and unmet care owing to cost were assessed with linear probability models. Analyses
took place from March 2019 to February 2020.
Results
Each additional 10 minutes of driving time was associated with an 8.9 percentage point
increase in the likelihood of avoided care owing to cost (95% CI=1.7, 16.2), a 10.4
percentage point decrease in the likelihood of mammogram receipt during the past 12
months (95% CI= –22.3, 1.5), and a 12.5 percentage point decrease in the likelihood
of ever receiving a clinical breast examination (95% CI= –18.7, –6.3). Driving time
had insignificant associations with other utilization outcomes. Similar results were
obtained when using driving distance.
Conclusions
Reduced access to family planning clinics was associated with unmet care due to cost
and a reduction in preventive service use among low-income, reproductive-aged females.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Financing family planning services for low-income women: the role of public programs.Kaiser Family Foundation, San Francisco, CAOctober 13, 2017 (Published October 25, 2019. Accessed July 26, 2020.)
HHS Office of Population Affairs. Fact sheet: final Title X rule detailing family planning grant program. Washington, DC: HHS Office of Population Affairs. https://opa.hhs.gov/grant-programs/title-x-service-grants/title-x-statutes-regulations-and-legislative-mandates-4. Published February 22, 2019. Accessed June 9, 2020.
- The impact of women's health clinic closures on preventive care.Am Econ J Appl Econ. 2016; 8: 100-124https://doi.org/10.1257/app.20140405
- Defunding women's health clinics exacerbates Hispanic disparity in preventive care.Econ Lett. 2017; 156: 61-64https://doi.org/10.1016/j.econlet.2017.04.013
State family planning funding restrictions. Guttmacher Institute. https://www.guttmacher.org/state-policy/explore/state-family-planning-funding-restrictions. Updated January 1, 2021. Accessed May 20, 2020.
- Lavrakas P Encyclopedia of Survey Research Methods. Sage Publications, Inc., Thousand Oaks, CA2008https://doi.org/10.4135/9781412963947
Family planning annual report. HHS, Office of Population Affairs. https://www.hhs.gov/opa/title-x-family-planning/fp-annual-report/index.html. Updated September 2020. Accessed June 8, 2020.
- NAMCS and NHAMCS web tables.Centers for Disease Control and Prevention, National Center for Health Statistics, January 29, 2020 (Updated January 29, 2020. Accessed August 23, 2020)
- American College of Obstetricians and Gynecologists updates breast cancer screening guidelines.Am Fam Physician. 2012; 85 (Accessed July 8, 2020): 654-655
- Screening for cervical cancer: recommendation statement.Am Fam Physician. 2012; 86 (Accessed July 8, 2020.): 555-559
- A review of hot deck imputation for survey non-response.Int Stat Rev. 2010; 78: 40-64https://doi.org/10.1111/j.1751-5823.2010.00103.x
- Evaluating the impact of non-response bias in the Behavioral Risk Factor Surveillance System (BRFSS).J Epidemiol Community Health. 2012; 66: 290-295https://doi.org/10.1136/jech.2009.103861
- Behavioral Risk Factor Surveillance System. Weighting BRFSS data: BRFSS 2015.Centers for Disease Control and Prevention, Atlanta, GAPublished 2015https://www.cdc.gov/brfss/annual_data/2015/pdf/weighting_the-data_webpage_content.pdfDate accessed: June 8, 2020
- Estimating the impact of changes in the Title X network on patient capacity.Guttmacher Institute, New York, NYFebruary 5, 2020https://www.guttmacher.org/article/2020/02/estimating-impact-changes-title-x-network-patient-capacity(Published)Date accessed: June 9, 2020
Article Info
Publication History
Published online: February 17, 2021
Identification
Copyright
© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
