Implementing Title X: policy design, administration, and geographic access to care

Area of Science:

• Public Health
• Health Services Research
• Reproductive Health Policy

Background:

• Title X is the sole federal program providing affordable, confidential, evidence-based reproductive healthcare to low-income populations.
• Programmatic capacity is influenced by multi-level governance decisions, including federal, state, and regional administrative and fiscal policies.
• Recent program and regulatory disruptions have impacted service delivery.

Purpose of the Study:

• To assess geographic access to Title X-funded clinics across the United States in 2024.
• To identify spatial and non-spatial barriers affecting access to reproductive healthcare services.
• To establish a baseline for evaluating future policy changes.

Main Methods:

• Employed the Integrated Two-Step Floating Catchment Area (I2SFCA) method.
• Utilized 2024 clinic locations and census-tract-level demographic data.
• Applied road-network-based drive time thresholds calibrated to urban-rural contexts.

Main Results:

• Identified widespread and substantial gaps in geographic access to Title X services.
• These access challenges affect all racial groups, rural and urban residents, and low-income individuals.
• Significant barriers limit the reach of essential reproductive health services.

Conclusions:

• The study provides a precise geographic analysis of Title X service reach limitations.
• Findings document the consequences of policy changes on healthcare access.
• This research establishes a critical baseline for future policy impact assessments.