title: Investigating access to reproductive health services using GIS: proximity to services and the use of modern contraceptives in Malawi.
abstract: This paper attempted to identify whether access to reproductive health services partly explains use of modern contraception in Malawi. Recent changes in Malawi's population policy have brought the state's population ambitions into alignment with the consensus reached at the International Conference on Population and Development held in Cairo in 1994. Concurrently, Malawi witnessed a large increase in the use of modern contraceptives from 7% in 1992 to 26% in 2000. A geographic information system (GIS) was employed to integrate health facility data from the Malawi health facilities inventory and global positioning data from the 2000 Malawi demographic and health survey. An effort to detect a plausible causal pathway was made by using distance to health services as a proxy variable for access to services. In a multivariate logistic regression analysis, after controlling for background variables traditionally associated with use of modern contraception, access could not be shown to explain use of modern contraception in Malawi.
authors.affiliation: The Department of Population and International Health, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Heard
authors.forename: Ulla
authors.initials: U
authors.lastname: Larsen
authors.forename: Dairiku
authors.initials: D
authors.lastname: Hozumi
mesh_terms: D001294:Attitude to Health / Q000208:ethnology; D003267:Contraception / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D040362:Geographic Information Systems / Q000458:organization & administration*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards; D006302:Health Services Research / Q000458:organization & administration*; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008295:Malawi; D015999:Multivariate Analysis; D010298:Parity; D011203:Poverty / Q000706:statistics & numerical data; D034121:Reproductive Health Services / Q000592:standards / Q000706:statistics & numerical data; D018456:Reproductive Medicine / Q000706:statistics & numerical data; D012111:Residence Characteristics; D014195:Travel; D014930:Women / Q000193:education / Q000523:psychology