title: Geographic access to family planning facilities and the risk of unintended and teenage pregnancy.
abstract: OBJECTIVE
  This study tested the hypotheses that greater geographic access to family planning facilities is associated with lower rates of unintended and teenage pregnancies.
  
  
  METHODS
  State Pregnancy Risk Assessment Monitoring System (PRAMS) and natality files in four states were used to locate unintended and teenage births, respectively. Geographic availability was measured by cohort travel time to the nearest family planning facility, the presence of a family planning facility in a ZIP area, and the supply of primary care physicians and obstetric-gynecologists.
  
  
  RESULTS
  83% of the PRAMS cohort and 80% of teenagers lived within 15 min or less of a facility and virtually none lived more than 30 min. Adjusted odds ratios did not demonstrate a statistically significant trend to a higher risk of unintended pregnancies with longer travel time. Similarly there was no association with unintended pregnancy and the presence of a family planning facility within the ZIP area of maternal residence, or with the supply of physicians capable of providing family planning services. Both crude and adjusted relative rates of teenage pregnancies were significantly lower with further distance from family planning sites and with the absence of a facility in the ZIP area of residence. In adjusted models, the supply of obstetricians-gynecologists and primary care physicians was not significantly associated with decreased teen pregnancies.
  
  
  CONCLUSIONS
  This study found no relationship between greater geographic availability of family planning facilities and a risk of unintended pregnancies. Greater geographic availability of family planning services was associated with a higher risk of teenage pregnancy, although these results may be confounded by facilities locating in areas with greater family planning needs.
authors.affiliation: The Center for the Evaluative Clinical Sciences and the Department of Pediatrics, Dartmouth Medical School, 7251 Strasenburgh Hall, Hanover, NH 03755, USA. david.goodman@dartmouth.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Goodman
authors.forename: Lorraine V
authors.initials: LV
authors.lastname: Klerman
authors.forename: Kay A
authors.initials: KA
authors.lastname: Johnson
authors.forename: Chiang-Hua
authors.initials: CH
authors.lastname: Chang
authors.forename: Nancy
authors.initials: N
authors.lastname: Marth
mesh_terms: D000293:Adolescent; D000328:Adult; D000407:Alabama; D000554:Ambulatory Care Facilities / Q000600:supply & distribution*; D015331:Cohort Studies; D005193:Family Planning Services / Q000706:statistics & numerical data / Q000600:supply & distribution*; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D009820:Ohio; D009825:Oklahoma; D011247:Pregnancy; D018873:Pregnancy Rate; D011253:Pregnancy in Adolescence / Q000517:prevention & control* / Q000706:statistics & numerical data; D011275:Pregnancy, Unwanted; D014861:Washington