title: The effect of access to contraceptive services on injectable use and demand for family planning in Malawi.
abstract: BACKGROUND
  Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use, but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access with increasing distance.
  
  
  METHODS
  Kernel density estimation was used to geographically link Malawi women's use of injectable contraceptives and demand for birth spacing or limiting, as drawn from the 2010 Demographic and Health Survey, with contraceptive logistics data from family planning service delivery points. Linear probability models were run to identify associations between access to injectable services-measured by distance alone and by distance combined with supply reliability-and injectable use and family planning demand among rural and urban populations.
  
  
  RESULTS
  Access to services was an important predictor of injectable use. The probability of injectable use among rural women with the most access by both measures was 7‒8 percentage points higher than among rural dwellers with the least access. The probability of wanting to space or limit births among urban women who had access to the most reliable supplies was 18 percentage points higher than among their counterparts with the least access.
  
  
  CONCLUSIONS
  Product availability in the local service environment plays a critical role in women's demand for and use of contraceptive methods. Use of kernel density estimation in creating facility service environments provides a refined approach to linking women with services and accounts for both distance to facilities and supply reliability. Urban and rural differences should be considered when seeking to improve contraceptive access.
authors: Research associate, Carolina Population Center, University of North Carolina at Chapel Hill, USA, marc_cunningham@jsi.com.
authors: Martha Priedeman
authors: MP
authors: Skiles
authors: Marc
authors: M
authors: Cunningham
authors: Andrew
authors: A
authors: Inglis
authors: Becky
authors: B
authors: Wilkes
authors: Ben
authors: B
authors: Hatch
authors: Ariella
authors: A
authors: Bock
authors: Janine
authors: J
authors: Barden-O'Fallon
mesh_terms: D000293:Adolescent; D000328:Adult; D001721:Birth Intervals; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000600:supply & distribution* / Q000627:therapeutic use*; D005193:Family Planning Services; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007267:Injections; D016014:Linear Models; D008295:Malawi; D008875:Middle Aged; D012424:Rural Population; D062206:Spatial Analysis; D014505:Urban Population; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female