title: Differences in Family Planning Services by Rural-urban Geography: Survey of Title X-Supported Clinics In Great Plains and Midwestern States.
abstract: BACKGROUND
  Understanding the nature of rural-urban variation in U.S. family planning services would help address disparities in unmet contraceptive need.
  
  
  METHODS
  In 2012, some 558 Title X-supported clinics in 16 Great Plains and Midwestern states were surveyed. Rural-urban commuting area (RUCA) codes were used to categorize clinic locations as urban, large rural city, small rural town or isolated small rural town. Bivariate analyses examined key domains of service provision by RUCA category and clinic type.
  
  
  RESULTS
  The proportion of clinics offering walk-in appointments was lower in isolated small rural towns (47%) than in the other RUCA categories (67-73%). Results were similar for sites that do not specialize in family planning or reproductive health, but no variation was seen among specialty clinics. Overall, availability of evening or weekend appointments varied in a linear fashion, falling from 73% in urban areas to 29% in isolated small rural towns. On-site provision of most hormonal methods was most common in urban areas and least common in isolated small rural towns, while provision of nonhormonal methods was similar across RUCA categories. Sixty percent of clinics provided IUDs or implants. For clinics that did not, the only barriers that varied geographically were low IUD demand and lack of trained IUD providers; these barriers were most common in isolated rural towns (42% and 70%, respectively).
  
  
  CONCLUSIONS
  While important characteristics, such as clinics' specialization (or lack thereof), are linked to the provision of family planning services, geographic disparities exist.
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. summermartins@gmail.com.
authors: Summer L
authors: SL
authors: Martins
authors: Department of Obstetrics and Gynecology, William Beaumont School of Medicine, Oakland University, Rochester, MI.
authors: Katherine A
authors: KA
authors: Starr
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
authors: Wendy L
authors: WL
authors: Hellerstedt
authors: Division of Biological Sciences, University of Chicago.
authors: Melissa L
authors: ML
authors: Gilliam
mesh_terms: D000328:Adult; D000069216:Contraceptive Prevalence Surveys / Q000706:statistics & numerical data; D005193:Family Planning Services / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015146:Midwestern United States / Q000453:epidemiology; D019035:Rural Health Services / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D019037:Urban Health Services / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*