Geographic access to assisted reproductive technology health care in the United States: a population-based cross-sectional study.
To evaluate the geographic distribution of assisted reproductive technology (ART) clinics and the number of ART clinics within U.S. Census metropolitan areas and to estimate the number of reproductive-age women who have geographic access to ART services in the United States.



A population-based cross-sectional study.



Not applicable.



None.



None.



Number of U.S. reproductive-age women living in areas with no ART clinic, a single ART clinic, or more than one ART clinic.



There were 510 ART clinics in the United States in 2009-2013. Multiple ART clinics were present in 76 metropolitan areas (median population of 1.45 million people), where a total of 442 clinics were located. A single ART clinic was present in 68 metropolitan areas (median population of 454,000 people). Among U.S. reproductive-age women in 2010, 38.1 million (60.4% of the U.S. population) lived in an area with multiple ART clinics, 6.8 million (10.8% of the U.S. population) lived in an area with a single clinic, and 18.2 million (28.8% of the U.S. population) lived in an area (metropolitan and nonmetropolitan) with no ART clinics.



Nearby geographic access to ART services is limited or absent for more than 25 million reproductive-age women (39.6% of the U.S. population) in the United States. This population estimate should spur continued policy and technological progress to increase access to ART services.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: harrisja@mail.magee.edu.
John A
JA
Harris
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
Marie N
MN
Menke
Robert Wood Johnson Foundation, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Jessica K
JK
Haefner
Institute for Healthcare Policy and Innovation, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
Michelle H
MH
Moniz
Robert Wood Johnson Foundation Clinical Scholars Program/U.S. Department of Veterans Affairs, Institute for Healthcare Policy and Innovation, Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Chithra R
CR
Perumalswami
D000554:Ambulatory Care Facilities / Q000639:trends; D002391:Catchment Area, Health; D003430:Cross-Sectional Studies; D005260:Female; D005298:Fertility; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000639:trends*; D006301:Health Services Needs and Demand / Q000639:trends; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D020380:Needs Assessment / Q000639:trends; D017064:Process Assessment, Health Care / Q000639:trends*; D027724:Reproductive Techniques, Assisted / Q000639:trends*; D012189:Retrospective Studies; D014481:United States
Infertility; access to care; geography