Examination of the ecological correlation between rates of pregnancy termination and spatial proximity to family planning services in Georgia, 2006 Pubblico
Mayes, Vita Lam (2011)
Abstract
ABSTRACT
The overall U.S. abortion rate has reached a plateau after a
multi-year decline; however, the rate
of abortion occurring in Georgia is back on the rise, with the
highest incidence being among
young, low-income, minority women. Publicly-funded family planning
services, such as Title X
clinics, offer contraceptive availability and services particularly
to vulnerable populations with a
goal of decreasing the rate of unintended pregnancies and, in turn,
effectively reducing the
abortion rate. As an indirect measure of program impact, this study
examines the geographic
distribution of Title X family planning clinics in Georgia and its
association with the abortion
rate. We hypothesize an inverse relationship exists between the
rate of pregnancy termination for
a geographic area and the spatial accessibility to the nearest
Title X family planning clinic in the
given area.
The 2006 Georgia ITOP (Induced Termination of
Pregnancy) file was utilized with written
permission from the state of Georgia Department of Public Health.
The rate of abortion occurring
on a zip code level was calculated and compared to the spatial
proximity of the centroid of each
zip code to the nearest Title X family planning services across
Georgia.
Abortion rates were highest among non-Hispanic Blacks,
20-24 year olds, predominantly poor
regions, and metropolitan areas. When adjusting for all factors
(distance, age, ethnicity/race,
neighborhood poverty, and rural/urban coding), the effect of
distance from clinic to centroid of
zip code showed a consistent linear pattern between distance and
abortion rate, with closest
proximity having the highest rates of abortion and farthest
distance having lowest rates of
abortion.
Although this association was opposite our hypothesized direction,
we do not conclude that
spatial proximity plays a causal role in increased abortion rates.
Perhaps geographic access is not
a barrier to women receiving family planning services in Georgia,
or spatial proximity and access
are not as connected as we thought and other factors may be
confounding the observed spatial
correlation. Increased efforts to reduce abortion rates should
extend beyond increasing the
number of family planning clinics, and also include greater patient
outreach and education,
particularly to young, minority, low-income women.
Table of Contents
TABLE OF CONTENTS
Chapter I: Background and Literature Review
Page 1
Introduction
Page 1
Preliminary Studies that Support this Stage of Research
Page 2
Significance and Justification for Current Study
Page 4
Georgia statistics
Page 6
Importance of Publicly Funded Family Planning Services
Page 9
Title X-Funded Family Planning Services
Page 9
Chapter II: Manuscript
Page 13
Abstract
Page 14
Introduction
Page 15
Methods
Page 20
Results
Page 24
Discussion
Page 26
Strengths and Limitations
Page 28
Conclusion
Page 30
Tables
Page 31
Figures
Page 34
Chapter III: Discussion
Page 37
Summary
Page 37
Public Health Implications
Page 37
Possible Future Directions
Page 38
References
Page 39
Appendix
Page 43
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