Improving Access to Reproductive Health Services Through GIS Mapping and Data-Informed Community Engagement

Abstract

Background: Since 1983, Affirm — Sexual and Reproductive Health for All has been the primary grantee for Arizona’s Title X Service Grant, the largest federal grant program specifically dedicated to providing affordable access to reproductive health services.1,2 Individuals attempting to access reproductive health services report a wide array of barriers, including cost, insurance coverage, and distance.3–6 Through the lens of implementation science, an emerging discipline focused on bridging the gap between health research and practice, we examine the existing reproductive health resources available within Arizona and areas of potential elevated need.7 Methods: A multi-part framework was utilized to assess current community needs and service area coverage. Geographic Information System (GIS) tools were developed for the community partner and integrated with the organization’s existing dashboard system. GIS tools were then used to map publicly-supported reproductive health service providers and associated drive time distances for each location. Using American Community Survey (ACS) data, multivariate overlay analysis was used to identify census tracts and Public Use Microdata Areas (PUMAs) where unmet Title X need may be present. Separate analyses were run for rural and urban census tracts. Results: Profile scoring identified 335 unique areas of potential need (APNs) based on the percent of the population ages 15-44 years, percent of the population without insurance coverage, percent of the population below 200% FPL, and percent of the population without access to a personal vehicle. Of Arizona’s overall population, 21.9% was estimated to live in an APN, including 52.7% of the population in Apache County. 30 APNs were located entirely outside of the current Title X service area. Discussion: 20 of the 22 identified rural APNs overlap with American Indian Areas. Unmet needs for reproductive health services in American Indian Areas may contribute to disparities in rates of maternal mortality and severe maternal morbidity for Native American and Alaskan Native women in Arizona. Recommendations for Affirm were developed to guide utilization of new GIS tools in strategic planning, stakeholder communication, and community needs assessment activities moving forward.