Rural/Urban Differences in Family Planning Service Provision: A Survey of Title X Clinics in Great Plains and Midwestern United States

Summer Martins, University of Minnesota
Katherine Damm, Somerset Gynecology and Obstetrics
Wendy Hellerstedt, University of Minnesota
Melissa Gilliam, University of Chicago

There is a paucity of research on rural/urban variations in U.S. family planning service provision. We surveyed 558 Title X family planning clinics in 16 Great Plains and Midwestern U.S. states regarding clinic accessibility, contraceptive methods provided, and perceived barriers. We classified clinics into a four-level rural/urban variable derived from Rural-Urban Commuting Area (RUCA) codes: Urban, Large Rural City, Small Rural Town, and Isolated Small Rural Town. Responses varied across rural/urban categories on most items that we evaluated, often along a gradient. The most rural respondents were the least likely to dispense contraception on site. The largest rural/urban disparities were seen for LARC methods. Similarly, isolated rural clinics had the highest rates of reported barriers to service provision. Our findings suggest that urban/rural differences have been an under-recognized factor shaping the dynamics of U.S. family planning care. RUCA is a valuable tool with which to evaluate rural/urban differences.