Reproductive Healthcare Deserts and Inequalities in Maternal and Infant Health

Project Summary/Abstract Access to reproductive healthcare in the U.S. has become increasingly constrained. Although a growing body of research has focused on identifying state-level policies that affect women's access to care, less attention has been paid to documenting access to reproductive healthcare at the local level. Understanding how

individuals actually experience access to care necessitates a finer-grained measure than the state level, although no data currently exist that would allow for such an approach. Local access to reproductive healthcare, including contraception, maternity care, and abortion, is a key structural factor that can hinder or

facilitate women's reproductive autonomy and maternal and infant health. Therefore, the primary goal of the proposed project is to create a new comprehensive longitudinal (2009-2021) dataset that will allow us to identify spatial variation in access to contraceptive, maternity, and abortion care at the U.S. county-level. We

will use the new dataset to identify “reproductive healthcare deserts” (RHD), or counties where access to contraceptive, maternity, and abortion care is severely limited or nonexistent, document how access has changed over time, identify disparities in access, and examine how such disparities shape health outcomes. To

create this unique dataset, we will integrate data sources on (a) access to publicly funded contraceptive care at Title X clinics from the Office of Population Affairs and at Federally Qualified Health Centers from the Centers for Medicare & Medicaid Services; (b) access to maternity care from the Health Resources and Service

Administration; and (c) access to abortion care from the Myers Abortion Facility Database. We will also create an interactive dashboard that will map the RHD dataset and include time-varying county-level sociodemographic characteristics obtained from supplementary datasets (e.g., American Community Survey).

The dashboard will guide our descriptive research into the spatial patterns and scale of changes to reproductive healthcare access over the study period and highlight disparities in access and their overlap with sociodemographic traits. We will merge the RHD dataset with restricted-use data from the National Vital

Statistics System and the National Survey of Family Growth to develop spatially clustered multilevel models analyzing the relationship between county-level reproductive healthcare access and individual-level measures of maternal morbidity, infant health, interbirth intervals, contraceptive use, and unintended birth. Each of these

outcomes is tied to women's ability to time, space, and limit births and therefore likely to be affected by their level of access to reproductive healthcare. Taken together, this project will provide a new comprehensive measure of reproductive healthcare, a novel dataset and interactive dashboard that will track changes over a

13-year period, and robust evidence of how reproductive healthcare deserts are related to reproductive autonomy and maternal and infant health.