Contraceptive Deserts FAQs

What is a contraceptive desert?
A contraceptive desert is a county in which there is not reasonable access to the full range of contraception for women who are eligible for publicly funded contraception.  Lack of reasonable access exists when there is less than one public clinic to every 1,000 women eligible for publicly funded contraception.  To determine this ratio, we consulted the ratios developed by Richard Cooper, M.D. of the University of Pennsylvania/Wharton School, one of the leading physician utilization and supply experts in the United States, in his “Hospital Specific Physician Requirements Model.”  Dr. Cooper’s model, developed in 2012, indicates the number of physicians in various specialties that a community can support and is “demand-based.”

Does access to the full range of contraceptive methods really matter?
Yes.  Recent research from Colorado and St. Louis makes clear that when women have access to the full range of contraceptive methods, including the most effective methods, rates of unplanned pregnancy plummet.  

How is this different than contraceptive coverage made available through the ACA?
The ACA expanded the universe of people covered by both private and public insurance.  In addition, it eliminated cost barriers to the full range of contraceptive methods in most private health plans and ensured that women newly covered by Medicaid have no-cost coverage of the full range of methods.  However, coverage does not necessarily equal access.  This research focuses on proximity.  According to our research, nearly 20 million women eligible for publicly funded contraception do not have reasonable access to clinics providing the full range of contraceptive methods in their counties, meaning that they face barriers such as lost work time, additional child care costs, or transportation costs that stand in their way of accessing the contraceptive method that is right for them.  It is also notable that there are still many women who lack health coverage (for example, many low income women live in states that have chosen not to expand Medicaid), and these women often rely on publicly funded clinics for their care.

Can’t women just use the methods of contraception that are available?  Condoms and birth control pills are widely available after all.  
Again, when women have access to the full range of methods so they can choose what’s best for them, unplanned pregnancy declines.  The majority of the American public believes that contraception is a basic part of health care and that women should have access to the contraceptive method that is right for them.  We don’t ration treatment for heart disease or high blood pressure, so why should we limit contraceptive options for women?  Moreover, nearly half the counties in the U.S. do not offer reasonable access to publicly funded clinics offering even limited contraceptive services, making birth control pills hard to get in states without pharmacy or online access.

Are these results an accurate depiction of contraceptive access for women eligible for publicly funded contraception?   
These results reflect the best data available on the need for and availability of services.  Nonetheless, we expect this to be a dynamic picture that will change over time and we will work to continually update and improve our results.

Where do these data come from?
The maps include more than 18,000 clinics and providers.  The data on clinics come from more than 10 verified sources, including Title X clinics, Planned Parenthood, the Indian Health Service, and The National Association of County and City Health Officials (NACCHO), among others.  The National Campaign manages this nationwide compilation of data, which also includes territories like Puerto Rico.  The vast majority of publicly funded clinic locations are included on these maps, as well as private providers and other health care sites that have made themselves known to us. Any site or provider can register their location and services at https://bedsider.org/clinic_submissions/new.  The data on the number of women in need of publicly funded contraception come from the Guttmacher Institute.

What are the limitations of your findings?  
The landscape of contraceptive access is constantly changing and our data are limited by the ability to stay up to date with the changes.  In addition, these data primarily reflect public safety-net clinics; very few private providers are in our database.  However, it is estimated that up to one-third of women covered by Medicaid access their contraceptive care through private providers.  Medicaid beneficiaries may obtain care from private office-based providers or from safety-net health centers and clinics, and hospitals that participate in Medicaid (either fee-for-service Medicaid or a Medicaid Managed Care program).  We currently don’t have access to data from many of these providers that would allow us to determine whether they provide the full range of methods.

We have released these data to begin a conversation about the importance of proximity and access.  We welcome any provider to become a part of our network and to add their data via this online tool: https://bedsider.org/clinic_submissions/new.  These maps will be living research and updated as new information comes available.

Why does preventing unplanned pregnancy matter?  
Birth control is directly linked to a wide array of benefits to women, men, children, and society, including fewer unplanned pregnancies, more educational and economic opportunities for young women, improved maternal and infant health, greater family wellbeing, and reduced public spending.

How is this information used to improve the conditions of contraceptive deserts in the United States?
Recent research makes clear that when women have ready access to the full range of contraceptive methods, rates of unplanned pregnancy plummet.  It is important that state and regional leaders take on the challenge of ensuring that ready access to the full range of contraceptive methods—especially the most effective methods—is available in their areas.  The infrastructure and means of delivery is largely in place; making the full range of methods available is not.  The National Campaign is ready to support states and regions interested in ensuring full contraceptive access.

How is the number of women who are in need of publicly funded contraception determined?
This is determined using data from the Guttamcher Institute.  In their data, women are defined as in need of publicly funded contraceptive services and supplies if they are age 13–44 and meet the following three criteria during all or part of a given year:

(1) They were sexually active (estimated as those who have ever had voluntary vaginal intercourse);

(2) They were able to conceive (neither they nor their partner had been contraceptively sterilized, and they did not believe that they were infecund for any other reason); and

(3) They were neither intentionally pregnant nor trying to become pregnant.

In addition, they have a family income below 250% of the federal poverty level.  All women younger than 20 who need contraceptive services, regardless of their family income, are also assumed to need publicly funded care because of their heightened need—for reasons of confidentiality—to obtain care without depending on their family’s resources or private insurance.

Does this take into account that accessing clinics can be more difficult in areas that rely heavily on public transportation?  
At this point, clinic access is measured for each county irrespective of transportation barriers, however in the future we hope to incorporate data on travel times and or transportation barriers.

A group of teenage girls