{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T17:54:43Z","timestamp":1776880483794,"version":"3.51.2"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008982","name":"National Science Foundation","doi-asserted-by":"publisher","award":["2116771"],"award-info":[{"award-number":["2116771"]}],"id":[{"id":"10.13039\/501100008982","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008982","name":"National Science Foundation","doi-asserted-by":"publisher","award":["2020302996"],"award-info":[{"award-number":["2020302996"]}],"id":[{"id":"10.13039\/501100008982","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Title X of the Public Health Service Act is a critical federal program\u2014the only one dedicated exclusively to providing affordable, confidential, evidence-based reproductive health care to low-income populations, yet its capacity to fulfill this mandate depends on political, administrative, and fiscal decisions made across multiple levels of governance\u2014from Congress and federal regulators to state and regional grantees and their sub-grantee clinic networks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study assesses geographic access to Title X-funded clinics across all 50 states and the District of Columbia in 2024, a period with significant program and regulatory disruption. Using the Integrated Two-Step Floating Catchment Area (I2SFCA) method\u2014which employs road-network-based drive time thresholds calibrated to urban\u2013rural context\u2014applied to 2024 clinic locations and census-tract-level demographic data, we identify a confluence of spatial and nonspatial barriers to Title X.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Findings reveal widespread and substantial gaps in geographic access, a challenge faced by people across all racial groups, rural and urban residents, and individuals with low incomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings offer a precise geographic account of where Title X's reach falls shortest\u2014documenting the ramifications of policy retrenchment and establishing a baseline against which future policy changes can be measured.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag082","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T11:42:51Z","timestamp":1775648571000},"source":"Crossref","is-referenced-by-count":0,"title":["Implementing Title X: policy design, administration, and geographic access to care"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5925-7596","authenticated-orcid":false,"given":"Tracee M","family":"Saunders","sequence":"first","affiliation":[{"name":"Department of Political Science, Pennsylvania State University , University Park, PA 16802 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5510-4593","authenticated-orcid":false,"given":"Kellen A","family":"Kane","sequence":"additional","affiliation":[{"name":"Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin , Austin, TX 78712 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8370-5628","authenticated-orcid":false,"given":"Candis","family":"Watts Smith","sequence":"additional","affiliation":[{"name":"Department of Political Science, Duke University , Durham, NC 27708 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"2026042213100914500_qxag082-B1","author":"Nixon","year":"1969"},{"issue":"11","key":"2026042213100914500_qxag082-B2","doi-asserted-by":"publisher","first-page":"2027","DOI":"10.2105\/AJPH.2011.300202","article-title":"Approaching 4 decades of legislation in the national family planning program: an analysis of Title X's history from 1970 to 2008","volume":"101","author":"Vamos","year":"2011","journal-title":"Am J Public 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