Abstract Background Title X of the Public Health Service Act is a critical federal program—the 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 – from Congress and federal regulators to state and regional grantees and their sub-grantee clinic networks. Methods This study assesses geographic access to Title X-funded clinics across all fifty 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 – which employs road-network-based drive time thresholds calibrated to urban-rural context – applied to 2024 clinic locations and census-tract-level demographic data, we identify a confluence of spatial and non-spatial barriers to Title X. Results 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. Conclusion These findings offer a precise geographic account of where Title X’s reach falls shortest – documenting the ramifications of policy retrenchment and establishing a baseline against which future policy changes can be measured.
Saunders et al. (Wed,) studied this question.