Using GIS as a tool to evaluate and monitor California's family planning program: Thinking spatially about contraception?

Geographic Information System (GIS) is utilized in public health for topics such as disease surveillance and air quality assessment, but its utility in family planning program monitoring and evaluation may not be immediately apparent. Family PACT is California's fee-for-service family planning program serving over 1.6 million residents annually. The UCSF program monitoring and evaluation team employs various techniques to monitor contraceptive provision, recommend targeted interventions, and assess outcomes. One technique includes the integration of GIS with administrative data. Nearly all of the program's administrative data has a 'spatial' component such as point locations for provider addresses and geographic boundaries of client zip codes. We will present several examples how GIS can be used with spatial data to create maps for presentation as well as spatial query and analysis for reporting. For example, in the case of Intrauterine Contraceptives (IUC), geographic patterns in low utilization may indicate a lack of trained providers willing to recommend or perform IUC insertions. Further, with the help of GIS we found that providers located in rural areas are more likely to offer IUCs to their clients than in urban areas (71% v. 58%; p≤0.001). Other topics that have been informed by GIS include Emergency Contraception provision, referrals for vasectomy services in isolated areas, and unmet need for publicly funded family planning services. As the technology has improved, the utility and value of cartography, spatial query/analysis is clearer, though there are still challenges and limitations to consider.