Pharmacies as an Access Point for Expanding Contraceptive Care: A Geographic Analysis

Overview

The pharmacy location addresses (as of March 10, 2024) were pulled from the Center for Medicare and Medicaid Services (CMS) National Plan and Provider Enumeration System National Provider Identifier (NPI) Registry based on previous research by E. Michael Murphy, Lucianne West, and Nimit Jindal’s paper, “Pharmacist Provider Status: Geoprocessing Analysis of Pharmacy Locations, Medically Underserved Areas, Populations, and Health Professional Shortage Areas” (November 2021).

Pharmacy Data

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that every health care provider and organization have an NPI number — Type 1 numbers are assigned to specific providers and Type 2 numbers are assigned to provider locations. Adhering to the Murphy et. al methodology, we pulled all providers with the taxonomy code 3336C0003X, which designates a community or retail pharmacy, excluded all Type 1 providers, removed duplicate addresses and phone numbers, and removed all territories. Then, after extensive data cleaning to prepare the data for geocoding, the data was geocoded using R, with a cascade method which first tried the US Census Geocoder, then Open Street Maps, and then Google Maps API. The remaining pharmacies that did not correctly geocode were manually checked and almost all were closed, so these closed pharmacies were removed from the database and the remaining were manually geocoded. After data cleaning and removing duplicates, we identified 74,752 pharmacies in the US.

Clinic Data

Federally Qualified Health Centers (FQHCs)

The FQHC data, current as of March 2024, was pulled from the Health Resources and Services Administration (HRSA) website.

Indian Health Service (IHS) clinics

Indian Health Service Clinic locations, current as of June 2023, were obtained from the Indian Health Service (IHS) website. Although the IHS data includes a flag for FQHCs, very few of the FQHC-flagged clinics were found in the FQHC dataset, and there were several others in the FQHC data that did not have a flag. For this reason, the IHS clinics were de-duplicated from the FQHCs by geographic location (clinics with the same or similar name within a half mile of each other).

Title X clinics

The Title X Clinic data from the Office of Population Affairs (OPA) in Health and Human Services (HHS) is current as of February 2024. Mobile clinics were excluded and duplicates based on location were removed. Title X clinics that are also FQHCs were counted as FQHCs to avoid double counting. Tennessee did not have any clinics reflected in the database due to the state’s refusal to comply with federal Title X funding rules requiring clinics to provide referral for abortion.

Planned Parenthood clinics

The Planned Parenthood dataset is an internally collected KFF dataset pulled from the Planned Parenthood Federation America (PPFA) website. This data is current as of March 2024.

Women of Reproductive Age Under the Federal Poverty Line

Women of reproductive age under the Federal Poverty Line (FPL) was calculated using the 2022 American Community Survey (ACS) 5-Year Estimates Detailed Tables: B17001, Poverty Status in the Past 12 Months by Sex by Age from the US Census website. Counts for females 15-49 under the FPL, over the FPL, and total by county were summed. To maintain data quality, any counties that had fewer than 50 women of reproductive age under the FPL were suppressed.

In 2024, the FPL was an annual income of $15,060 per year for a family of 1 and $25,820 for a family of 3. In 2022, the last year used in the 5-year American Community Survey sample cited, it was $13,590 for a family of 1 and $23,030 for a family of 3.

In 2022, Connecticut made a change to its counties – going from 8 to 9, and redrawing some of the county lines. ACS released a 1-year comparison file for Connecticut with these new counties, which is used in lieu of the 5-year in this analysis. The full 5-year ACS file with the new Connecticut counties will not be available until 2027. The 5-year was used for all other states as the sample size is larger.

A Note About Sex and Gender Language

Throughout this research, we refer to women of reproductive age. This is a nationally collected metric often used in reproductive health research. This is not a full representation of people who seek access to the full range of contraceptive methods: people of all gender identities use contraception.