Context

Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access as distance increases.

Methods

We used kernel density estimation to geographically link a woman’s use of injectable contraceptives and demand for birth spacing/limiting in Malawi with routine contraceptive logistics data from family planning service delivery points. Using linear probability models, we estimated the associations between access to services, measured by distance alone and distance adjusted by supply reliability, and injectable use and demand for birth spacing or limiting in rural and urban environments.

Results

Access to services is an important predictor of injectable use. Women in rural communities with the most access by both measures were over 7 percentage points more likely to report injectable use than women with the least access. In urban environments, women with more reliable contraceptive supplies reported up to 18.3 percentage points higher demand for birth spacing or limiting than women with the least distance-and-supply access.

Conclusions

Our findings highlight the importance of product availability in the local service environment, and its relationship with demand for and use of family planning. Constructing facility service environments using kernel density estimation provides a refined means of linking women with services that takes into account distance decay and supply reliability. Distinct urban and rural results highlight the importance of considering both urban and rural service environments when working to improve modern contraceptive use.