Strategy & Insights, Population Services International, Washington, DC, USA
Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
BMJ Glob Health. 2022 May;7(5). doi: 10.1136/bmjgh-2021-008366.
Geographic access to family planning (FP) services has been characterised through a variety of proximity metrics. However, there is little evidence on the validity of women's self-reported compared with modelled travel time to an FP outlet, or between different distance measures.
We used data from four urban sites in Kenya. A longitudinal FP outlet census was directly linked with data from cross-sectional FP user surveys. We combined characteristics of outlet visited to obtain FP, transport mode, self-reported travel time and location of households and outlets with data on road networks, elevation, land use and travel barriers within a cost-distance algorithm to compute modelled travel time, route and Euclidean distance between households and outlets. We compared modelled and self-reported travel times, Euclidean and route distances and the use of visited versus nearest facility.
931 contraceptive users were directly linked to their FP source. Self-reported travel times were consistently and significantly higher than modelled times, with greater differences for those using vehicles rather than walking. Modelled and Euclidean distances were similar in the four geographies. 20% of women used their nearest FP outlet while 52% went to their nearest outlet when conditional on it offering their most recently used FP method.
In urban areas with high facility density and good road connectivity, over half of FP users visited their nearest outlet with their chosen method available. In these settings, Euclidean distances were sufficient to characterise geographic proximity; however, reported and modelled travel times differed across all sites.
计划生育（FP）服务的地理可达性已通过各种接近度指标来描述。然而，关于妇女自我报告的与模型旅行时间到 FP 出口相比的有效性的证据很少，或者关于不同距离测量的证据很少。
我们使用了肯尼亚四个城市地点的数据。纵向 FP 出口普查直接与来自 FP 用户横断面调查的数据相关联。我们结合了访问的出口的特征以获得 FP、交通方式、自我报告的旅行时间以及家庭和出口的位置与道路网络、海拔、土地利用和成本距离算法中的旅行障碍的数据相结合，以计算模型旅行时间、路线和家庭与出口之间的欧几里得距离。我们比较了模型和自我报告的旅行时间、欧几里得和路线距离以及使用访问的与最近设施的距离。
931 名避孕药具使用者直接与其 FP 来源相关联。自我报告的旅行时间始终且显着高于模型时间，使用车辆而不是步行的差异更大。在四个地理区域中，模型和欧几里得距离相似。20%的妇女使用最近的 FP 出口，而 52%的妇女在条件是最近的出口提供她们最近使用的 FP 方法时，会去最近的出口。
在设施密度高且道路连通性良好的城市地区，超过一半的 FP 用户使用其首选方法访问最近的出口。在这些环境中，欧几里得距离足以描述地理接近度；然而，报告和模型旅行时间在所有地点都有所不同。
