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Impacts of Access to Reproductive Healthcare

Paper Session

Sunday, Jan. 8, 2023 1:00 PM - 3:00 PM (CST)

Hilton Riverside, Fulton
Hosted By: American Economic Association
  • Chair: Kate Pennington, U.S. Census Bureau

Reproductive Policy Uncertainty and Defensive Investments in Contraception

Kate Pennington
,
U.S. Census Bureau
Joanna Venator
,
University of Rochester

Abstract

Reproductive healthcare policy has become a knife-edge issue in the United States, with narrow legislative majorities passing laws that dramatically change access to affordable family planning services and abortion on a state-by-state basis. This paper investigates the role of the policy environment in women's choice of a contraceptive method. We model contraceptive choice as a dynamic discrete choice under uncertainty about future pregnancy, abortion access, and contraceptive method costs. The model predicts that women are forward-looking and risk averse, switching to lower failure-rate methods when they expect abortion access may fall and to longer-lasting methods when they expect costs may rise. Using de-identified patient level data from Planned Parenthood of Wisconsin and Planned Parenthood of Northern New England, we evaluate the impacts of four shocks to the policy environment: Wisconsin's introduction and then passage of its 2015 abortion ban, Vermont's 2016 reproductive healthcare expansion, and the 2016 presidential election. We find strong evidence in support of the model predictions, with the probability of switching increasing by 2-22 percentage points after the policy shocks. Next, we build a structural model motivated by the reduced form to explore the policy counterfactuals of fully unconstrained and fully constrained access to contraception and abortion. These counterfactuals show that policy constraints meaningfully shift women away from their preferred method in an unconstrained world. Women choose a contraceptive method in response not only to method attributes, but also to the policy environment, making defensive investments in methods that can shield them from adverse policy changes in the future.

The Effect of Long-Acting Reversible Contraception Uptake on CPS Involvement of Children

Christine Durrance
,
University of Wisconsin-Madison
Lonnie Berger
,
University of Wisconsin-Madison
Jessica Pac
,
University of Wisconsin-Madison

Abstract

About half of all pregnancies are unintended. Unplanned births are correlated with poor health outcomes for mothers and infants, and can increase family stress and economic vulnerability, key predictors of child abuse and neglect. LARCs are the most effective form of contraception, but have been underutilized. No/low-cost access to LARC methods have been associated with large impacts on births. One potential implication is whether increased LARC access may be associated with decreased child maltreatment. This may occur because parents experiencing planned births are economically and psychosocially prepared than those experiencing unplanned births and/or because they experience less parental stress and/or more preferable birth timing. We use event study design, DiD, and synthetic control methods combined with administrative data from NCANDS and variation in state LARC programming to estimate the causal effects of LARC access on CPS involvement of future birth cohorts.

Economic Shocks, Inequality, and Unintended Fertility

Kelly Jones
,
American University
Kate Pennington
,
U.S. Census Bureau

Abstract

It is well documented that negative economic shocks reduce fertility demand. In this study, we formalize a model in which negative shocks also impact fertility through a countervailing effect on healthcare access. For a disadvantaged minority of women, negative shocks can reduce access to reproductive healthcare, increasing unintended births. Combining county-level unemployment shocks during the Great Recession with birth records, we find that high exposure to unemployment induced fertility decline among White women but increased fertility among Black women. We supplement our analysis using detailed individual data from the National Survey of Family Growth. We document that the Great Recession reduced fertility desire across all groups, with economically disadvantaged women experiencing slightly greater declines. However, realized fertility declines are concentrated among relatively more advantaged women, with women who are both Black and disadvantaged experiencing no decline (or an insignificant increase). Our findings suggest that the impact of economic shocks on fertility differ by race and socioeconomic status and that the most disadvantaged women may experience increases in unintended fertility as a result of a shock.

Changes in Abortion Access and Obtainment in a Post-Roe America

Caitlin Myers
,
Middlebury College

Abstract

Court watchers widely expect the United States Supreme Court will overturn Roe v. Wade in the summer of 2022, returning the authority to enforce abortion bans to the states. I am tracking states bans, abortion facilities openings and closures, and surveying appointment availability, and I plan to continue these efforts through the summer and fall of 2022 to provide information on changing abortion access in a post-Roe America. The proposed paper and presentation will provide timely information on how access changed in 2022 and what the economics literature has to tell us about the likely effects of these changes on abortions and births. I will use data from SafeGraph tracking cell phone movements and visitor counts at abortion facilities to measure effects of travel distance and congestion at remaining providers on abortion obtainment. This will provide an early preview of effects we cannot measure with official vital statistics data, which takes years to release.

Discussant(s)
Caitlin Myers
,
Middlebury College
Kate Pennington
,
University of California-Berkeley
Joanna Venator
,
Univeristy of Rochester
Christine Durrance
,
University of Wisconsin-Madison
JEL Classifications
  • I1 - Health
  • J1 - Demographic Economics