Abstract: We estimate the effect of Colorado's Family Planning Initiative, the largest program to have focused on long-acting reversible contraceptives in the United States, which provided funds to Title X clinics so that they could make these contraceptives available to low-income women. We find substantial effects on birth rates, concentrated among women in zip codes within 7 miles of clinics: the initiative reduced births by approximately 20 percent for 15-17 year olds and 18-19 year olds living in such zip codes. We also examine how extensive media coverage of the initiative in 2014 and 2015 altered its reach. After information spread about the availability and benefits of LARCs, we find a substantial increase in LARC insertions, extended effects on births among 15-17 year olds living greater than 7 miles from clinics, and significant reductions in births among 20-24 and 25-29 year olds.
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I estimate the effect of reduced clinic capacity for abortion services using a natural experiment in Pennsylvania. In 2011, a law was passed requiring any facility that provided abortion services to meet ambulatory surgical facility standards, which included required hallway widths and elevator sizes, minimum operating room square footage, and stricter staff requirements. Nine of the 22 existing clinics failed to meet the new regulations and permanently closed their doors in the 2012 calendar year. Because most of these closures occurred in urban settings with multiple clinics, distance to the nearest abortion clinic changed minimally for most women in the state. Meanwhile, there were suddenly fewer clinics available to serve the same number of women. Using a difference-in-differences approach, I find that as a result of these clinic closures, most likely due to longer wait times for abortion services, at least 13 percent fewer abortions occurred early in the pregnancy (the first 8 weeks gestational age) and more abortions occurred in weeks 9-14 of gestation. Reduced clinic capacity also increases the birth rate for black women, by 11 percent, highlighting the existence of racial disparities in access to reproductive control technology. I confirm the results of the difference-in-difference estimation using synthetic control methods, and find that the results from the synthetic control method-which uses a better-fitting comparison group-are larger and more statistically significant. Synthetic control estimates suggest that reduced clinic capacity may have reduced the overall abortion rate by as much as 8.5% per year after the new regulations were passed.
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