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.
The impacts of access to healthcare on health outcomes are important to understand, yet difficult to measure. Researchers have documented the importance of health insurance, quality of local hospitals, and distance to the nearest healthcare facility, but have struggled to identify the impacts of constrained local capacity. I estimate the effect of reduced clinic capacity for abortion services using a natural experiment in Pennsylvania. In 2011, Pennsylvania passed new regulations requiring any facility that provided abortion services to meet ambulatory surgical facility standards, which ultimately caused the closure of almost half of the state's abortion facilities---but all closing facilities were near facilities that remained open. This meant that distance to the nearest clinic was largely unchanged, but local clinic capacity was reduced. I use both a difference-in-differences and a synthetic control design and find similar results. Reduced clinic capacity caused at least 13 percent fewer abortions to occur in the first 8 weeks of gestation and more abortions to occur at later gestational ages. There is also suggestive evidence that reduced clinic capacity reduced the overall abortion rate, increased rates of sexually transmitted infections, and increased the birth rate for black women, highlighting the potential for racial disparities in access to reproductive control technology.
with Jennifer Doleac and Manisha Shah
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