The Impact of Title X Rule Changes on Teen Birth Rate

• In Event: Health Policy, Family Shocks, and Behavioral Responses Across the Life Course

Abstract

U.S. teen birth rates have declined substantially over the past three decades, but they remain comparatively high among developed countries and exhibit persistent geographic and socioeconomic disparities. The federal Title X Family Planning Program plays a critical role in reducing unintended teen pregnancies by ofering abotion referral and expanding access to contraceptive services, which are particularly important for low-income and adolescent populations. This paper examines the causal impact of two recent federal policy changes on teen birth rates: the July 2019 rule restricting abortion referrals under Title X and its subsequent reversal in November 2021. These policy shifts significantly altered the scope of services and the provider network, potentially affecting access to reproductive healthcare and fertility outcomes among teenagers.To estimate these effects, I construct a county-level monthly panel dataset spanning 2014–2024, combining natality data with population and socioeconomic controls. The empirical strategy employs multiple quasi-experimental approaches, including Difference-in-Differences (DID), time-based Regression Discontinuity (RD), and dynamic event-study models. The DID framework exploits variation between counties with and without Title X clinic presence, while the RD design leverages the sharp timing of policy implementation to identify immediate discontinuities. The event-study specification further examines the dynamic evolution of policy effects and tests the parallel trends assumption. This multi-method approach allows for a comprehensive assessment of both short-run and lagged responses to federal policy changes.This study utilizes monthly county-level teen birth data from the National Vital Statistics System (NVSS), administered by the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS), covering the period from January 2010 to December 2023. The outcome of interest is the monthly teen birth rate, calculated as the number of births to females aged 15 to 19 per 1,000 teen females in a given county month. While publicly released datasets typically aggregate births annually, detailed monthly birth counts by maternal age are available through the NVSS, which collects complete birth certificate data from all U.S. states and territories.
The results indicate small, statistically insignificant immediate effects for both policy changes across all empirical strategies. Regression Discontinuity estimates show no clear discontinuities at either the 2019 or 2021 policy cutoffs. Difference-in-Differences and event-study analyses yield consistent directional patterns: the 2019 restrictions are associated with modest increases in teen birth rates, while the 2021 reversal corresponds to modest declines. These findings suggest that while Title X policy changes may influence teen fertility, their short-run effects are limited in magnitude and may operate through gradual behavioral and institutional adjustments rather than immediate shifts.

Author

• Xiaoqian Zhang, Georgia State University
  Presenting Author