Access to Abortion Facilities and Low-Income Women's Health: Evidence from Medicaid Beneficiaries

• In Event: Reproductive Care at the Margins: Abortion, Contraception, and the Consequences of Access

Abstract

Travel distance to the nearest abortion facility is a central determinant of access to abortion services in the United States. A large literature establishes that increases in distance reduce abortion rates and raise birth rates, but there is limited causal evidence on the downstream consequences for women's physical and mental health. These consequences are likely borne disproportionately by low-income women: roughly three-quarters of people seeking abortions report family incomes below 200% of the federal poverty line, and the marginal births induced by reduced access are concentrated among populations at elevated risk of maternal morbidity. 

We link 2011–2019 administrative Medicaid enrollment and claims data with the restricted-use Myers Abortion Facility Database to estimate the causal effects of travel distance to the nearest brick-and-mortar abortion facility on the physical and mental health of low-income women of reproductive age. We exploit within-person variation in distance stemming from state-level and local legal changes that affected facility operations in the years leading up to Dobbs. Following recent advances in the staggered-adoption literature, we implement a "clean" event-study design in which treated beneficiaries reside in ZIP codes that experienced a distance increase of at least 50 miles and control beneficiaries reside in ZIP codes without distance changes, with individual and state-by-year-by-quarter fixed effects. 

We examine three families of outcomes: live births; pregnancy and delivery complications, decomposed into sixteen ICD-based sub-indicators including hypertensive disorders, hemorrhage, infection, diabetes in pregnancy, and preterm labor; and severe maternal morbidity, using the CDC's twenty-one-indicator composite and its obstetric and non-obstetric components. We report estimates pooled and stratified by age (15–18, 19–24, 25–34, 35–44) and by race and ethnicity (non-Hispanic white, non-Hispanic Black, Hispanic). We find evidence of large increases in births, labor and delivery complications, and severe maternal morbidity, with particularly pronounced effects on sub-indicators capturing substance use and mental health conditions in pregnancy.

Author

• Caitlin Knowles Myers, Middlebury College
  Presenting Author