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

Session Submission Type: Panel

Abstract

Access to reproductive healthcare in the United States is shaped as much by policy as by medicine. Who can obtain an abortion, afford contraception, or reach a qualified provider depends critically on the legal and institutional landscape in which individuals live. This panel brings together four papers that use rigorous causal methods and administrative data to examine how policy-induced changes in access to reproductive care affect maternal health, contraceptive use, economic wellbeing, and public safety—with particular attention to low-income, young, and marginalized populations. The first paper links administrative Medicaid data with abortion facility operational records from 2011–2019 to estimate the health consequences of distance to the nearest abortion provider. Using within-person variation in distance, the authors find that increased travel distance substantially raises births, pregnancy complications, and severe maternal morbidity—documenting that geographic barriers to abortion impose serious health costs on low-income women. The second paper examines the ACA Medicaid expansion's effects on contraceptive provision, with a focus on adolescents. Drawing on the universe of Medicaid claims linked to a comprehensive index of contraceptive NDCs from 2010–2019, the authors find that expansion increased provision of any contraceptive among 15–19 year-olds by 22.3 per 1,000 women and long-acting reversible contraceptives (LARCs) by 3.6 per 1,000—a proportionately larger gain that suggests the expansion improved actual contraceptive efficacy for teens. The third paper studies how reduced abortion access affects economic outcomes and crime. Exploiting clinic closures triggered by Texas HB-2 enforcement in 2013, the authors find that increased distance to abortion facilities reduces labor force participation, raises debt and income inequality, increases housing insecurity, and leads to higher rates of financially motivated crime—demonstrating that reproductive access restrictions have broad social and economic consequences that extend well beyond health. The fourth paper examines a quieter but consequential policy change: the legalization of pharmacist prescribing of hormonal contraceptives. Exploiting the staggered adoption of pharmacist prescribing authority across states, this study estimates the effect of this expanded access point on contraceptive utilization, with a focus on populations for whom traditional provider visits present the greatest barriers. The findings speak to the potential of low-cost supply-side interventions to meaningfully expand reproductive care access. Together, these papers offer a comprehensive and policy-relevant portrait of reproductive access in America—one that connects clinic closures, insurance expansions, provider scope-of-practice laws, and their downstream effects on health, economic security, and public safety. The panel highlights the importance of viewing reproductive policy through an equity lens, accounting for the heterogeneous burdens borne by those least positioned to absorb restricted access.

Policy Area

• Health Policy

Chair

• Laura Dague, Texas A&M University

Discussants

• Joaquin Alfredo-Angel Rubalcaba, University of North Carolina, Chapel Hill

• Joel E Segel, Pennsylvania State University

Organizer

• Nicole Y Siegal, Indiana University

Individual Presentations

• ACA Medicaid Expansion and Contraceptive Provision to Teens - Presenting Author: Savannah Lillian Ellison, Georgia Institute of Technology

• Access to Abortion Facilities and Low-Income Women's Health: Evidence from Medicaid Beneficiaries - Presenting Author: Caitlin Knowles Myers, Middlebury College

• The Effect of Pharmacy Scope of Practice Regulations on Healthcare: Evidence from Contraceptive Prescribing - Presenting Author: Nicole Y Siegal, Indiana University