Essays in Women's and Reproductive Health Economics

Abstract

The impacts of access to health care and protective services on health and wellness outcomes are important to understand, yet difficult to measure. To establish these causal relationships, researchers need an exogenous shock to access. Since there are a lot of factors that play in to the local networks---particularly in regard to women's health and safety issues---finding these exogenous shocks can be difficult. Some questions of particular relevance to women's health and safety may be the following: How does access to highly effective contraception impact childbearing behavior? Can unintended pregnancies be reduced through pre-existing local health care networks? Does a reduction in local capacity for abortions actually impact abortion behavior, or do women still obtain abortions at the same time and rate that they would in a capacity-unconstrained environment? Are there any direct consequences to leaving sexual assault kits untested, or are untested kits just the rational response by agencies to a lack of evidence? Can testing old, backlogged evidence kits have a meaningful effect on DNA databases? In this dissertation, I use natural experiments in which policy or funding changes created a shock to the provision of health care or protective services unrelated to demand for these services. My combined findings suggest that reducing barriers to reproductive control technology can improve outcomes for women: providing free, long-acting reversible contraception through Title X clinics reduced both teen births and the teen abortion rate by approximately 20-30 percent each. Similarly, reducing local abortion clinic capacity may have reduced the overall abortion rate by as much as 11 percent. Reduced local clinic capacity also delayed the timing of abortions---shifting women from obtaining abortions in the first 8 weeks of gestation into weeks 9-12 and beyond---and increased the birth rate by approximately 3 percent. Finally, increased funding for testing backlogged sexual assault kits increased the rate of profiles entered into state DNA databases by approximately 18 new profiles per 100,000 residents. This increase in profiles could impact victim (or potential victim) health through increased arrests, deterrence of future assaults, or improved mental health from knowing the perpetrator is behind bars.