This dissertation is composed of three chapters detailing the health and fertility effects of restricted access to abortion in the United States. Chapter 1: The Maternal and Infant Health Consequences of Restricted Access to Abortion in the United States Since the recent US Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, people across the country have experienced large sudden changes in their access to abortion care. In this paper, I look to the history of abortion access in the United States to inform predictions for this new future. I study the effects of targeted regulations on abortion providers (TRAP laws) on a variety of maternal and infant health outcomes, using variation in the timing of policy adoption across states and a direct measure of the distance to an abortion provider. I implement difference- in-differences techniques across outcomes from restricted-use microdata on the universe of US births and national survey data from the Behavioral Risk Factor Surveillance System. I find that TRAP laws lead to 11-16% increased rates of hypertensive disorders of pregnancy, and I provide suggestive evidence that these health effects may not be isolated to the period of pregnancy and birth. Additionally, I find evidence that TRAP laws widen existing disparities in adverse infant health outcomes across parental race and education. These results demonstrate the potentially wide-ranging health effects of restricting access to abortion. Chapter 2: Notification vs Consent: The Differential Effects of Parental Involvement Laws on Teen Abortion US state legislation requiring parental involvement in the abortion decision of a minor has grown in prevalence since its origin in the 1970s. Today, 36 states impose a parental involvement requirement on their residents below the age of 18. These laws come in two primary categories: parental notification and parental consent. Though much research estimates the effects of these policies, limited evidence exists regarding any differential impact between parental notification and parental consent. This paper uses the synthetic control method to determine if the increased marginal cost of an abortion imposed by a parental consent statute affects the abortion rate and birth rate for minors relative to parental notification. Results indicate no evidence of a marginal effect of parental consent laws on the abortion/birth rate of minors overall, suggesting that the additional cost of a parental consent law may be small. Chapter 3: The Effects of Restricted Abortion Access on IUDs, Contraceptive Implants, and Vasectomies: Evidence from Texas (with Cara Haughey and Brad Crowe) Abortion and contraception are often considered to be substitutes, such that an increase in the cost of abortion will increase the demand for contraception. Although the effects of restricted abortion access are wide-reaching and often studied, we know little about the influence of abortion access on the take-up of contraception. In this paper, we exploit the timing of passage of House Bill 2 (HB2) in Texas, a regulation on abortion providers that shut down over half of all abortion clinics in the state. Using administrative outpatient records from Texas, we identify the effects of HB2 on the timing and take-up of intrauterine devices (IUDs), contraceptive implants, and vasectomies using difference-in-differences methods. We find suggestive evidence that expectations of limited abortion access significantly increase the take-up of IUDs, with no substantial evidence of an effect for the incidence of implants or vasectomies. These early findings support the hypothesis that abortion and contraception are substitutes, but the lack of evidence to indicate an effect of HB2 on the incidence of vasectomies suggests that partners may not internalize the cost of abortion in their contraceptive choices.
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