Contraceptive access reform and abortion: Evidence from Delaware.
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abstract
OBJECTIVE: To examine the effects of a comprehensive contraceptive access reform, Delaware Contraceptive Access Now, on abortion-one of the most common outcomes of unintended pregnancy. DATA SOURCE: We used abortion data by state of residence from the Abortion Surveillance System, published by the Centers for Disease Control and Prevention. Our data covers 5years prior to (2010-2014) and 5years after the intervention (2015-2019). STUDY DESIGN: We used synthetic control methods to estimate program effects. Our design compares Delaware to a weighted average of 45 control states ("synthetic Delaware"), where the quality of the comparison is assessed by its similarity to Delaware in pre-period outcome levels and trends. DATA COLLECTION/EXTRACTION METHODS: Not applicable. We relied on secondary sources. PRINCIPAL FINDINGS: We did not find statistically significant evidence that the program reduced abortion rates (0.61 fewer abortions per 1000 women, p-value=0.74) on average, during the intervention period. The treatment effects were slightly larger in 2016 and 2017 (1.97 fewer abortions per 1000 women but not statistically significant) and attenuated in 2018 and 2019. This does not rule out program benefits in easing barriers to contraceptive methods or in reducing unplanned births. However, findings do suggest that increasing contraceptive access might not be an adequate substitute for restricted abortion access resulting from Dobbs v. Jackson Women's Health Organization. CONCLUSIONS: Our results suggest that comprehensive efforts to improve contraceptive access may not reduce the need for accessible and affordable abortion care.
