Mayra Pineda-Torres

In the U.S., more than one-third of counties qualify as maternity care deserts, affecting over 5 million women of reproductive age. These areas often lack a sufficient healthcare workforce to meet patient needs. Policies affecting reproductive healthcare provision can influence who wants to become a physician, where they study, the specialty they choose, and ultimately, where they practice. In this paper, we study the causal effect of abortion bans following the 2022 Supreme Court decision in Dobbs v. Jackson Women's Health Organization on physician career decisions and explore its underlying mechanisms. Combining novel data sources and empirical approaches, we find modest increases in the number of unfilled residency slots in reproductive healthcare specialties and a 3% decrease in reproductive healthcare physicians practicing in ban states relative to states protecting abortion access. This work contributes to our understanding of how healthcare regulatory landscapes shape physician workforce development and distribution.

We develop and estimate a structural model to study the extent to which reproductive health policy affects physicians' clinical labor market entry and geographic mobility at the transition from training to practice. We focus on the biggest reproductive policy change in the U.S. in the last 50 years: the Supreme Court decision in Dobbs, which transferred regulatory authority over abortion to individual states. We leverage a unique dataset of residents and fellows in New York State, interviewed at the precise moment of transition from training completion to practice. Our results indicate that Dobbs reduced immediate clinical labor-market entry among physicians in reproductive-care specialties by 4%, primarily through decreases in expected compensation. This work contributes to our understanding of how healthcare regulatory landscapes shape physician workforce occupational choices and geographic distribution.

We use difference-in-differences research designs to estimate the effects of abortion bans on births at the county level, leveraging data on changes in driving distance and appointment availability at the nearest facility where abortion remains legal. We find that bans alone increase births, but their total impact depends on geographic barriers to access. Even in counties where distance and appointment availability remain unchanged, a total ban leads to a 1.0% increase in births, suggesting a chilling effect—potentially due to legal uncertainty, misinformation, or logistical hurdles—that is independent of measurable barriers. However, the effects grow substantially with travel burdens. In counties where the nearest abortion facility was 50 miles away pre-Dobbs, a total ban increases births by 2.8% when distance rises to 300 miles. Limited appointment availability in destination cities further amplifies these effects, resulting in an additional 0.4 percentage point increase in births. The largest increases occur among Black and Hispanic women, those without a college degree, and unmarried women. We do not observe evidence that the effects have diminished with time despite expanded logistical, financial, and telehealth abortion support, underscoring the persistent role that geographic barriers play in abortion access.

Do restrictions on public funding create unintended reliance on social assistance? In this paper, we study the Hyde Amendment, which eliminated federal Medicaid funding for abortion nearly 50 years ago. Exploiting variation across AFDC households and state-level funding declines, we find that the Amendment raised fertility among AFDC recipients by 19 percent, with the effect concentrated on the margin from one to two (or more) children. These additional children were raised in households with prolonged welfare dependence and higher transfer income throughout childhood. Our results illustrate how restricting access to one public program can lead to extended reliance on other programs.

Public funding restrictions in the U.S. limit access to abortion services. In this paper, we study the 1976 Hyde Amendment, which barred federal Medicaid funding for abortion. Before Hyde, Medicaid paid for roughly 300,000 abortions, or a quarter of U.S abortions. Using a county-level event-study design, we find that fertility increased by 1.9% among women under 30 in counties with higher Medicaid eligibility after the Hyde Amendment. Fertility increased the most for unmarried women with existing children, the population most likely to be Medicaid-eligible. In Georgia, the only state reporting abortions by county, abortions fell by 9.6% at the average level of AFDC, enough to account for the additional births we observe. Today, nearly fifty years later, these restrictions through the Hyde Amendment still govern abortion coverage for one in five reproductive-age women.

We study the impact of improved access to abortion on intimate partner violence (IPV) by exploiting variation in abortion access induced by the legalization of abortion in Mexico City in 2007. Using a difference-in-differences framework and individual-level information on IPV, we find that after the abortion legalization, IPV declined by 7-9 percent for women residing in Mexico City and nearby municipalities. This effect is driven by women with children and those of low or middle socio-economic status. We provide evidence for potential mechanisms, including substitution of in-clinic abortions for self-induced ones, decreases in unwanted children, and increases in contraceptive use.

The innovation of ridesharing apps, such as Uber and Lyft, may be beneficial in assisting domestic violence (DV) victims with transportation access. Ridesharing may also facilitate employment, both via work as a driver and through reduced barriers to commuting, which can impact household bargaining and overall income-related stressors. However, the entrance of these app-based services has been shown to increase alcohol consumption, one of the strongest predictors of family violence. We use the spatial and temporal variation introduced by the roll-out of UberX in a staggered difference-in-differences design to estimate the net effect of ridesharing access on family violence. We find that the rollout of UberX reduced county-level child maltreatment rates, along with suggestive evidence that other forms of family violence may have also decreased.

We quantify the impact of federal subsidies for graduate medical education on primary care physician (PCP) supply by examining the impact of Section 5503 of the Affordable Care Act, which increased the number of residents that teaching hospitals in rural and high-need areas could receive subsidies for training. Instrumenting for selection into the program using its eligibility criteria, we find that the provision increased both recruitment of residents into primary care and time spent at teaching hospitals in high-need areas, resulting in a 4.1% increase in PCP supply.

We study the causal relationship between educational attainment and teenage birth rates by focusing on a large-scale, country-wide reform that made high school compulsory and removed previously existing school capacity constraints in Mexico. Relying on administrative data on schools and births, we implement a difference-in-differences strategy that exploits variation across time and municipality-level exposure to the reform to explore the effects of expanding educational opportunities on teenage fertility. We find that teenage birth rates decreased by 2.8 percent after the education reform in municipalities with high increases in high school availability relative to municipalities with low increases. Our findings suggest that this decline is not driven by a reduction in the time teenagers had to engage in risky behaviors.

The U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization sparked the most profound transformation of the landscape of abortion access in 50 years. We provide the first estimates of the effects of this decision on fertility using a pre-registered synthetic difference-in-differences design applied to newly released provisional natality data for the first half of 2023. The results indicate that states with abortion bans experienced an average increase in births of 2.3 percent relative to states where abortion was not restricted.

Following the 2022 decision of the U.S. Supreme Court, Dobbs v. Jackson Women's Health, several U.S. states have severely restricted or eliminated access to abortion. To shed light on the potential economic impacts of this landmark ruling, we estimate the impact of abortion access on women's educational attainment. We first codify the legal history of all targeted regulations of abortion providers (TRAP laws) ever implemented. We document that TRAP laws increased teen births by more than 3 percent and offer evidence that these impacts are driven by reductions in abortion access and abortion use. We further document that exposure to TRAP laws before age 18 reduces college initiation by 2.1 percent and college completion by 5.8 percent among Black women. For White women, despite comparable impacts on teen births, educational impacts are on college completion only, are less than half as large, and are not robust. Our findings suggest that modern abortion restrictions affect women's economic participation and contribute to racial inequality.

In August 2021, Roberts et al. published a research article in AJPH showing that pandemic-related lockdowns and legal restrictions led to a 31% decline in the number of abortions per month in Louisiana but an increase in the likelihood of obtaining a second-trimester abortion. In this editorial, we examine how COVID-19 and the Dobbs decision have impacted abortion services in Louisiana since the publication of this influential article. Concerns raised by Roberts et al. about the negative effects of clinic closures have only grown since their prescient study.

The Dobbs v. Jackson decision by the United States Supreme Court has rescinded the constitutional guarantee of abortion across the United States. As a result, at least 13 states have banned abortion access with unknown effects. Using Texas SB8 law that similarly restricted abortions in Texas, we provide insight into how individuals respond to these restrictions using aggregated and anonymized human mobility data. We find that Texas SB 8 law reduced mobility near abortion clinics in Texas by people who live in Texas and those who live outside the state. We also find that mobility from Texas to abortion clinics in other states increased, with notable increases in Missouri and Arkansas, two states that subsequently enacted post-Dobbs bans. These results highlight the importance of out-of-state abortion services for women living in highly restrictive states.

Beyond a handful of studies examining early-adopting states in the early 1990s, little is known about the causal effects of mandatory waiting periods for abortion. In this study, we evaluate the effects of a Tennessee law enacted in 2015 that requires women to make an additional trip to abortion providers for state-directed counseling at least 48 hours before they can obtain an abortion. Our difference-in-differences and synthetic-control estimates indicate that the introduction of the mandatory waiting period caused a 53–69 percent increase in the share of abortions obtained during the second trimester. Our analysis examining overall abortion rates is less conclusive but suggests a reduction caused by the waiting period. To put these estimates into context, we provide back-of-the-envelope calculations on the additional monetary costs that Tennessee's MWP imposes on women seeking abortions.

We investigate how historical changes in contraception and abortion access impact women's long-run outcomes. We use data from the Health and Retirement Study and an identification strategy that leverages variation in exposure to legal changes in access across cohorts born in the same states during the 1960s and 1970s. Our results for educational attainment align with prior work but are not statistically significant. The results for earnings indicate increases in the probability of working in a Social Security (SS) covered job in women's 20s and 30s associated with early access to contraception and abortion, but we find no evidence of positive effects on women's earnings in their 50s.