RESEARCH

Working Papers

Reproductive Healthcare Policy and Physician Career Decisions (with Cecilia Diaz-Campo)

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.

Reproductive healthcare physicians in ban vs protective states

The Road Not Taken: How Driving Distance and Appointment Availability Shape the Effects of Abortion Bans (with Daniel Dench and Caitlin Myers), NBER Working Paper No. 33548.

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.

Predicted increases in births by county

Access to abortion and intimate partner violence (with Aixa Garcia-Ramos)

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.

Distribution of facilities providing ILE service

Improvements in Schooling Opportunities and Teen Births (with Maria Padilla-Romo, Cecilia Peluffo, and Lucas Nogueira Garcez). IZA Discussion Paper No.16791. R&R

We study the causal relationship between educational attainment and teenage fertility 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 fertility rates decreased by 3 percent after the education reform in municipalities with high increases in high school availability relative to municipalities with low increases. This decline in fertility is driven by teenagers changing their expectations for the future rather than an incapacitation effect.

Estimated effects of the education reform on teen births

Medical Residency Subsidies and Physician Shortages (with Cici McNamara). IZA Discussion Paper No.17263 . Under Review

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 and allocation criteria, we find that the provision increased both the recruitment of residents into primary care and time spent at teaching hospitals in high-need areas, resulting in an increase in PCP supply in treated counties of 5.2 percent.

Estimated effects of Section 5503 on residents per 100 beds

Publications

The Effects of the post-Dobbs Abortion Bans on Fertility (with Daniel Dench and Caitlin Myers). IZA Discussion Paper No. 16608. Journal of Public Economics, June 2024.

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.

Media coverage:

"Population, Aging, and the Economy," 3/21/24, The 2024 Economic Report of the President

"How Many Abortions Did the Post-Roe Bans Prevent?" 11/22/23, The New York Times.

"Births have increased in states with abortion bans, research finds," 11/21/23, CNNhealth.

"Birth Rates Have Risen in States With Abortion Bans," 11/22/23, Healthday. (reprinted worldwide).

"Abortion Bans Raised Annual US Births by 32,000, Study Shows," 11/22/23, Bloomberg. (reprinted worldwide).

"Overturning of Roe v. Wade led to 32,000 additional births, study finds," 11/25/23, The New York Post.

Effects of abortion bans on births by state

TRAP'd Teens: Impacts of abortion provider regulations on fertility & education (with Kelly M. Jones). IZA Discussion Paper No. 14837. Journal of Public Economics, June 2024.

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.

Impacts of admitting privileges law implementation on black teen birth rates

Looking Back: The Changing Landscape of Abortion Care in Louisiana (with Yana van der Meulen Rodgers). American Journal of Public Health, May 2024.

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.

Average distance from a county in Louisiana to the nearest abortion facility

Texas Senate Bill 8 significantly reduced travel to abortion clinics in Texas (with Martin Andersen, Chris Marsicano, and David Slusky), Frontiers in Global Women's Health, March 2023

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.

Percentage change in mobility near abortion clinics by state for Texas devices relative to non-Texas devices

New Evidence on the Effects of Mandatory Waiting Periods for Abortion (with Jason Lindo), NBER Working Paper 26228, Journal of Health Economics, December 2021

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.

Media coverage:

"Tennessee's abortion wait period law faces court arguments," 9/20/19, Associated Press (reprinted worldwide)

"Mandatory waiting periods can make abortions nearly $1,000 more expensive," 9/10/19, MarketWatch

Percent of abortions in the second trimester

Legal Access to Reproductive Control Technology, Women's Education, and Earnings Approaching Retirement Outcomes (with Jason Lindo, David Pritchard, and Hedieh Tajali), Papers and Proceedings 2020

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.

Effects of The Pill and abortion access on working in an SS-covered job

Work in Progress

Abortion Access and Family Well-Being (with Daniel Dench, Savannah Ellison, and Jason Lindo)
The Economics of Abortion Funding (with Kelly Jones)
What is the Potential for Dobbs to Impact Economic Well-Being? (with Kelly Jones)
The Consequences of Abortion Funding Bans (with Nikita Dhingra and Lauren Hoehn-Velasco)
Evolving Trends in Contraceptive Choice: Understanding the Role of Medical Providers (with Melanie Guldi and Sarah Rosenberg)