The Children of the Missed Pill

Abstract

We would like to thank Fernando Alvarado, MD for his valuable input. We are indebted to the useful comments of Melissa Kearney, Jeanne Lafortune, Santiago Truffa, Sarah Okoampah, John Casterline, Monica Deza, Jackie Buhrmann and seminar participants at the World Bank NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.© 2017 by Tomás Rau, Miguel Sarzosa, and Sergio S. Urzúa. All rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including © notice, is given to the source. ABSTRACTWe use sharp, massive and unexpected price increases of oral contraceptives-product of a documented case of collusion among pharmaceutical retailers in Chile-as a natural experiment to estimate the impact of access to the Pill on fertility and newborn health. Our empirical strategy combines multiple sources of information and takes into account the seasonality of conceptions and the general trends of fertility, as well as the dynamics that arise after interrupting Pill's intake. Our estimates suggest that due to the price hike, the weekly birth rate increased by 4%. We show large effects on the number of children born to unmarried mothers, from mothers in their early 20's, and to primiparae women. Moreover, we find evidence of significant deterioration of newborn health as measured by the incidence of low birthweight and infant mortality. We suggest that the "extra" conceptions faced dire conditions during gestation as a result of mothers' unhealthy behaviors. In addition, we document a disproportional increase of 27% in the weekly miscarriage and stillbirth rates, which we interpret as manifestations of active efforts of termination in a country where abortion was illegal. As the "extra" children reached school age, we find lower school enrollment rates and higher participation in programs for students with special needs. Our results suggest that access to contraceptives may prevent conceptions that will turn out to be in relatively poor health, and thereby may improve the average health of children conceived.

Shared Decision-Making: Can Improved Counseling Increase Willingness to Pay for Modern Contraceptives?

“…Ashraf et al (2014) find that provision of vouchers to married women in the presence of husbands reduces their redemption compared to them being offered when they are alone in the setting of a large clinic in Lusaka. Recent quasi-experimental studies also indicate that women, unmarried young women in particular, may be responsive to contraceptive prices (Rau et al, 2017), with adolescents in the U.S. selecting LARCs and continuing to use them longterm (Mestad et al, 2011) and programs encouraging clinics to stock and provide free LARCs to low-income women causing decreases in teen birth rates (Lindo and Packham, 2017).…”

Improving the Well-Being of Adolescent Girls in Developing Countries

“…While large changes in prices of contraceptive methods were found to have little impact on contraceptive use in Indonesia during the 1998 financial crisis (McKelvey, Thomas, and Frankenberg 2012), 32 more recent studies indicate that women, unmarried young women in particular, may be more responsive to contraceptive prices (Lindo and Packham 2017;Rau, Sarzosa, and Urzúa 2017). In the United States, adolescents who receive comprehensive counseling and face no cost barriers preferentially select long-active reversible contraceptive methods (LARCs) and continue to use them long-term (Mestad et al, 2011).…”