The Impact of Women's Health Clinic Closures on Fertility

Abstract

The government of Texas recently enacted multiple restrictions and funding limitations on women's health organizations that provide abortion services or are associated with those that do. These policies have caused numerous clinic closures throughout the state, drastically reducing access to care. We study the impact of these clinic closures on fertility by combining quarterly snapshots of health center addresses from a network of women's health centers with restricted geotagged data of all Texas birth certificates for 2007-2013. We calculate the driving distance to the nearest clinic for each ZIP code, and find that an increase of 100 miles to the nearest clinic results in a 1.2 percent increase in the birth rate. This increase is driven by fertility changes for unmarried women and those having their first or second child. It also reduces average maternal age.

The Impacts of Reduced Access to Abortion and Family Planning Services: Evidence from Texas

“…Most related to this paper are Grossman et al (2017) and two concurrent working papers, Lu and Slusky (2017) and Cunningham et al (2017), which all leverage the recent restrictions in reproductive clinic access in Texas. Using a unique data source on the locations of a large family planning clinic provider, Lu and Slusky (2017) examine the effect of clinic closures within that network on births through 2013 (prior to the major change in access to abortion).…”

“…Much of the existing literature focuses on early expansions in family planning and abortion access (e.g., Roe v. Wade and the adoption of the birth control pill). 11 Exceptions include the implementation of parental consent and notification laws (Blank et al, 1996;Joyce and Kaestner, 1996;Levine, 2001;Averett et al, 2002;Levine, 2003;Joyce et al, 2006; 10 This indirect test for parallel trends in the pre-policy period is similar to a procedure used in Lu and Slusky (2017). 11 For example, many studies have examined the expansion of oral contraceptives and show that it led to delayed childbearing, reduced fertility, increased career investment for women, and better child outcomes (Goldin and Katz, 2002;Bailey, 2006;Kearney and Levine, 2009;Bailey, 2010Bailey, , 2012Ananat and Hungerman, 2012;Bailey, 2013).…”

“…Using a unique data source on the locations of a large family planning clinic provider, Lu and Slusky (2017) examine the effect of clinic closures within that network on births through 2013 (prior to the major change in access to abortion). However, such analyses miss changes to the market of abortion services and other family planning clinics in Texas.…”

“…Third, we employ a procedure similar to that used in Lahey (2014) and Lu and Slusky (2017) as another indirect test of the parallel trends assumption. Collapsing to the county level, we predict the change in access to each type of clinic occurring between 2011 and 2015 (the roll-out and post-period) using the change in fertility rates from the pre-period, 2006-2010.…”

“…For comparison, we contrast our results with Lu and Slusky (2017), who use variation in access to one single large provider of family planning services through the year 2013. Using a linear family planning access measure without controls for abortion clinic access, they find that an increase of 25 miles to the nearest clinic translates into a 0.3 percent increase in the birth rate.…”