Accepted for publication at Journal of Human Resources
Abstract: In 2011, Pennsylvania passed regulations requiring abortion-providing facilities to meet ambulatory surgical facility standards, which ultimately caused the closure of almost half of the state’s abortion facilities. All closing facilities were geographically near facilities that remained open, meaning distance to the nearest clinic was unchanged while local clinic capacity fell. I use a difference-in-differences design supplemented with a synthetic control method and find that reduced clinic capacity caused 30-40 percent fewer abortions in the first 8 weeks of gestation and more abortions at later gestational ages. Evidence suggests an increase in birth rates for Black women, though these results are sensitive to specification and control group choices.
With Jason Lindo and Analisa Packham
Journal of Public Economics, vol. 192, December 2020, Article 104288
https://doi.org/10.1016/j.jpubeco.2020.104288
NBER link: #25656, Pre-publication version
Abstract: We estimate the effect of Colorado's Family Planning Initiative, the largest program to have focused on long-acting reversible contraceptives in the United States, which provided funds to Title X clinics so that they could make these contraceptives available to low-income women. We find substantial effects on birth rates, concentrated among women in zip codes within 7 miles of clinics: the initiative reduced births by approximately 20 percent for 15-17 year olds and 18-19 year olds living in such zip codes. We also examine how extensive media coverage of the initiative in 2014 and 2015 altered its reach. After information spread about the availability and benefits of LARCs, we find a substantial increase in LARC insertions, extended effects on births among 15-17 year olds living greater than 7 miles from clinics, and significant reductions in births among 20-24 and 25-29 year olds.
Media coverage: The Daily Mail, The Denver Post, The Weeds (Vox)
Abstract: In 2016, Oregon became the first state to allow pharmacist prescription of hormonal contraceptive pills. I find that births in treated zip codes decrease by nearly 13% per year following legalization of pharmacists’ prescription of birth control. The effect is somewhat stronger when focusing on zip codes with a history of Medicaid physician shortages. Quarterly, state-level Medicaid prescriptions data show an increase in birth control prescriptions that is persistent after a delayed spike. Using county-level monthly data, I show the reduction in births is accompanied by an initial reduction in abortions in the first year and a continued decline in births only when focusing on provider-shortage counties. This evidence suggests that pharmacists can play an important role in alleviating problems caused by health worker shortages, and that analyzing localized effects is important in the reproductive health context.
Draft coming soon!
Abstract: Doulas, or specifically birth/labor and delivery doulas, have long been viewed as a useful support in the labor and delivery process. Yet little is known about population-level effects of doulas in deliveries for low-income families. This paper studies the impact of Medicaid coverage of pregnancy- and labor-and-delivery-related doulas. I find that after the implementation of state policies to provide Medicaid support for doula services, the number of registered doulas in a state increases and the likelihood of delivery by Cesarean section drops. Overall, the rate of C-sections drops by about 3.8%, but drops by as much as 5 and 7% for Black and Hispanic mothers respectively. Effects are driven by a reduction in failed labor attempts.
With Lilly Springer
Draft coming soon!
Abstract: In August of 2022, Idaho’s trigger abortion ban began to be enforced, making abortion illegal in almost all cases. Idaho residents in need of abortion, then, had to travel out-of-state or self-manage their abortions. In the immediate aftermath of this ban, abortions in Oregon obtained by out-of-state residents increased dramatically – jumping 38% from July to August of 2022 (74 to 102) and peaking at a high of 179 (a 163% increase from the pre-ban average) in May of 2024. While 2025 data are still preliminary, it does appear that out-of-state residents obtaining abortions in Oregon fell somewhat by the end of 2025, though never quite reaching the pre-ban monthly average. This dramatic increase in out-of-state abortion patients – while already a demonstration of increased travel for out-of-state patients – may also represent an increase in congestion in Oregon’s abortion providing facilities, which may have reduced access to abortion for Oregon residents.
with Saki Ehara
Draft coming soon!
with Slawa Rokicki
Papers with a * indicate work with undergraduate students at Grinnell College.