Subsidizing contraception: Effects on contraceptive coverage, abortions, and births
Journal of Health Economics · 2026 · Sarah J. Rosenberg
中文摘要
扩大医疗保险覆盖既可能增加也可能减少怀孕和生育，取决于其对避孕可及性和生育经济成本的影响。我利用双重差分模型以及州级层面的避孕服务提供、出生和堕胎数据，研究《平价医疗法案》的医疗补助（Medicaid）扩展，并综合分析这些结果以区分补贴避孕的作用。该扩展导致避孕服务提供大幅增加，尤其是短效激素避孕方法。青少年生育率显著下降 5%，这一下降归因于父母参保资格的扩大，而扩展对总体生育率的影响与零无法区分。对堕胎的估计效应并不精确，但提示青少年堕胎可能有所减少。基于避孕服务提供的模拟表明，避孕补贴使怀孕率和生育率下降约 1% 至 2%。这些发现表明，医疗补助的避孕补贴适度减少了怀孕、堕胎和生育，但也表明，生殖健康医疗的经济障碍总体上并非生育行为的主要驱动因素。
Abstract
Expanding health insurance can either increase or decrease pregnancies and births, depending on how it affects access to contraception and the financial costs of childbearing. I study the Affordable Care Act's Medicaid expansion using difference-in-differences models and state-level data on contraceptive provision, births, and abortions, synthesizing analysis of these outcomes to distinguish the role of subsidized contraception. The expansion led to a substantial increase in contraceptive provision, particularly for short-acting hormonal methods. Teen birth rates fell significantly by 5%, a reduction that owes to increased parental eligibility, while effects on overall birth rates are not distinguishable from zero. Estimated effects on abortion are imprecise but suggestive of reductions for teens. Simulations based on contraceptive provision imply that subsidized contraception led to reductions in the pregnancy and birth rate of approximately 1% to 2%. These findings indicate that Medicaid's contraceptive subsidies modestly reduced pregnancies, abortions, and births, but also suggest that financial barriers to reproductive health care are not a primary driver of fertility behavior overall.