Can Expanding Contraceptive Access Reduce Adverse Infant Health Outcomes?

This paper demonstrates that expanding access to Long-Acting Reversible Contraceptives (LARCs) to lower-income women creates positive selection in the health of the cohorts of children being born. I exploit the staggered timing of three privately funded programs which distributed LARCs at no cost to lower-income women in Colorado, Iowa and St. Louis, implementing an event-study design which compares trends in treated counties with other U.S. counties with similar family planning clinics. I find that expanded LARC access led to reductions of approximately 1.0 `extremely preterm’ births and 1.1 infant deaths per 1,000 live births. I find significant reductions in deaths due to birth defects, maternal pregnancy complications, Sudden Infant Death Syndrome, and homicide. Using a back-of-the-envelope calculation, I find that the Colorado program, which was funded by a $27 million donation, led to reductions in ventilation costs for extremely preterm births of approximately $4.3 million per year. These results suggest that giving lower-income women the means to control their fertility has the potential to reduce adverse infant health outcomes and could decrease the infant mortality gap which exists between the US and other leading economies