Losing Coverage, Losing Voice: Healthcare Access and Intimate Partner Violence Reporting

Healthcare providers are a frontline channel for detecting intimate partner violence (IPV): physicians are legally required to report suspected criminal injuries to the authorities and can refer victims to support and protection services. We study how restricting healthcare access affects the detection and formal reporting of IPV, exploiting a 2012 Spanish reform that withdrew public healthcare entitlement from undocumented immigrants while leaving emergency care universally accessible. Using a difference-in-differences design that compares foreign and Spanish-national women before and after the reform, we find that foreign women's use of public primary care fell by 4.9%, with no corresponding drop in emergency care use. IPV cases reaching the courts and applications for protection orders subsequently declined by about 12% among foreign relative to Spanish women, with larger effects in regions that enforced the restriction more strictly. The decline is concentrated in cases initiated through medical injury reports, and we find no accompanying change in self-reported victimization or in female homicide, suggesting a drop in detection rather than in underlying violence. Restricting healthcare access thus weakened the detection and formal reporting of IPV, an overlooked cost of policies that limit marginalized groups' access to public services.