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Subsidized Contraception, Fertility, and Sexual Behavior

  • Melissa S. Kearney
  • Phillip B. Levine

This paper examines the impact of recent state-level Medicaid policy changes that expanded eligibility for family planning services to higher income women and to Medicaid clients whose benefits would expire otherwise. We begin by establishing that the income-based policy change led to a substantial increase in the number of program recipients. We then examine Vital Statistics birth data from 1990 to 2003 and determine that it also reduced overall births to non-teens by about two percent and to teens by over four percent. Our estimates suggest a nearly nine percent reduction in births to women age 20-44 made eligible by the policy change. We supplement our state-level analysis with an investigation of individual-level data from the 1988, 1995, and 2002 National Surveys of Family Growth (NSFG) to examine the impact of these policies on sexual behavior and contraceptive use. Evidence from this analysis suggests that the reduction in fertility associated with raising income thresholds for eligibility was accomplished via greater use of contraception. Our calculations indicate that allowing higher income women to receive federally-funded family planning cost on the order of $6,800 for each averted birth.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 13045.

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Date of creation: Apr 2007
Date of revision:
Publication status: published as Melissa S Kearney & Phillip B Levine, 2009. "Subsidized Contraception, Fertility, and Sexual Behavior," The Review of Economics and Statistics, MIT Press, vol. 91(1), pages 137-151, October.
Handle: RePEc:nbr:nberwo:13045
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  1. Timothy Besley & Anne Case, 1994. "Unnatural Experiments? Estimating the Incidence of Endogenous Policies," NBER Working Papers 4956, National Bureau of Economic Research, Inc.
  2. Paul Gertler & John Molyneaux, 1994. "How economic development and family planning programs combined to reduce indonesian fertility," Demography, Springer, vol. 31(1), pages 33-63, February.
  3. Phillip B. Levine, 2001. "The Sexual Activity and Birth-Control Use of American Teenagers," NBER Chapters, in: Risky Behavior among Youths: An Economic Analysis, pages 167-218 National Bureau of Economic Research, Inc.
  4. Phillip B. Levine, 2002. "The Impact of Social Policy and Economic Activity Throughout the Fertility Decision Tree," NBER Working Papers 9021, National Bureau of Economic Research, Inc.
  5. Martha J Bailey, 2006. "More Power to the Pill: The Impact of Contraceptive Freedom on Women's Life Cycle Labor Supply," The Quarterly Journal of Economics, MIT Press, vol. 121(1), pages 289-320, 02.
  6. Melissa Schettini Kearney, 2002. "Is There an Effect of Incremental Welfare Benefits on Fertility Behavior? A Look at the Family Cap," NBER Working Papers 9093, National Bureau of Economic Research, Inc.
  7. Jennifer M. Mellor, 1998. "The Effect of Family Planning Programs on the Fertility of Welfare Recipients: Evidence from Medicaid Claims," Journal of Human Resources, University of Wisconsin Press, vol. 33(4), pages 866-895.
  8. Paton, David, 2002. "The economics of family planning and underage conceptions," Journal of Health Economics, Elsevier, vol. 21(2), pages 207-225, March.
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