Birth Collapse and Long-Acting Reversible Contraceptive Policies

We estimate the quantitative impact of a long-acting reversible contraceptive (LARCs) policy on the unexpected recent collapse of the Total Fertility Rate (TFR) in Uruguay. We exploit, first, the expansion schedule of a large-scale policy of access to sub-dermal implants in public hospitals across the country, through an event study to capture causal effects, and second, detailed birth administrative records for the last 20 years. We document an average reduction of 3% in the birth rate in public hospitals across the two years after the policy was implemented. These effects were concentrated among teens, with a decrease of 5.5%, and this decrease affects mainly the first birth. In the context of a reduction of 20% in births in three years, the use of implants can explain one-third of the reduction in births in public hospitals. We also document a more significant effect on first births and no effect on pregnancy outcomes such as childbirth weight or weeks of gestation.