HOMEPAGE

The Effects of State Reproductive Health Laws on Maternal and Infant Health

Abstract: In 2013, Texas implemented House Bill 2 (HB2), a law imposing strict operational requirements on abortion providers, which led to the closure of numerous clinics across the state. This policy created cross-county variation in access to abortion services, which I exploit to estimate the effects of restricted access on maternal and infant health. I find that a 100-mile increase in distance to the nearest abortion clinic is associated with a 31% increase in maternal morbidity, driven by large rises in severe obstetric complications, including third and fourth degree perineal lacerations and ruptured uterus cases. These adverse outcomes are not explained by general declines in healthcare access, such as maternity ward closures or reductions in prenatal care. Instead, these outcomes reflect a compositional shift in the birthing population, whereby restricted abortion access increases the share of births among women with preexisting or pregnancy-related health conditions, including chronic hypertension, diabetes, and prior preterm birth, as well as among teenagers, less educated, unmarried, older, and White women, thereby raising both the medical and socioeconomic risk of the birthing population. A counterfactual simulation suggests that if all counties had an abortion facility within 50 miles, approximately 952 cases of maternal morbidity, including 771 severe perineal lacerations and 24 ruptured uterus cases, could have been avoided. Infant outcomes show mixed effects, with Hispanic infants experiencing disproportionate adverse outcomes, and Neonatal Intensive Care Units (NICU) admissions rising in counties most affected by clinic closures. These findings demonstrate that restrictions on abortion access not only limit reproductive choice but also meaningfully increase maternal health risks, highlighting the broader public health consequences of policies that impose travel barriers to abortion services.

Medicaid Expansion and Disability Employment
with Adriana Corredor-Waldron & Raymond Guiteras

Abstract: The Affordable Care Act (ACA), enacted in 2010, sought to expand Medicaid eligibility to low-income individuals with incomes up to 138 percent of the federal poverty level (FPL). This policy could affect employment outcomes among individuals with disabilities through multiple channels. On one hand, providing access to health insurance independent of employment requirements might reduce the incentive to work, potentially lowering employment rates within the disabled population. On the other hand, the higher income threshold for Medicaid eligibility could encourage labor force participation by allowing individuals to seek employment without the risk of losing health coverage. Using data from the American Community Survey (ACS) and a staggered Difference-in-Differences (sDID) research design, I find that the ACA had a negative, though statistically insignificant, effect on employment among individuals with disabilities, and a positive but also statistically insignificant effect on labor force participation. Results from a Two-Way Fixed Effects (TWFE) model yield similar results, though with differences in magnitude. The discrepancy between the TWFE and sDID estimates highlights potential endogeneity bias in the TWFE approach, underscoring the importance of using more robust quasi-experimental methods when evaluating staggered policy interventions.

Family Planning Budget Cuts and Sexually Transmitted Infections
with Adriana Corredor-Waldron & Raymond Guiteras