Children of the Pill: The Effect of Subsidizing Oral Contraceptives on Children’s Health and Wellbeing SFOG-veckan, August 2015 Andreas Madestam, Stockholm University Emilia Simeonova, Johns Hopkins University

VECKAN 2015 

Disclosure of interests 

There is no conflict of interest to declare

Motivation 

Large literature on the effects of legalizing oral contraceptives on fertility and women’s education and career 

US institutional setup tricky: legalization of abortion and oral contraception often happen simultaneously for affected groups

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Work showing strong correlations between family socioeconomic status and children’s health and wellbeing

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No evidence on 

Long-term effect of lowering access barriers to the pill on the human capital of women and next generation

This study 

Investigates impact of lowering cost of contraception on health/education outcomes of women/next generation 

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Long-term effects of the subsidies on women’s socio-economic status (SES) Short- and long-term effects on the SES of the children of the affected women Compositional effects/selection into motherhood among the currently eligible women

Present additional short-term supportive evidence   

Subsidizing oral contraceptives significantly affects pill sales Subsidies decrease abortions in the affected groups Subsidies have effects on fertility in the affected groups

Good setting to study power of the pill 1. Link mothers and their children throughout their lives using individual-level registry data from Sweden  

Short- and long-term impact of the lowering the cost of the pill Identify heterogeneous effects on health and education across different groups of women and their children

2. Abortion available at low cost during the subsidyimplementation period 

Separate effect of oral contraceptives from other means of birth control

3. Identification strategy 

Staggered introduction across Swedish municipalities/counties and age eligibility at the end of the 1980s throughout the 1990s

Institutional background, at large

Pill is free No subsidy available Partial subsidy available

Institutional background, at large 

In the US, price of oral contraceptives depends on women’s individual insurance policies. Some community health centers provide subsidized products

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Mixed picture within EU 

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About half of the EU countries subsidize the price fully or to some extent to all women, 15-44 (Belgium, Denmark, Estonia, France, Greece, Ireland, Netherlands, Portugal, Slovenia, Spain, United Kingdom) Other half, subsidize some contraceptives or provide subsidizes to women under certain ages/low-income groups (Finland, Germany, Hungary, Italy, Luxembourg, Poland, Romania, Sweden)

Institutional background, Sweden  

Free legalized abortion since 1975 Oral contraceptives approved by National Board of Health and Welfare (Socialstyrelsen) for widespread use in 1964 

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Pill comes to market in 1965, fully subsidized in 1972 but subsidies removed in 1984 and all women pay full price in 1985

Municipalities react to rising teen abortion rates in early 1990s 

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Implement schemes between 1989-1998 that subsidize cost of oral contraceptives for young women (up to ages 19-24 depending on location); average subsidy size 75% of sticker price Sticker price of a yearly supply of oral contraceptives in 2001 ranged between $45 and $120 in 2001 US dollars (Socialstyrelsen, 2001)

Institutional background – how did the reform spread 

First to implement was a youth clinic in Gävle in 1989 

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Clinic subsized the pill for young girls below the age of 20 during a 1-year pilot period The cost of oral contraception constrained the regular use of the pill for young women (”ett hinder för en regelbunden användning av preventivmetoden”) Vivi-Anne Rahm adm. chief

Institutional background – how did the reform spread 

Others followed suit…

Institutional background – how did the reform spread (first three years) Location

Start date

Eligible cohorts

Gävle

Sep 01, 1989