Contraceptive access reform and abortion: Evidence from Delaware.

OBJECTIVE

To examine the effects of a comprehensive contraceptive access reform, Delaware Contraceptive Access Now, on abortion-one of the most common outcomes of unintended pregnancy.

DATA SOURCE

We used abortion data by state of residence from the Abortion Surveillance System, published by the Centers for Disease Control and Prevention. Our data covers 5 years prior to (2010-2014) and 5 years after the intervention (2015-2019).

STUDY DESIGN

We used synthetic control methods to estimate program effects. Our design compares Delaware to a weighted average of 45 control states ("synthetic Delaware"), where the quality of the comparison is assessed by its similarity to Delaware in pre-period outcome levels and trends.

DATA COLLECTION/EXTRACTION METHODS: Not applicable. We relied on secondary sources.

PRINCIPAL FINDINGS

We did not find statistically significant evidence that the program reduced abortion rates (0.61 fewer abortions per 1000 women, p-value = 0.74) on average, during the intervention period. The treatment effects were slightly larger in 2016 and 2017 (1.97 fewer abortions per 1000 women but not statistically significant) and attenuated in 2018 and 2019. This does not rule out program benefits in easing barriers to contraceptive methods or in reducing unplanned births. However, findings do suggest that increasing contraceptive access might not be an adequate substitute for restricted abortion access resulting from Dobbs v. Jackson Women's Health Organization.

CONCLUSIONS

Our results suggest that comprehensive efforts to improve contraceptive access may not reduce the need for accessible and affordable abortion care.