The Impact of Abortion Legalization on Fertility and Female Empowerment, with Damian Clarke. Policy Brief for The Expert Group for Aid Studies (EBA), Sweden, 2018.

Kejsarsnitt vid högriskförlossningar – effekter på hälsa, fertilitet och arbetsmarknadsutfall, Ekonomisk Debatt, Nationalekonomiska Föreningen, nr 1 2019 årgång 47.

We examine the impact of progressive and regressive abortion legislation on women’s health and survival in Mexico. Following a 2007 reform in the Federal District of Mexico which decriminalised and subsidised early-term elective abortion, multiple other Mexican states increased sanctions on illegal abortion. We observe that the original progressive policy resulted in a sharp decline in maternal morbidity, particularly maternal morbidity due to haemorrhage early in pregnancy. We observe small or null impacts on women’s health from increasing sanctions on illegal abortion. We find some evidence to suggest that these impacts were also observed when considering maternal mortality, though effects are less precisely estimated.

(with Damian Clarke)  

Despite the fact that Cesarean section (C-section) is the most commonly performed surgery in a number of industrialized countries, little is known about the long-term consequences for the mothers and children involved. In this study, I use a sample of high-risk births—namely, breech births, in which the fetus is presented with its head upward instead of downward—to study the causal effect of C-sections on child health and on the health, fertility and labor market responses for mothers. Because selection into C-section may be endogenous, I exploit an information shock to doctors in 2000, in which new scientific evidence about the benefits of planned C-sections for breech births led to a sharp 23% increase in planned C-sections. Using Swedish registry data, I find that having a C-section improves child health in both the short and long run, indicated by higher Apgar scores at birth and fewer nights hospitalized during ages 1-7. I find little evidence to suggest any significant impact on maternal health, future fertility or maternal labor market outcomes.

In this study we examine the passage of a reform to in-vitro fertilization (IVF) procedures in Sweden in 2003. Following publication of medical evidence showing that pregnancy success rates could be maintained using single rather than multiple embryo transfers, the single embryo transfer (SET) was mandated as the default IVF procedure. Using linked registry data for the period 1998-2007, we find that the SET reform was associated with a precipitous drop in the share of multiple births of 63%. This narrowed differences in health between IVF and non-IVF births by 53%, and differences in the labor market outcomes of mothers three years after birth by 85%. For first time mothers it also narrowed the gap in maternal health between IVF and non-IVF births by 36%. Our findings imply that more widespread adoption of SET could lead to massive gains, reducing hospitalization costs and the foregone income of mothers and improving the long-run socioeconomic outcomes of children. This is important given that the share of IVF facilitated births exceeds 3% in several industrialized countries and is on the rise.

(with Sonia Bhalotra, Damian Clarke and Mårten Palme)  

We examine the effect of a large-scale, free, elective abortion program implemented in Mexico City in 2007. This reform resulted in a sharp increase in the request and use of early term elective abortions: approximately 90,000 abortions were administered by public health providers in the four years following the reform, versus only 62 in the five years preceding the reform. We document, firstly, that this localised reform resulted in a legislative backlash in 18 other Mexican states which constitutionally altered penal codes to increase sanctions on abortions. We take advantage of this dual policy environment to estimate the effect of progressive and regressive abortion reform on fertility and women's empowerment. Using administrative birth data we find that progressive abortion laws reduce rates of child-bearing, particularly among young women. Additionally, the reform is found to increase women's role in household decision making—an empowerment result in line with economic theory and empirical results from a developed-country setting. We however find little evidence to suggest that the resulting regressive changes to penal codes have had an inverse result over the time-period studied. In turning to mechanisms, evidence from a panel of women suggests that results are directly driven by increased access to abortion, rather than changes in sexual behaviour, contraceptive use or contraceptive knowledge.  

(with Damian Clarke)