Effect of an Abrupt Change in Sexual and Reproductive Health Policy on Adolescent Birth Rates in Ecuador, 2008-2017

Omar Galárraga, Jeffrey E. Harris

NBER Working Paper No. 26044
Issued in July 2019
NBER Program(s):Health Care, Health Economics, Political Economy

In recent years, several countries have implemented restrictive, abstinence-only policies toward reproductive health, as opposed to comprehensive, adolescent-friendly health services. Little is known, however, about the effects of these restrictive policies on adolescent birth rates at the national level or their differential effects by race and ethnicity. The extant literature is even scarcer in low- and middle-income countries. We fill this knowledge gap by exploiting an unexpected policy change in Ecuador that abruptly reversed course for reproductive health services for adolescent women in 2014. In a difference-in-differences analysis of age-specific birth rates in Ecuador’s 221 cantons, we find that the abrupt policy change was associated with an increase in teen birth rates by 9 births per 1000 women. In a difference-in-difference-in-differences analysis, we find that the policy change was associated with an additional increase of 12 births per 1000 women among those cantons where at least 12 percent of the population is self-declared as indigenous. Our results are robust to changes in standard error clustering, population weighting, logarithmic model specification, adjustments for underreporting, and changes in the year when the new policy went into effect.

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Document Object Identifier (DOI): 10.3386/w26044

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