Effects of Expanding Contraceptive Choice: New Evidence from Virginia's Contraceptive Access Initiative

In 2018, the Virginia Department of Health implemented the Contraceptive Access Initiative (CAI) to increase access to long-acting reversible contraceptives (LARCs). We use encounter-level data on contraceptive choice in participating CAI clinics and county-level natality data from 2014--2021 to estimate relative changes in LARC take-up and childbearing rates before and after the CAI. Difference-in-differences estimates indicate that the CAI reduced birth rates in participating counties by approximately 3 percent, or less than half of the effect size of other similar, state-level programs. We show that this smaller effect is likely due to existing high LARC take-up and contraceptive substitution.