The Multigenerational Effects of Legal Access to the Pill on Infant Health

We examine whether expanded legal access to the contraceptive pill for minors generated health benefits for subsequent generations. We use data from the restricted-use Natality files from 1970-2020, linking mothers to the level of access to the pill in their state and year of birth and the extent to which their mothers could access the pill as minors. Our results show that children whose mothers were born after expanded access to the pill as minors had better birth outcomes, with gains concentrated among Black families. Among affected births, legalization increased birth weight by 12-16 grams and reduced incidence of low birth weight by 2.7-3.4 percent. These magnitudes have economic significance, corresponding to approximately $113.8–$115.3 million in medical cost savings, measured in 2025 dollars, for the 2000 Black birth cohort alone. Our mechanism analysis points to a postponement of early childbearing by the generation directly affected by legal access to the pill as minors whose daughters subsequently attained higher levels of education, used more prenatal care, and had longer birth spacing. Taken together, our results suggest that reproductive health policy can generate multigenerational benefits and contribute to reductions in racial disparities in early-life health.