Contraceptive Access Reform and Fertility

Daniel Marthey, Liyang Xie, Constanza Hurtado-Acuna and Michel Boudreaux

American Journal of Health Economics, 2026, vol. 12, issue 4, 695 - 721

Abstract: We investigated the impact of a comprehensive state-based contraceptive access program on fertility. The multimillion-dollar program reformed Medicaid payment, stocked reproductive health clinics with contraceptive supplies, trained providers across the state, and fielded a public awareness campaign. Despite modest changes to contraceptive use, synthetic control method estimates suggest no evidence that the program affected fertility in the general population. Null results are consistent by age, parity, and educational attainment. However, we observed suggestive evidence of delayed reductions in non-Hispanic Black and non-Hispanic White births. Our findings have implications for the many US states engaged in or considering similar programs.

Date: 2026
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