Subdermal contraceptive implants and repeat teenage motherhood: Evidence from a major maternity hospital-based program in Uruguay.


Journal

Health economics
ISSN: 1099-1050
Titre abrégé: Health Econ
Pays: England
ID NLM: 9306780

Informations de publication

Date de publication:
12 2023
Historique:
revised: 16 03 2023
received: 23 09 2022
accepted: 10 07 2023
medline: 6 11 2023
pubmed: 2 8 2023
entrez: 2 8 2023
Statut: ppublish

Résumé

Teenage fertility is a social problem because of its private and public costs in countries of different development levels. Reductions in adolescent birth rates do not necessarily follow drops in overall fertility due to the demographic transition model. This paper analyses the impact of a subdermal contraceptive program on repeat teenage motherhood. Using a regression discontinuity design, we find that the intervention reduced mothers' likelihood of having another child in the next 48 months by 10 percentage points. This reduction is not random, and we also identify small positive selection in subsequent births.

Identifiants

pubmed: 37528619
doi: 10.1002/hec.4745
doi:

Substances chimiques

Contraceptive Agents 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

2679-2693

Informations de copyright

© 2023 The Authors. Health Economics published by John Wiley & Sons Ltd.

Références

Aguirre, R., Gorgoroso, M., Píriz, G., Cambre, L., Alegretti, M., Cardozo, S., Dáaz, J., & Ramos, V. (2017). Introducción de implantes anticonceptivos subdérmicos en Uruguay: Estudio piloto sobre aceptación y desempeño clínico de los implantes utilizados en servicios de salud del área metropolitana de Montevideo (Technical report). Ministerio de Salud Pública.
Aizer, A., Devereux, P., & Salvanes, K. (2022). Grandparents, moms, or dads? Why children of teen mothers do worse in life. Journal of Human Resources, 57(6), 2012-2047. https://doi.org/10.3368/jhr.58.2.1019-10524R2
American College of Obstetricians and Gynecologists (2018). ACOG committee opinion No. 735: Adolescents and long-acting reversible contraception: Implants and intrauterine devices. Obstetrics & Gynecology, 131(5), e130-e139. https://doi.org/10.1097/AOG.0000000000002632
Ananat, E. O., & Hungerman, D. M. (2012). The power of the pill for the next generation: Oral contraception’s effects on fertility, abortion, and maternal and child characteristics. The Review of Economics and Statistics, 94(1), 37-51. https://doi.org/10.1162/REST_a_00230
Angrist, J. D., & Evans, W. N. (2000). Schooling and labor market consequences of the 1970 state abortion reforms. Research in Labor Economics, 18, 75-113. https://doi.org/10.1016/S0147-9121(99)18020-8
Antón, J.-I., Ferre, Z., & Triunfo, P. (2018). The impact of the legalisation of abortion on birth outcomes in Uruguay. Health Economics, 27(7), 1103-1119. https://doi.org/10.1002/hec.3659
Arribas-Mir, L., Rueda-Lozano, D., Agrela-Cardona, M., Cedeño-Benavides, T., Olvera-Porcel, C., & Bueno-Cavanillas, A. (2009). Insertion and 3-year follow-up experience of 372 etonogestrel subdermal contraceptive implants by family physicians in Granada, Spain. Contraception, 80(5), 457-462. https://doi.org/10.1016/j.contraception.2009.04.003
Bailey, M. (2006). More power to the pill: The impact of contraceptive freedom on women’s life cycle labor supply. Quarterly Journal of Economics, 121(1), 289-320. https://doi.org/10.1093/qje/121.1.289
Balsa, A. I., & Triunfo, P. (2021). The effects of expanded social health insurance on young mothers: Lessons from a pro-choice reform in Uruguay. Health Economics, 30(3), 603-622. https://doi.org/10.1002/hec.4213
Bearak, J. M., Popinchalk, A., Beavin, C., Ganatra, B., Moller, A.-B., Tunçalp, Ö., & Alkema, L. (2022). Country-specific estimates of unintended pregnancy and abortion incidence: A global comparative analysis of levels in 2015-2019. BMJ Global Health, 7(3), e007151. https://doi.org/10.1136/bmjgh-2021-007151
Bentancor, A., & Clarke, D. (2017). Assessing plan B: The effect of the morning after pill on children and women. Economic Journal, 127(607), 2525-2552. https://doi.org/10.1111/ecoj.12390
Bitler, M., & Zavodny, M. (2001). The effect of abortion restrictions on the timing of abortions. Journal of Health Economics, 20(6), 1011-1032. https://doi.org/10.1016/S0167-6296(01)00106-0
Boden, J. M., Fergusson, D. M., & Horwood, L. J. (2007). Early motherhood and subsequent life outcomes. Journal of Child Psychology and Psychiatry, 49(2), 151-160. https://doi.org/10.1111/j.1469-7610.2007.01830.x
Branson, N., & Byker, T. (2018). Causes and consequences of teen childbearing: Evidence from a reproductive health intervention in South Africa. Journal of Health Economics, 57, 221-235. https://doi.org/10.1016/j.jhealeco.2017.11.006
Cabella, W., Nathan, M., & Pardo, I. (2019). La caída de la fecundidad en Uruguay entre 2015 y 2018. In United Nations Fund for Population Activities, Ministerio de Salud Pública, & Universidad de la República (Eds.), Descenso acelerado de la fecundidad en Uruguay entre 2015 y 2018. Tres estudios para su análisis (pp. 33-70). United Nations Fund for Population Activities, Ministerio de Salud Pública, and Universidad de la República.
Cabella, W., & Velázquez, C. (2022). Abortion legalization in Uruguay: Effects on adolescent fertility. Studies in Family Planning, 53(3), 491-514. https://doi.org/10.1111/sifp.12204
Calonico, S., Cattaneo, M. D., Farrell, M. H., & Titiunik, R. (2019). Regression discontinuity designs using covariates. The Review of Economics and Statistics, 101(3), 442-451. https://doi.org/10.1162/rest_a_00760
Canay, I. A., & Kamat, V. (2017). Approximate permutation tests and induced order statistics in the regression discontinuity design. The Review of Economic Studies, 85(3), 1577-1608. https://doi.org/10.1093/restud/rdx062
Carr, J. B., & Packham, A. (2017). The effects of state-mandated abstinence-based sex education on teen health outcomes. Health Economics, 26(4), 403-420. https://doi.org/10.1002/hec.3315
Ceni, R., Parada, C., Perazzo, I., & Sena, E. (2021). Birth collapse and a large-scale access intervention with subdermal contraceptive implants. Studies in Family Planning, 52(3), 321-342. https://doi.org/10.1111/sifp.12171
Clarke, D., & Mühlrad, H. (2021). Abortion laws and women’s health. Journal of Health Economics, 76, 102413. https://doi.org/10.1016/j.jhealeco.2020.102413
Diaz-Rossello, J. L. (1998). Health services research, outcomes, and perinatal information systems. Current Opinion in Pediatrics, 10(2), 117-122. https://doi.org/10.1097/00008480-199804000-00001
Diedrich, J. T., Klein, D. A., & Peipert, J. F. (2017). Long-acting reversible contraception in adolescents: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 216(4), 364.e1-364.e12. https://doi.org/10.1016/j.ajog.2016.12.024
Duncan, G. J., Lee, K. T. H., Rosales-Rueda, M., & Kalil, A. (2018). Maternal age and child development. Demography, 55(6), 2229-2255. https://doi.org/10.1007/s13524-018-0730-3
Durrance, C. P. (2013). The effects of increased access to emergency contraception on sexually transmitted disease and abortion rates. Economic Inquiry, 51(3), 1682-1695. https://doi.org/10.1111/j.1465-7295.2012.00498.x
Engelhardt, H., & Prskawetz, A. (2004). On the changing correlation between fertility and female employment over space and time. European Journal of Population, 20(1), 35-62. https://doi.org/10.1023/B:EUJP.0000014543.95571.3b
Farah, D., de Moraes Andrade, T. R., Sansone, D., Batista Castello Girão, M. J., & Machado Fonseca, M. C. (2022). A cost effectiveness model of long-acting reversible contraceptive methods in the Brazilian National Health System. American Journal of Preventive Medicine, 62(1), 114-121. https://doi.org/10.1016/j.amepre.2021.06.023
Finer, L. B., Jerman, J., & Kavanaugh, M. L. (2012). Changes in use of long-acting contraceptive methods in the United States, 2007-2009. Fertility and Sterility, 98(4), 893-897. https://doi.org/10.1016/j.fertnstert.2012.06.027
Fondo Nacional de Salud. (2023). Arancel MLE 2016. Fondo Nacional de Salud. Retrieved from https://www.fonasa.cl/sites/fonasa/adjuntos/MLE
Fox, A. M., Himmelstein, G., Khalid, H., & Howell, E. A. (2019). Funding for abstinence-only education and adolescent pregnancy prevention: Does state ideology affect outcomes? American Journal of Public Health, 109(3), 497-504. https://doi.org/10.2105/AJPH.2018.304896
Francesconi, M. (2008). Adult outcomes for children of teenage mothers. The Scandinavian Journal of Economics, 110(1), 93-117. https://doi.org/10.1111/j.1467-9442.2008.00526.x
Galárraga, O., & Harris, J. E. (2021). Effect of an abrupt change in sexual and reproductive health policy on teen birth rates in Ecuador, 2008-2017. Economics and Human Biology, 41, 100967. https://doi.org/10.1016/j.ehb.2020.100967
Gelman, A., & Imbens, G. (2019). Why high-order polynomials should not be used in regression discontinuity designs. Journal of Business & Economic Statistics, 37(3), 447-456. https://doi.org/10.1080/07350015.2017.1366909
Gomez Ponce de Leon, R., Ewerling, F., Serruya, S. J., Silveira, M. F., Sanhueza, A., Moazzam, A., Becerra-Posada, F., Coll, C. V. N., Hellwig, F., Victora, C. G., & Barros, A. J. D. (2019). Contraceptive use in Latin America and the Caribbean with a focus on long-acting reversible contraceptives: Prevalence and inequalities in 23 countries. Lancet Global Health, 7(2), e227-e235. https://doi.org/10.1016/S2214-109X(18)30481-9
Gross, T., Lafortune, J., & Low, C. (2013). What happens the morning after? The costs and benefits of expanding access to emergency contraception. Journal of Policy Analysis and Management, 33(1), 70-93. https://doi.org/10.1002/pam.21731
Guerra, S., Sánchez, F., Encinas, A., Ugarte, L., Barbadillo, N., & Lete, I. (2015). Costes de la anticoncepción hormonal combinada en España: ¿Hay algún método más coste-efectivo? Progresos de Obstetricia y Ginecología, 58(5), 221-226. https://doi.org/10.1016/j.pog.2015.01.001
Guldi, M. (2008). Fertility effects of abortion and birth control pill access for minors. Demography, 45(4), 817-827. https://doi.org/10.1353/dem.0.0026
Heil, S. H., Gaalema, D. E., & Herrmann, E. S. (2012). Incentives to promote family planning. Preventive Medicine, 55, S106-S112. https://doi.org/10.1016/j.ypmed.2012.06.014
Henry, N., Schlueter, M., Lowin, J., Lekander, I., Filonenko, A., Trussell, J., & Skjeldestad, F. E. (2014). Cost of unintended pregnancy in Norway: A role for long-acting reversible contraception. Journal of Family Planning and Reproductive Health Care, 41(2), 109-115. https://doi.org/10.1136/jfprhc-2014-100878
Hoffman, S. D., & Maynard, R. A. (2008). Kids having kids: Economic costs and social consequences of teen pregnancy (2nd ed.). The Urban Institute.
Johansen, E. R., Nielsen, H. S., & Verner, M. (2020). Long-term consequences of early parenthood. Journal of Marriage and Family, 82(4), 1286-1303. https://doi.org/10.1111/jomf.12634
Joyce, T. J., & Kaestner, R. (1996). State reproductive policies and adolescent pregnancy resolution: The case of parental involvement laws. Journal of Health Economics, 15(5), 579-607. https://doi.org/10.1016/s0167-6296(96)00496-1
Joyce, T. J., Kaestner, R., & Colman, S. (2006). Changes in abortions and births and the Texas parental notification law. New England Journal of Medicine, 354(10), 1031-1038. https://doi.org/10.1056/NEJMsa054047
Julious, S. A. (2004). Using confidence intervals around individual means to assess statistical significance between two means. Pharmaceutical Statistics, 3(3), 217-222. https://doi.org/10.1002/pst.126
Kearney, M. S., & Levine, P. B. (2015). Investigating recent trends in the U.S. teen birth rate. Journal of Health Economics, 41, 15-29. https://doi.org/10.1016/j.jhealeco.2015.01.003
Kelly, A., Lindo, J. M., & Packham, A. (2020). The power of the IUD: Effects of expanding access to contraception through Title X clinics. Journal of Public Economics, 192, 104288. https://doi.org/10.1016/j.jpubeco.2020.104288
Lacerda, Y., Garbarino, B., Quintela, V., Fiol, V., & Rieppi, L. (2019). Implementación del implante subdérmico degestágenos como método anticonceptivo pos-evento obstétrico en una población de adolescentes del Centro Hospitalario Pereira Rossell. Sugia, 8(2), 60-67.
Levine, P. B. (2003). Parental involvement laws and fertility behavior. Journal of Health Economics, 22(5), 861-878. https://doi.org/10.1016/S0167-6296(03)00063-8
Levine, P. B., Staiger, D., Kane, T. J., & Zimmerman, D. J. (1999). Roe v Wade and American fertility. American Journal of Public Health, 89(2), 199-203. https://doi.org/10.2105/ajph.89.2.199
Lindo, J. M., & Packham, A. (2017). How much can expanding access to long-acting reversible contraceptives reduce teen birth rates? American Economic Journal: Economic Policy, 9(3), 348-376. https://doi.org/10.1257/pol.20160039
Luca, D. L., Stevens, J., Rotz, D., Goesling, B., & Lutz, R. (2021). Evaluating teen options for preventing pregnancy: Impacts and mechanisms. Journal of Health Economics, 77, 102459. https://doi.org/10.1016/j.jhealeco.2021.102459
MacGregor-Fors, I., & Payton, M. A. (2013). Contrasting diversity values: Statistical inferences based on overlapping confidence intervals. PLoS One, 2(8), 217-222. https://doi.org/10.1371/journal.pone.0056794
Mavranezouli, I. (2008). The cost-effectiveness of long-acting reversible contraceptive methods in the UK: Analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Human Reproduction, 23(6), 1338-1345. https://doi.org/10.1093/humrep/den091
Mayo Clinic. (2021). Contraceptive implant. Retrieved from https://www.mayoclinic.org/tests-procedures/contraceptive-implant/about/pac-20393619
McCrary, J. (2008). Manipulation of the running variable in the regression discontinuity design: A density test. Journal of Econometrics, 142(2), 698-714. https://doi.org/10.1016/j.jeconom.2007.05.005
Ministerio de Salud Pública. (2022a). Sistema informático perinatal [Dataset]. Ministerio de Salud Pública.
Ministerio de Salud Pública. (2022b). Población afiliada a ASSE, IAMC y Seguros Privados Integrales, según censos. Serie 2005-2021. Ministerio de Salud Pública. Retrieved from https://www.gub.uy/ministerio-%20salud-%20publica/sites/ministerio%20-%20salud%20-%20publica%20/files%20/2022%20-%2004%20/Censos_2005%20-%202021_ASSE_IAMC_SEGUROS.xlsx
Myers, C., & Ladd, D. (2020). Did parental involvement laws grow teeth? The effects of state restrictions on minors’ access to abortion. Journal of Health Economics, 71, 102302. https://doi.org/10.1016/j.jhealeco.2020.102302
National Health System. (2021). Contraceptive implant. Retrieved from https://www.nhs.uk/conditions/contraception/contraceptive-implant/
Ngacha, J. K., & Ayah, R. (2022). Assessing the cost-effectiveness of contraceptive methods from a health provider perspective: Case study of Kiambu county hospital, Kenya. Reproductive Health, 19(1), 11. https://doi.org/10.1186/s12978-021-01308-3
Packham, A. (2017). Family planning funding cuts and teen childbearing. Journal of Health Economics, 55, 168-185. https://doi.org/10.1016/j.jhealeco.2017.07.002
Raine, T. R., Foster-Rosales, A., Upadhyay, U. D., Boyer, C. B., Brown, B. A., Sokoloff, A., & Harper, C. C. (2011). One-year contraceptive continuation and pregnancy in adolescent girls and women initiating hormonal contraceptives. Obstetrics & Gynecology, 117(2), 363-371. https://doi.org/10.1097/AOG.0b013e31820563d3
Rodríguez Vignoli, J., Di Cesare, M., & Páez, K. (2017). Reproducción temprana: Diferencias entre grandes regiones del mundo al inicio y al final de la adolescencia (Serie Población y Desarrollo No. 117). Comisión Económica Para América Latina y el Caribe. Santiago de Chile. Retrieved from https://repositorio.cepal.org/bitstream/handle/11362/41609/1/S1700063_es.pdf
Rosenstock, J. R., Peipert, J. F., Madden, T., Zhao, Q., & Secura, G. M. (2012). Continuation of reversible contraception in teenagers and young women. Obstetrics & Gynecology, 120(6), 1298-1305. https://doi.org/10.1097/aog.0b013e31827499bd
Short, M., Dallay, D., Omokanye, S., Hanisch, J. U., & Inki, P. (2011). Acceptability of the levonorgestrel releasing-intrauterine system and etonogestrel implant: One-year results of an observational study. The European Journal of Contraception and Reproductive Health Care, 17(1), 79-88. https://doi.org/10.3109/13625187.2011.636088
Simini, F. (1999). Perinatal information system (SIP): A clinical database in Latin America and the Caribbean. The Lancet, 354(9172), 75. https://doi.org/10.1016/S0140-6736(05)75345-9
Sindicato Médico del Uruguay. (2022). Arancel médico mínimo. Sindicato Médico del Uruguay. Retrieved from https://www.smu.org.uy/laudos-medicos/laudosmedicos-%20en-el-sector-publico-asse/
Sonfield, A., & Kost, K. (2015). Public costs from unintended pregnancies and the role of public insurance programs in paying for pregnancy-related care national and state estimates for 2010. Guttmacher Institute. Retrieved from http://www.guttmacher.org/pubs/public-costs-of-UP-2010.pdf
Strupat, C. (2017). Do targeted reproductive health services matter?-The impact of a midwife program in Indonesia. Health Economics, 26(12), 1667-1681. https://doi.org/10.1002/hec.3465
Tristant, V., Morini, N., Ayul, N., Nidegger, V., Díaz, E., Torrado, C., Estefan, S., Keuchkerian, S., & Murillo, N. (2019). Estudio descriptivo sobre la tolerancia del uso de implantes subdérmicos como método anticonceptivo. Archivos de Ginecología y Obstetricia, 57(3), 185-190. https://ago.uy/descargar/adjunto/45-2pdzfo-ago-2020-57-3-185-190.pdf
Trussell, J., Henry, N., Hassan, F., Prezioso, A., Law, A., & Filonenko, A. (2013). Burden of unintended pregnancy in the United States: Potential savings with increased use of long-acting reversible contraception. Contraception, 87(2), 154-161. https://doi.org/10.1016/j.contraception.2012.07.016
Varela Petito, C. (2004). El reemplazo de la población en el Uruguay, un fenómeno ausente en la agenda estatal. In Centro Latinoamericano y Caribeño de Demografía (Ed.), La fecundidad en América Latina: ¿Transición o revolución? (pp. 399-420). Comisión Económica Para América Latina y el Caribe.
Varela Petito, C., Pardo, I., Lara, C., Nathan, M., & Tenenbaum, M. (2014). La fecundidad en el Uruguay (1996-2011): Desigualdad social y diferencias en el comportamiento reproductivo (Fascículo del Atlas sociodemográfico y de la desigualdad del Uruguay No. 3). Instituto Nacional de Estadística. Retrieved from https://www.ine.gub.uy/documents/10181/34017/Atlas_fasciculo_3_Fecundidad.pdf/b5f4c7da-2efb-4d1d-8d24-62894ba09c3e
World Health Organization. (2010). History of the Perinatal Information System. Making pregnancy safer. A Newsletter of Worldwide Activity, 8.

Auteurs

Zuleika Ferre (Z)

University of the Republic, Montevideo, Uruguay.

Patricia Triunfo (P)

University of the Republic, Montevideo, Uruguay.

José-Ignacio Antón (JI)

University of Salamanca, Salamanca, Spain.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH