The economics of emergency contraception

About half of all pregnancies in the United States are unintended and half of those end in abortion. Plan B, a form of emergency contraception (EC), can reduce the risk of pregnancy after unprotected sex. In the last decade, there have been policy efforts to encourage emergency contraception use as a means to reduce the burden of unintended pregnancy and abortions in the US. This dissertation exploits variation in the timing of pharmacy access to Plan B across states over time. The primary contribution of this work is its treatment of emergency contraception as lowering the cost of sex and serving as a substitute for abortion. Improved access to EC acts to lower the cost of sex by significantly reducing the risk of pregnancy. This leads to an increase in quantity of sex demanded and may increase sexually transmitted infections (STIs). It may also lead to a substitution away from abortions. I provide new evidence of the impact of access to emergency contraception on STIs, abortions, fertility, maternal characteristics, and child birth weight. I estimate the costs and outcomes of national over-the-counter (OTC) access to Plan B relative to prescription access, including the cost of providing emergency contraception, cost of treating STIs, and cost savings from preventing unintended pregnancy.;The first part of this dissertation examines the impact of OTC access to Plan B on individual's behavior using insurance claims data. I use the natural experiment provided by variation in state pharmacy access legislation and subsequent FDA approval of OTC status for Plan B in late 2006. Using a large claims database, I find evidence of a substitution from abortion to Plan B when both are available. Results suggest an increase in STIs associated with OTC access to Plan B. The results are robust across a number of specifications and to various sensitivity analyses. The findings are estimated in a population that has relative access to emergency contraception prior to the FDA announcement, suggesting that the impact could be even greater for women without relative access.;The second part of this dissertation explores the effect of availability of emergency contraception on short-term fertility and STIs at the state level from 1996-2008. I exploit variation in access to emergency contraception from the introduction of Plan B as a prescription drug in 1999 to the subsequent implementation of pharmacy access to Plan B across states leading up to national OTC access in 2007. I find evidence that states with early pharmacy access to Plan B experienced declines in birth rates before the rest of the nation. I test whether the difference in birth rates returns to previous levels after the remaining states implement OTC access to Plan B in 2006, allowing for a gestation lag. I offer suggestive evidence that improved access to Plan B leads to a decline in the birth rate and to an increase in STIs over the period 1996-2008 for both early and late states.;The third part and final part examines how EC influences the selection of women who carry pregnancies to term. I attempt to identify whether the marginal child who was not born because of EC access would have had different maternal characteristics and outcomes than the average child. Specifically I explore the effect of access to Plan B on the fraction of births to single mothers and to teenagers and on birth weights of children born the immediately after improved access to EC. I find that pharmacy access to Plan B led to a modest decline in the fraction of children born to single mothers and to teenagers. Women who would never have an abortion may now have an incentive to use EC to postpone childbearing. I find that early access to Plan B led to immediate increases in the probability of low birth weight births in total and amongst blacks. The impact of EC on fertility seems to be driven by a selection effect-- the "marginal child" whose birth was avoided due to EC would have had above average characteristics. The findings are consistent with the effects of diffusion of the birth control pill, contrary to the effects of abortion legalization.