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Birth Collapse and a Large-Scale Access Intervention with Subdermal Contraceptive Implants.

Rodrigo Ceni1, Cecilia Parada1, Ivone Perazzo1

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Studies in Family Planning
|August 2, 2021
PubMed
Summary

Uruguay saw a significant birth rate decline, especially among teens, between 2016-2018. Expanded access to free subdermal contraceptive implants is estimated to have caused one-third of this adolescent birth collapse.

Keywords:
Subdermal contraceptive implants. Fertility. Adolescent fertility. Public policy. Birth collapse

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Area of Science:

  • Public Health
  • Reproductive Health
  • Health Policy

Background:

  • Uruguay experienced a notable decline in total births and adolescent fertility between 2016 and 2018.
  • This demographic shift occurred after decades of stagnant adolescent fertility rates.

Purpose of the Study:

  • To quantify the impact of increased availability of subdermal contraceptive implants on birth rates, particularly teen births.
  • To assess the causal effect of a national policy providing free access to contraceptive implants.

Main Methods:

  • Utilized a large-scale policy expansion of free subdermal implants in Uruguay's public health system.
  • Employed an event study methodology analyzing 20 years of detailed birth administrative records.
  • Captured causal effects by exploiting the staggered policy implementation across departments.

Main Results:

  • Observed an average 3% reduction in birth rates in public health facilities within two years of policy implementation.
  • Found significantly higher reductions among adolescents and for first births.
  • Subdermal implants accounted for an estimated one-third of the decline in teen and young women's births.

Conclusions:

  • The expanded availability of subdermal contraceptive implants significantly contributed to the reduction in birth rates, especially among adolescents.
  • This policy intervention played a key role in addressing the recent collapse of the adolescent fertility rate in Uruguay.
  • Fertility decisions are multifactorial, but this policy demonstrates a substantial impact on teen birth rates.