Stay-at-home orders in Mexico led to a fall in abortions of around 25%; fewer unwanted pregnancies from decreased sexual activity is at most 9.8% of the total fall in abortions

The unintended effects of the COVID-19 pandemic and stay-at-home orders on abortions. Fernanda Marquez-Padilla & Biani Saavedra. Journal of Population Economics, Sep 15 2021. https://rd.springer.com/article/10.1007/s00148-021-00874-x

Abstract: We study the effect of the COVID-19 pandemic and of government mandated mitigation policies on the number of abortions performed by Mexico City’s public abortion program. We find that the COVID-19 pandemic and stay-at-home orders (SAHO) implemented in Mexico led to unintended consequences for women’s sexual and reproductive health. Using difference-in-differences and event study analyses, we show that SAHO and the pandemic led to a fall in abortions of around 25% and find no evidence that unsafe abortions increased. We find a decrease in the share of single and teenage women getting abortions, arguably due to fewer unwanted pregnancies from decreased sexual activity, and estimate that at most 9.8% of the total fall in abortions can be attributed to this. We complement our analysis using call data from a government helpline and show that the SAHO time period led to fewer abortion- and contraception-related calls but to an increase in pregnancy-related calls.

Discussion and conclusions

We find that the COVID-19 pandemic and SAHO implemented to mitigate the spread of the virus led to a significant decline in the number of abortions performed by CDMX’s public abortion program. We show that the effects were driven by municipalities more likely to comply with SAHO and present evidence of anticipatory effects to the policy. We find that the composition of women getting abortions changed after the lockdown, where single and adolescent women were less likely to get an abortion. We interpret this compositional change as reflecting a decline in unwanted pregnancies for these groups of women (in addition to stronger mobility restrictions). Conditional on municipality of residence, SAHO and the pandemic did not affect women’s average SES as measured by their schooling, suggesting that the reduction in abortions is not explained by changes in women’s preferences over continuing with a pregnancy.

While most of our analysis focuses on the sudden start of SAHO in Mexico, it is hard to separate the total effect of the pandemic from the effects of the SAHO, which are likely to have affected abortion simultaneously and likely in correlated ways—as the fact that effects were stronger for municipalities with high COVID-19 mortality would suggest. We believe that in any case, identifying the total effect of the pandemic on abortions is both relevant and important.

We find no evidence that the reduction in ILE abortions led to an increase in unsafe abortions as hospital discharge data for ARM shows no increases following SAHO, but rather falls following the general hospital usage trends. While abortions not obtained through the public ILE program may have been obtained in the private sector, we show that at least for the case of births we do not observe a shift from public to private healthcare services, mitigating concerns that our results merely suggest a shift from public to private abortions. Our data does not rule out the possibility that self-managed abortions may have compensated for ILE’s reduction in the supply of abortions.

We present additional evidence from helpline calls consistent with SAHO affecting women’s ability to access safe and legal abortions. This is likely to be due to limited access (a fall in the supply of abortions by public health facilities and mobility restrictions), fear of visiting healthcare facilities, and to a loss of women’s autonomy and privacy.

Taken the evidence together, our results present some of the first empirical evidence anticipating the potential effects of COVID-19 and SAHO on fertility, suggesting evidence consistent with an increase in unwanted pregnancies after SAHO started. Its potential relation with increased domestic violence and sexual abuse within the home highlights the importance of focusing policy efforts on providing more and better reproductive health services to women.

Some possible policy recommendations may include a “hotline” and/or telemedicine alternatives for safe misoprostol use in order to make home abortions safe (Drovetta 2015; Donovan 2019) and moving sexual and reproductive health services and care out of hospitals or into the community, in addition to improving the distribution of contraception (Cousins 2020).