THE EFFECT OF PLAN B ON TEEN ABORTIONS: EVIDENCE FROM THE 2006 FDA RULING

I. INTRODUCTION In June 2013, the Food and Drug Administration (FDA) approved over the counter sales of Plan B One-Step, a single-dose emergency contraceptive (EC) for women of all ages. The decision came after more than a decade of controversy and 2 years after the Health and Human Services director Kathleen Sebelius overruled the FDA decision and prevented Plan B from being sold over the counter across the country. (1) Unplanned pregnancies impose high costs on women. Therefore, easy and timely access to EC can mitigate these costs. Plan B, a well-known form of EC, has been available by prescription since 1999. It is an effective and relatively cheap way to avoid unintended pregnancy when other forms of birth control fail, or when birth control is not used. In 2006, the FDA lifted the EC prescription requirement for women 18 years of age or older; those 17 and younger, on the other hand, still required a prescription. The need for a prescription is particularly salient since Plan B works best when it is taken as soon as possible after unprotected sex, and any delays in access lower its efficacy rate. A clear age cutoff set by the ruling decreases costs associated with sexual behavior for some young women relative to other young women, and can be exploited to identify a differential response to increased EC access across these two groups. Unlike most related studies that rely on differences across locations, we use a variation in EC availability across age groups to identify a link between changes in access and fertility behavior measured with abortion rates. The policy set up (i.e., age differentiation) allows us to improve upon the existing literature by utilizing single age-by-year data on abortions instead of 5-year age group aggregates commonly used in economic studies. There are likely to be cost differences within the aggregated age groups because available resources, housing options, independence level, and overall financial situation varies as one progresses from age 15 to age 19. Over time, the cost differences across groups can be affected by policy changes, such as the prescription elimination in August 2006 that affected only 18- and 19-year-old women. If the change in costs is sufficient, we would expect measurable differences in abortion rates in the years after the policy change. Using a difference-in-difference (DID) methodology, where women aged 15, 16, and 17 are treated as a control group, and focusing on states that were affected by the FDA policy change, we find a considerable reduction in abortion rates among women aged 18-19 in the years following the FDA's announcement in 2006, compared with changes in the control group. The relative magnitude of change associated with the elimination of the prescription requirement ranges from 8% to 9% (or 1.6-1.8 abortions per 1,000 women). However, the magnitude, to some extent, is driven by a substantially large change in abortion rates among "treated" women in 2010. The exclusion of 2010 yields a more conservative estimate of 6%, or 1.2-1.3 abortions. We do not observe a similarly large reduction in abortion rates in the post-policy years among women aged 20-24. After adjusting for a small number of clusters, we also fail to reject the null of zero effect for this age group. Further disaggregation of women aged 18-19 into two separate age groups indicates that the effect might be concentrated among women aged 18. The magnitude of the effect, to some degree, is sensitive to the choice of the control group (age 15 or 16), and the use of population weights. All estimated models pass the event-study specification test. Our estimation strategy also passes the falsification test. The results reported here are in contrast to Gross, Lafortune, and Low (2013), who conclude that the change in the FDA's policy does not affect abortion rates among women under the age of 20. Differences in results might be due to differences in empirical strategies. …