title: Behind-the-Counter, but Over-the-Border? The Assessment of the Geographical Spillover Effects of Emergency Contraception on Abortions.
abstract: Washington was the first state to ease the prescription requirements making emergency contraception (EC) available behind-the-counter at pharmacies to women of any age in 1998. Using county-level vital statistics data in conjunction with the pharmacy specific location data from the Not-2-Late Hotline database, I study whether the increased access to EC affects fertility rates within the state and beyond the borders of the state that allows it. Unlike other studies that rely on geographic variations in access, I show that increased availability of EC in Washington, measured by the distance to the closest 'no-prescription EC pharmacy', is associated with a statistically significant albeit economically moderate decrease in abortion rates in Washington counties where women had access to 'no-prescription EC'. These effects are localized (i.e., decrease with travel distance) and robust in a number of specifications. Finally, I find some evidence in support of geographical spillover effects in Idaho, but not in Oregon. However, after accounting for the availability of abortion services, the decrease in 'treated' Idaho counties is rather small. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: The Lewin Group, Falls Church, VA, USA.
authors.forename: Inna
authors.initials: I
authors.lastname: Cintina
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D001723:Birth Rate; D003157:Community Pharmacy Services / Q000706:statistics & numerical data*; D044363:Contraception, Postcoital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D014195:Travel; D014861:Washington; D055815:Young Adult
keywords: Plan B; abortion; border-hopping; distance; emergency contraception; pregnancy; spillover