The Economics of Women's Health Risks

Spencer, Melissa, Economics - Graduate School of Arts and Sciences, University of Virginia
Miller, Amalia, Economics, University of Virginia
Tello Trillo, Sebastian, Batten School, University of Virginia
Chyn, Eric, Economics, Dartmouth College
Pepper, John, Economics, University of Virginia

This dissertation studies the health and well-being of women with a specific focus on reproductive health and domestic violence. In Chapter 1, “Safer Sex? The Effect of AIDS Risk on Birth Rates,” I study the effect of increases in the risk of sexually transmitted infection (STI) and resulting STI avoidance behaviors on birth rates. The emergence of AIDS in the 1980s dramatically increased the cost of contracting a sexually transmitted infection (STI). Prior research shows that people responded to the AIDS epidemic by switching to sexual behaviors and contraceptive methods with lower likelihood of AIDS transmission. These behavioral adjustments also affect the likelihood of pregnancy and the incidence of other STIs. This paper provides the first evidence that the AIDS epidemic in the United States increased the birth rate and the abortion rate, and decreased the gonorrhea rate. I show that births among adult women increased on average by 0.5 births per 1,000 women per year, for a total of 330,000 additional births between 1981 and 2001 due to AIDS avoidance behaviors. My analysis suggests that the overall estimates are driven by women who avoid AIDS by shifting to monogamous relationships.

The second chapter, joint with Amalia Miller and Carmit Segal, looks at the effect of the COVID-19 pandemic on domestic violence in Los Angeles. Around the world, policymakers and news reports have warned that domestic violence (DV) could increase as a result of the COVID-19 pandemic and the attendant restrictions on individual mobility and commercial activity. However, both anecdotal accounts and academic research have found inconsistent effects of the pandemic on DV across measures and cities. We use high-frequency, real-time data from Los Angeles on 911 calls, crime incidents, arrests, and calls to a DV hotline to study the effects of COVID-19 shutdowns on DV. We find conflicting effects within that single city and even across measures from the same source. We also find varying effects between the initial shutdown period and the one following the initial re-opening. DV calls to police and to the hotline increased during the initial shutdown, but DV crimes decreased. The period following re-opening showed a continued decrease in DV crimes, as well as decreases in arrests for those crimes and calls to the police and to the hotline. Our results highlight the heterogeneous effects of the pandemic across DV measures and caution against relying on a single data type or source.

The third chapter is joint with Rebecca Brough and studies the effect of abortion counseling laws on birth rates. Nearly two-thirds of states have abortion counseling laws requiring that women receive and acknowledge state-mandated information prior to giving their informed consent for abortion. The mandated information varies widely across states, and may include scientifically inaccurate statements regarding the risks of abortion, illustrations of fetuses, or ultrasound requirements. Despite the ubiquity of these laws, little is known about the effect of counseling laws on women’s abortion decision and birth rates. Using a novel dataset of state-level abortion counseling laws, we find that counseling laws that contain ultrasound requirements increase the birth rate to white women by as much as 1 birth per 1,000 women.

PHD (Doctor of Philosophy)
Fertility, Birth Rate, HIV/AIDS, Domestic Violence, Abortion
Issued Date: