Between 2016 and 2018, we observe in Uruguay a steep decline of almost 20 percent in the number of total births, leading to the collapse of the adolescent fertility rate after decades of relative stagnation. We estimate the quantitative contribution on birth rates, especially teen births, of a policy of expanded availability of subdermal contraceptive implants. We exploit the expansion schedule of a large-scale policy of free-of-charge access to subdermal implants in the country's public health system through an event study to capture causal effects. We use detailed birth administrative records for the past 20 years. We document an average reduction of 3 percent in the birth rate in public health facilities across the two years after the policy was implemented in each department. These reductions were notably higher among teens and first births. Although changes in women's fertility decisions are a multicausal phenomenon, we claim that the expanded availability of subdermal contraceptive implants accounted for one-third of the teen and young women's birth collapse.

中文翻译：

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出生塌陷和皮下避孕植入物的大规模介入干预

在 2016 年至 2018 年期间，我们观察到乌拉圭的总出生人数急剧下降了近 20%，导致青少年生育率在经历了数十年的相对停滞后崩溃。我们估计了扩大皮下避孕植入物供应政策对出生率，尤其是青少年出生率的定量贡献。我们通过一项事件研究来利用该国公共卫生系统中免费获得皮下植入物的大规模政策的扩展时间表，以捕捉因果关系。我们使用过去 20 年的详细出生管理记录。我们记录了该政策在每个部门实施后的两年内，公共卫生机构的出生率平均降低了 3%。这些减少在青少年和第一胎中明显更高。尽管女性生育决定的变化是一种多因现象，但我们声称，皮下避孕植入物的扩大可用性占青少年和年轻女性分娩崩溃的三分之一。