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Visiting Researcher
Stockholm University
Swedish Institute for Social Research (SOFI)
"The Power of the Pill: Evidence from Oral Contraceptive Sales" Forthcoming in The Economic Journal (DOI: 10.1093/ej/ueaf017)
Abstract: The introduction of oral contraception ('the pill') was a watershed in fertility control. Yet, the pill's impact on childbearing has been hard to establish due to limited data. I exploit rich data on pill sales across markets and time to characterize how Swedish teens' access to pharmacies shaped pill sales and fertility after the pill's introduction. Pill sales are highly sensitive to pharmacy access, and teen fertility responds strongly to pill sales. The unique data establish an important link in the causal chain from pill access to women's fertility. Estimated fertility responses to the pill could explain the halving of teen births after the pill's introduction, a finding which is robust to accounting for trends in female education, abortion provision, and other factors.
Related Coverage:
VoxEU "Contraceptive access and teen childbearing: Lessons from Sweden" (April 17, 2025)
Reproductive Rights in Action: Estimating the Pill's Fertility Effects Across the Age Profile Using Contraceptive Sales
Abstract: I estimate how the diffusion of oral contraception ('the pill') altered fertility across the age profile in Sweden. Here, women had a right to contraception from the age of 15 for a quarter century before the pill was introduced. Granular sales data allow me to directly quantify the pill's diffusion across local markets and time to estimate age-specific fertility elasticities. I find large negative fertility elasticities, which decay rapidly in age, becoming indistinguishable from zero before the age of thirty. I use pharmacy access to isolate a source of exogenous variation in pill sales, a consequence of centuries of regulation which shaped the location of pharmacies. Pharmacy access isolates a source of exogenous variation in pill sales and quantifies how contraceptive use costs play a particularly important role for teen fertility behavior. The findings illustrate how reproductive rights and policies which support fertility control interact with use costs to shape contraceptive sales and childbearing across the reproductive lifespan when abortion is not a right.
Related Coverage:
This paper was included in the CEPR WE_ARE Seminar Series (March 24th, 2025) and the Rosenkranz Global Health Policy Research Symposium at Stanford University (May 21, 2024).
Upcoming Presentations:
Society of the Economics of the Household (SEHO) Zaragoza Spain, June 10-11, 2025
The Impact of Hormonal Contraception on Teen Suicide (American Economics Association Papers and Proceedings, May 2024)
Abstract: Access to modern fertility control methods such as hormonal contraception (HC) impact women's health and well-being in many ways. Yet, little is known about how the pill's introduction altered the incidence of suicide among adolescent girls, a potential side effect of HC use reported in recent epidemiological studies. This paper studies how the diffusion of HC after approval for contraceptive use is associated with changes in the incidence of suicide among young women in Sweden. Although HC sales increased rapidly, with over a quarter of fecund females using some form of HC on an annual basis within five years of HC's approval for contraceptive use, and over half of teenage girls a decade later, data from death registers following cohorts of Swedish women born since 1941 reveal no evidence of a positive correlation between the pill's diffusion across markets and time and the occurrence of suicide and accidental poisonings among teenage girls.
Ragan, Kelly. 2024. "The Impact of Hormonal Contraception on Teen Suicide." AEA Papers and Proceedings, 114: 369–74.
DOI: 10.1257/pandp.20241121
Empowerment or Immiseration? The Pill and a Century of Unwed Childbearing
Abstract: Prominent theories posit that fertility control liberalization contributed to rising unwed childbearing, an immiseration effect. This view is challenged by studying local oral contraceptive sales and fertility data surrounding the pill's introduction in Sweden. I present a model where women's demand for premarital sex is a function of customs for preventing unwed birth and equilibrium determined promiscuity norms. These factors jointly determine past unwed birth and demand for contraceptive innovations. Sales data confirm 19th Century unwed birth to be a positive and highly robust predictor of the pill's adoption. The theory motivates an empirical model which is used to estimate how pill use shaped unwed birth. The data reveal how the pill's diffusion reduced unwed childbearing among teens, consistent with the model predictions. The rising share of births occurring out-of-wedlock is driven by a decline in marital childbearing that coincided with the pill’s introduction but is uncorrelated with the extent of pill use in a market, consistent with an empowerment effect.
Upcoming Presentations:
Barcelona School of Economics (BSE), Barcelona Summer Forum, Economics of Institutions, June 3-4, 2025.
London School of Economics (LSE), Hayek Programme on Economics and Political Economy, Narratives and Culture in Historical Perspective, June 20-21, 2025.
Historical Evidence on a Modern Theory of Out-of-Wedlock Childbearing
Economics Letters 175(2), February, 2019.
Abstract: According to Willis (1999), when women outnumber men in a marriage market, out-of-wedlock births increase as women's incomes rise in real terms and relative to men's. These predictions are born out in 19th century Swedish data; exogenous shocks that raised women's real and relative earnings increased the share of births to single mothers. The results are consistent with theory and and quantitatively significant; increases in women's real and relative wages in the unskilled agricultural sector explain sixty-four percent of the increase in births outside of wedlock in Sweden from 1865-1910.
Research on Home Production and Fiscal Policy:
Taxes, Transfers and Time Use: Fiscal Policy in a Household Production Model
American Economic Journal: Macroeconomics 5(1), 2013.
Abstract: We present time use data on market work, home work and leisure for 15 O.E.C.D. countries. We develop a home production model that explicitly accounts for both taxes and public expenditures on goods like day care and elderly care which are good substitutes for the time households spend working outside of the market. Taxes are important for matching the time use patterns observed in the data for Japan, Canada, the U.K.and continental Europe, but they cannot explain the high levels of market work, and low levels of home work observed in the Scandinavian countries. Including subsidies of services like day care that substitute for home time can bring model predictions in line with the data. Our results are robust to alternative specifications that explicitly distinguish between subsidized and unsubsidized inputs to home production.
National Accounts data for replicating the tax measures used in this paper. STATA code for computing time use measures for the U.S. based on the ATUS micro data files available through the BLS.
Quantitative Evidence on the Welfare Effects of Home Sector Fiscal Policy
Economics Letters 118(2), 2013.
Abstract: A home production model that explicitly accounts for taxes and public expenditures on day-care and elder-care, substitutes for work households perform at home, is used to evaluate the welfare implications of alternative public expenditure policies. Both subsidy and workfare policies are welfare improving relative to a model where tax revenues are rebated lump-sum. The welfare gains from optimal home sector policy design can be large.
Research on Taxes and Labor Supply:
Labor Supply and the Tax Reform of the Century
with Martin Ljunge (IFN)
Abstract: We estimate the elasticity of labor income to the net of marginal tax rate following a very large tax reform in Sweden. Labor income measures both hours and effort margins of labor supply. We estimate structural models in static and dynamic environments. In the dynamic environment we estimate a model that accounts for the effect of an unanticipated tax reform on the marginal utility of lifetime wealth. We use detailed individual panel data where we exploit the thousands of differential treatments individuals faced. We find significant responses to the tax reform, with elasticities of about 0.37 on the intensive margin.
Estimating a Collective Model of Labor Supply: How Did Households Respond to the Tax Reform of the Century?
Abstract: We model the household explicitly and take into account how taxes affect intrahousehold allocations and in turn the labor supply decisions of spouses. We estimate a collective labor supply model using a large tax reform in Sweden as a source of exogenous variation in tax prices. We find general support for the restrictions implied by theory and quantify the importance of after tax wage rates, non labor income, and marriage market conditions on the labor supply decisions of spouses in both married and cohabitating households.
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