We examine the sharp expansion in availability of the emergency contraceptive pill in Chile following legalized access through municipal public health-care centres. Combining a number of administrative datasets on health outcomes and pharmaceutical use, and using difference-in-difference and event study methods, we document that this expansion improved women’s reproductive health outcomes, particularly reducing rates of haemorrhage early in pregnancy. These improvements are most notable in areas of the country in which the rollout of the pill was largest. We also document some evidence that refusal to grant the pill upon a women’s request is linked with a worsening in reproductive health outcomes. JEL Classification: I18, J13, K38, H75 Keywords: emergency contraceptives, maternal morbidity, haemorrhage, abortion, event studies, difference-in-differences Corresponding author: Damian Clarke Universidad de Santiago de Chile Av. Libertador Bernardo O’Higgins 3363 Estación Central Santiago de Chile Chile E-mail: damian.clarke@usach.cl * We acknowledge institutional support from the Ministry of Economics of the Government of Chile in funding the Millennium Nucleus for the Study of Life Course and Vulnerability (MLIV), and Clarke gratefully acknowledges FONDECYT Chile (grant number 1200634) for financial support. We thank the editor Mark D. Hayward and three anonymous referees, as well as Blair G. Darney, Alejandra Ramm, Amanda Stevensen, Christine Valente and participants at PAA Austin and the Institute for Research in Market Imperfections and Public Policy workshop for useful comments. We thank Electra González and Ingrid Leal Fuentes for providing information related to Emergency Contraceptive usage in Chile. We also thank Valentina Jorquera Samter, José Mora Castillo and Kathya Tapia Schythe for excellent research assistance. Replication materials for all results in this paper are available at https://github.com/ damiancclarke/pillHealth. 1 Introduction This study examines whether access to the emergency contraceptive (EC) pill can impact maternal health. Contraceptive use has been linked with an improvement in maternal health indicators, at least when considering survival (Cleland et al., 2012; Stover and Ross, 2010).1 Bongaarts and Westoff (2000) had formerly proposed the idea that increasing contraceptive use could reduce abortion, an idea that more recently has been supported by the work of Miller and Valente (2016), who point to modern contraceptives acting as substitutes for abortion. What’s more, there is clear evidence that unsafe abortion significantly impacts maternal health and survival (United Nations, 2014; Grimes et al., 2006) as well as evidence in the medical literature that abortive agents bought on the black market2 are used in the absence of legal alternatives (see eg Grimes et al. (2006)). Thus, a causal chain could plausibly exist which is that the availability of the EC pill reduces clandestine abortions, and the reduction in clandestine abortions results in improvements in health outcomes. To empirically test for a link between EC pill access and maternal health, we focus on the sharp expansion in availability of the EC pill in Chile over the first two decades of the 21st century. We seek to determine whether this availability resulted in reductions in key maternal morbidity events by examining legislative reform which made the EC pill available for free to any women enrolled in the public health system. In the entirety of the period under study, abortion was completely illegal in Chile, and our working hypothesis is that the EC provides an alternative post-coital contraceptive option for women, potentially avoiding clandestine and unsafe abortions. In line with this, our 1Maternal mortality has received considerably more attention in the literature (Loudon, 1992), and is often referred to as the “tip of the iceberg”, with the remaining mass consisting of the many events of maternal morbidity. For every woman who dies due to causes related to child birth, 20–30 more experience events inducing chronic morbidity with ongoing sequelae (Reichenheim et al., 2009; Firoz et al., 2013). As such, in this study we focus principally on morbidity outcomes. 2Or even over the counter in the case of misoprostol, which, while designed to treat stomach ulcers, has an off-label effect of inducing abortion in pregnant women. 2 key maternal health measures are those caused by unsafe abortion, namely haemorrhage in early pregnancy, and abortion related morbidity. In general, we focus on the large number of non-mortal hospital visits (ie morbidity), though also document effects on mortality. While we aim to continue a line of research which considers the impact of modern contraceptives on women’s health, to our knowledge, this paper is the first study to examine the impact of access to the EC pill on maternal health. This study takes advantage of universal microdata on full inpatient visits, as well as variation in the availability of EC pill over time by municipalities within Chile, providing a credible causal estimate of the impact of the EC pill. Using difference-indifferences and event study methods we are able to control for all fixed characteristics at the level of municipalities and time, while also controlling for additional potential confounders, namely, political characteristics of each