Access to abortion, investments in neonatal health, and sex-selection: evidence from Nepal

Every year, over 9 million children die under the age of five in developing countries, where the abortion regime is generally very restrictive. Evidence from the United States suggests that abortion liberalization may be a powerful policy tool in the fight against mortality in early life. In this paper, I consider the impact of providing affordable, legal abortion facilities in the high-fertility, high-mortality context of Nepal, on pregnancy outcomes, antenatal and perinatal health inputs, neonatal mortality, and sex-selection. In order to exploit geographical and time variation in coverage, I combine fertility histories with a unique data set recording geo-referenced coordinates and registration dates of newly introduced legal abortion centers. Consistent with the prediction that proximity to a legal abortion center reduces the cost of abortion, I find that the probability of a pregnancy ending in a live birth decreases by 8.1 percent, for a given mother. However, there is no evidence that improved access to abortion increases observed investments in antenatal and prenatal care or unobserved investments favorable to neonatal survival. Access to these legal, fist-trimester abortion centers does not appear to have led to more sex-selective terminations.