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Long-acting reversible contraceptives, LARCs, have been gaining popularity in the past two decades, but other methods, including sterilization, are still more frequently used. Different sociodemographic and societal factors influence contraceptive use among different groups of women. In particular, mothers and younger women have the highest rates of LARC use. In comparison, mothers and older women have the highest rates of those using sterilization. I analyze the relationship between motherhood status/parity and age on contraceptive method use using the 2015-2017 and 2017-2019 cycles of the National Survey of Family Growth. Mothers are more likely to use LARCs and sterilization relative to other methods compared to childless women. Higher parities increase the likelihood of using LARCs and sterilization relative to other methods, along with using sterilization relative to LARCs. Age increases the likelihood of using sterilization relative to LARCs and other methods. There is evidence that age moderates the relationship between motherhood and parity and contraception use, especially for sterilization use relative to LARCs and other methods. Younger mothers at parity three or more have a higher likelihood of being sterilized relative to using other methods than childless women and older mothers. Older women and women in the middle of their childbearing years are less likely to use LARCs and sterilization relative to other methods compared to their childless counterparts. Older mothers with higher parities are less likely to use sterilization relative to LARC compared to childless women. These findings suggest that mothers and childless women use contraception for different reasons across the childbearing years.

Historically, the most vulnerable members of United States society— Black, indigenous, criminalized, disabled, and poor people—have been systematically subjected to reproductive control by the state. This control continues to take new, complex forms with important local and regional variation, setting national precedents. Tennessee is an exemplary case of “voluntary” sterilization through the implementation of new coercive programming. Through an ethnographic case study of long-acting reversible contraceptives (LARCs) in Tennessee, this dissertation addresses four primary questions: 1) How did longacting reversible contraceptives become the primary mechanism of reproductive control in East Tennessee? 2) How do criminal justice system actors, health care providers, non-profit organizations, and community organizers work together to influence reproductive control? 3) What is the role of long-acting reversible contraceptives in the carceral state? 4) How are long-acting reversible contraceptives structured through the intersections of race, class, and gender? Drawing upon 33 in-depth interviews, 18 months of participant observation, and archival data, I argue LARCs became mechanisms of reproductive control through the influx of private dollars into public infrastructures which targeted Black, immigrant, undocumented, and poor women. Expanding upon the theoretical frameworks of Reproductive Justice and mass surveillance, I argue the spaces of reproductive control are, simultaneously, spaces of resistance and transformation. Exploring the dialectic experience of LARCs as mechanisms of vi reproductive control and as mechanisms of reproductive autonomy, I elucidate the interlocking webs of oppression in Tennessee to enable organized resistance as an emergent pathway of reproductive liberation.

This dissertation consists of three essays, each examining a topic in health economics. These papers are connected by the theme of exploring the ways in which institutions, such as hospitals and pharmaceutical companies, interact with federal and state policies and what that ultimately means for healthcare consumers. In Chapter 1, I estimate the effect of prescription drug coupons on generic drug use, medication adherence, and competition between branded drugs. I take advantage of a law in Massachusetts banning, and then allowing, prescription drug coupons to estimate a series of difference-in-differences and triple-difference regressions. I find that prescription drug coupons decrease own-molecule generic drug use, and that this effect is driven by patients requesting the brand name drug. I find no effect of coupons on medication adherence, competition between branded drugs, or cross-molecule generic substitution. These results are consistent with prescription drug coupons increasing costs without improving health. In Chapter 2, I estimate the effect of for-profit hospital ownership on the probability of admission through the emergency department (ED). I use variation from hospital conversions to estimate difference-in-differences and event study regressions. I find that for-profit hospital ownership increases the probability of inpatient admission, with the effect driven by Medicare and Medicaid patients. However, I also find evidence that increased admission rates occur when hospitals convert from for-profit as well as to for-profit, indicating that the estimated effect may actually be measuring the effect of hospital system membership and not ownership. In Chapter 3, I estimate the effect of policies that decrease the time cost to patients of accessing long-acting reversible contraceptives (LARCs) on LARC uptake, birth rates, and birth outcomes. I take advantage of Medicaid policies which were implemented by states at different times to estimate difference-in-differences and event study regressions. I find no evidence that Medicaid coverage for immediate postpartum LARCs affected LARC use or birth outcomes, though our estimates are imprecise.