Contraceptive Supply, Use, and Unintended Pregnancy in the Aftermath of a Disaster

Jenna Nobles, University of Wisconsin-Madison
Elizabeth Frankenberg, Duke University
Duncan Thomas, Duke University

An important theoretical link between humanitarian crises and population change operates through the disruption to contraceptive supply. Damage to facilities and transportation routes, alongside health care provider mortality, risks generating large discontinuities in contraceptive availability. In turn, unmet need increases the probability of unintended pregnancy and sexually transmitted infection. Surprisingly, few studies have measured changes to contraceptive behavior following environmental shocks. To fill this gap, we analyze longitudinal data on individuals, families, communities, and health facilities in the disaster-affected regions of Indonesia. Data come from the population-representative Study of Tsunami Aftermath and Recovery. MODIS satellite imagery is used to stratify survey communities by the disaster-induced loss of vegetation. Pre- and post-tsunami differences observed in communities without direct tsunami damage facilitate ascription of changes in the service environment and changes in contraceptive use to the tsunami's destruction. We then test whether reductions in contraceptive supply increased unintended fertility in affected areas.