Preventing Teen Pregnancies at Scale: School-Based Access to Contraceptives and Reproductive Health

Abstract

This paper evaluates the impact of Argentina’s National Plan for the Prevention of Unintended Pregnancy in Adolescence (ENIA)—a large-scale, school-based reproductive health program combining comprehensive sex education, confidential counseling, and access to long-acting reversible contraceptives (LARCs). Launched in 2018 across 36 counties, ENIA reached over 500,000 adolescents annually. Leveraging variation in program rollout and multiple administrative data sources—including birth records, school censuses, and health inventories—I find that ENIA reduced adolescent birth rates by approximately 10% relative to control counties, amounting to over 1,800 averted births per year. These effects emerged nine months after implementation and were primarily driven by increased uptake of subdermal implants via in-school counseling. Heterogeneity analyses show larger impacts in socially conservative regions—such as Pro-Life counties or those with legislators opposing abortion—where informal barriers to contraceptive access may be more binding. The findings demonstrate that integrating reproductive health services into schools can reduce adolescent fertility at scale by relaxing institutional and social constraints on reproductive autonomy.