Long-term impact of birth control access

A study by Olivier Marie, Professor at Erasmus School of Economics, and Esmée Zwiers (University of Amsterdam) called “Religious Barriers to Birth Control Access” shows how religious norms shaped who benefitted from 1970 pill liberalisation in the Netherlands, and how this affected women’s life trajectories. ‘Our study provides strong evidence that access to the pill at a young age had lasting positive effects on women’s educational and economic outcomes’, Marie mentioned. They found that women with access to the pill had lower underage marriage and childbirth rates, had a greater likelihood of completing long higher education and were more likely to end up in the top quartile of household wealth distributions.  

These results showed that the life changing impacts of the pill availability were not felt equally by all women. ‘We also highlight that even when something is legal, access can still depend on gatekeepers such as GPs or pharmacists’, Marie added.  

Historical background on the Dutch pill 

The Dutch Morality Law of 1911 was designed to restrict sexual activity only within marriage. This law prohibited the public offering or promotion of instruments that could prevent a pregnancy, or interfere with it. Violations could lead to a prison sentence or a fine.  

In the early 1960s, the Dutch birth control pill Lyndiol became available as a gynaecological medicine to regulate menstrual cycles, with temporary infertility presented as a side effect. It was only prescribed to women in very fertile marriages. Finally, in 1969, the Morality Law was changed, making it legal to provide information about contraceptives. This was followed by a liberalisation of access to the contraceptive pill for minors (aged 16-20) in 1970. 

The access to and uptake of the pill 

The authors compared the life trajectories of women from areas with similar views on the pill. For this, they focused on women who gained legal access just before or after their twenty-first birthday.  

The authors used information about how much municipalities accepted the pill to capture the religious preferences of the women who were allowed to use the pill. They measured this by looking at the amount of votes for political parties that were in favour of pill liberalisation at the election just prior to its legalisation.  

With regards to the religious preferences of pill-suppliers, the authors examined the proportion of religious health professionals in each municipality. This measure thus reflects the average willingness of health professionals (general practitioners and pharmacists) in the area to prescribe women oral contraceptives. They then looked at the gaps between the uptake of the pill and the amount of religious health professionals. 

Impact on life-trajectory 

The study shows that access to the pill during the liberalisation of contraceptives had major implications on women’s life-trajectory.  

In more liberal areas, women exposed to the reform as minors were less likely to become mothers before the age of 21 (around 12 percent) and less likely to marry early (around 6 percent). Furthermore, they had a greater likelihood of completing lengthy higher education degrees (28 percent), such as law or medicine and had a higher probability of being in the top quartile of the household's wealth distribution later in life, even if they were not working themselves.  

However, taking up the pill was influenced by religious preferences; women voting for Orthodox Protestant parties were about twice less likely to start taking contraceptives after legislation than those voting for any other political party. 

Moreover, the benefits for women weakened or even disappeared where local gatekeepers were more likely to oppose prescribing based on their own religious beliefs. The authors document a ‘mismatch’ between the health practitioner’s religious view and the local population’s support for the pill. This finding suggests that provider discretion could restrict practical access, even after the law changed. 

Policy Implications 

The role of religious beliefs of health practitioners in access to contraception remains highly debated in many countries. Based on the results of this study, current and future birth control policies may be more effective if they preserve the important advisory role of medical professionals, while ensuring that access remains as neutral and unobstructed as possible. ‘Policymakers should take this into account when designing laws, to ensure equal access in practice’, emphasises Marie. For example, this could mean guaranteeing clear referral obligations, alternative providers, or expanding access points, as seen in recent Dutch reforms that broaden access to reproductive health services through general practitioners.