The Consequences of Community Violence for Contraceptive Use and Provision in Mexico

This study examines the relationship between community violence and the use and provision of contraception in Mexico, where family planning is a long-standing policy priority and the "war on drugs" has led to chronically high levels of violence. We adopt a two-step approach. First, we investigate the association between women's exposure to violence and first contraceptive use. Combining individual-level data (n = 86,219) from two waves of the National Survey of Demographic Dynamics (ENADID) with information on monthly municipality-level homicides in event-history models, we analyze the timing and method of women's first contraceptive use and the source of first contraception. Second, leveraging rare data from Mexico's Ministry of Health in clinic fixed-effects models, we study the association between homicides and contraceptive provision from public clinics. Results show strong positive associations between community violence and both the transition to first contraceptive use and the contraceptive provision of reversible methods. These relationships are stronger in the long term; one more homicide per 10,000 population during the past five years is associated with triple the risk of initiating contraceptive use and two to three more reversible contraception users served in each public clinic per month. The findings suggest increasing contraceptive vigilance and fertility regulation preferences-but also healthcare system resilience-in times of insecurity.