The unintended effects of the COVID-19 pandemic and stay-at-home orders on abortions.

We study the effect of the COVID-19 pandemic and of government mandated mitigation policies on the number of abortions performed by Mexico City's public abortion program. We find that the COVID-19 pandemic and stay-at-home orders (SAHO) implemented in Mexico led to unintended consequences for women's sexual and reproductive health. Using difference-in-differences and event study analyses, we show that SAHO and the pandemic led to a fall in abortions of around 25% and find no evidence that unsafe abortions increased. We find a decrease in the share of single and teenage women getting abortions, arguably due to fewer unwanted pregnancies from decreased sexual activity, and estimate that at most 9.8% of the total fall in abortions can be attributed to this. We complement our analysis using call data from a government helpline and show that the SAHO time period led to fewer abortion- and contraception-related calls but to an increase in pregnancy-related calls.

Changes in Weight-Related Outcomes Among Adolescents Following Consumer Price Increases of Taxed Sugar-Sweetened Beverages.

Importance: Following the implementation of a tax on sugar-sweetened beverages (SSBs) in Mexico in 2014, SSB prices increased by about 10% on average, but differently across cities. It remains unclear how observed SSB price changes are associated with adolescent weight-related outcomes. Objective: To compare weight-related outcomes among adolescents living in cities with differential SSB price changes before and after the SSB tax was implemented in Mexico. Design, Setting, and Participants: Associations between differential SSB price changes and changes in weight-related outcomes were examined overall and by sex among 12 654 adolescents aged 10 to 18 years born between 1999 and 2002 living in 39 cities in Mexico. Multivariate regressions with individual fixed effects were applied on longitudinal individual-level yearly clinical data (height and weight) from 2012 to 2017 collected by the Instituto Mexicano del Seguro Social (IMSS) and merged with city-level SSB price data from 2011 to 2016 collected by the National Institute of Statistics and Geography (INEGI). Data were analyzed from July 2018 to July 2021. Exposures: Yearly city-level changes in SSB prices between 2011 and 2016. Main Outcomes and Measures: Age- and sex-specific body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) percentile and indicator for overweight or obesity if BMI was at or above the 85th percentile. Results: Before 2014, 46% of 12 654 adolescents (6850 girls and 5804 boys) included in this study had obesity or overweight. The mean (SD) age was 11.38 (1.08) years. Among girls, a 10% SSB price increase was associated with a 1.3 percentage point absolute decrease (95% CI, -2.19 to -0.36; P = .008) or a 3% relative decrease in overweight or obesity prevalence within 2 years of a price change. For girls with BMI at or above the 75th percentile pretax, this price increase was associated with a 0.59 lower BMI percentile (95% CI, -1.08 to -0.10; P = .02) or a 0.67% relative decrease. Improved outcomes for girls were observed in cities where price increases were greater than 10% after the tax. No such associations were observed for boys. Conclusions and Relevance: In this study, increased SSB prices were associated with decreased overweight or obesity prevalence among girls but not among boys. Improvements in outcomes were small, and mostly observed for girls with heavier weight and in cities where price increases after the tax were greater than 10%.

When less is more: Can reduced health monitoring improve medication adherence?

As the prevalence of chronic diseases rises, improving self-management has become an important determinant of the productivity of healthcare delivery. Recently, Mexico's largest healthcare provider began issuing automatic-refill prescriptions to stable hypertensive patients, thus reducing the frequency of health monitoring from 30- to 90-day intervals. Exploiting this change, I find that less monitoring implies no drawbacks in health outcomes and actually improves self-management of disease by increasing medication adherence when baseline monitoring is relatively frequent. The number of days when patients are out of medication between fillings falls by 2.2 days-an improvement in adherence of 6.4%. Furthermore, patients appear to value being on a low-frequency regime as they improve adherence in order to remain on it, suggesting that lower monitoring could be used as a "reward" to promote medication adherence or, potentially, other health behaviors. Finally, I find evidence of positive spillovers on adherence, as clinic congestion falls.

Air pollution exposure and COVID-19: A look at mortality in Mexico City using individual-level data.

We use individual-level data to estimate the effects of long- and short-term exposure to air pollution (PM2.5) on the probability of dying from COVID-19. To the best of our knowledge, our study is the first to look at this relationship using individual-level data. We find that for Mexico City there is evidence of a positive relationship between pollution and mortality that significantly grows with age and that appears to be mostly driven by long- rather than short-term exposure. By using a rich set of individual- and municipal-level covariates we are able to isolate the effect of exposure to pollution from other crucial factors, thus alleviating endogeneity concerns related to selection. Our results provide yet another reason for the need to implement environmental strategies that will reduce the exposure to air pollution: it is a key element to improve the general population's health. In addition, and considering that at this moment we do not know when the pandemic will stop or if SARS-CoV-2 will become a recurrent threat, the relationship that we uncovered suggests that financial resources should be allocated to improve medical services in those areas where PM2.5 concentrations tend to be high.