Publisher/Institution: University of Michigan

Abstract: In the early 2000s, the National Adolescent Friendly Clinic Initiative (NAFCI) aimed to reduce teen pregnancy in South Africa by eliminating physical and social barriers to reproductive health services. NAFCI was implemented by the NGO loveLife in partnership with the South African Department of Health. NAFCI consisted of an intensive clinic accreditation process that involved training nurses, stocking supplies to cater to youth needs, youth-targeted educational materials, building dedicated spaces at clinics for youth education, and community outreach including employing local youth to run reproductive health education programs. By 2010, 500 clinics were accredited as “youth friendly.” Based on interviews with stakeholders and a series of controls, I argue that geographic and timing variation of the NAFCI rollout led to a conditionally random increase in reproductive health knowledge and clinical access. I use restricted GPS data in the South African National Income Dynamics Study to geo-link women to clinic locations and estimate that living near a NAFCI clinic as an adolescent significantly reduced the likelihood of having a first birth by age 18. I use information on loveLife satellite facilities that only offered the education treatment, but were not linked to a clinic, to parse out the separate impact of education and clinical access and find suggestive evidence that the education component alone had a smaller and less significant impact on teen-pregnancies than the clinical component.