This dissertation examines three health insurance eligibility policies and their impact on reproductive health outcomes for low-income women of reproductive age. The first paper examines the effects of expanded eligibility for Medicaid under the Affordable Care Act (ACA), on fertility among low-income women of childbearing age. The second paper explores the effect of presumptive eligibility policies in Medicaid for pregnant women on access to prenatal care and health insurance coverage. Finally, the third paper exploits state-level differences in eligibility for public versus private insurance under the ACA, and the effects on perinatal coverage patterns, childbirth outcomes, and access to care.

Decisions about marriage and childbearing, and the subsequent interactions between members of a family unit can have important individual and societal impacts on income, well-being, and economic mobility. This is especially true for women in developing countries, given limited female formal labor force participation, the economic significance of marriage markets, and the reliance on kin networks in the absence of formal safety nets. This dissertation consists of three essays that analyze how individuals form families, how those family members interact, and the subsequent impacts on the well-being of the family unit. The first chapter studies the effects of a rapid university expansion on access to education and family formation for women. The second chapter examines the long-term effects of a primary schooling expansion program on the prevalence of child marriage. The final chapter examines the long-term consequences of early life exposure to armed conflict on family formation. In the first essay, I analyze the impact of increased access to higher education on family formation outcomes for women in developing countries. Using a difference-in-differences design that accounts for the staggered nature of university openings, and a combination of household surveys and administrative data, I examine the impact of women’s exposure to a rapid university expansion in Nigeria in the 2000s on three key aspects of the family formation process - the likelihood and timing of first marriage and birth, their spouses’ characteristics, and the quantity and “quality” of any children produced in the marriage. I find that university openings improved years of schooling and educational attainment among school-aged women, and delayed the timing of the first marriage and childbirth of women. Women also had fewer births, and their children were more likely to have better development outcomes. I show suggestive evidence that these outcomes are driven by increased autonomy - women delay sexual activity and are more likely to work, use contraception and have the final say over important decisions. My second essay analyzes the impact of a 1976 universal primary education reform that provided free primary education to all school-aged children in Nigeria on the prevalence of child marriage. Using data from household surveys, I implement a difference-in-difference empirical strategy that exploits variation in exposure to the reform across birth cohorts and localities. I find that women exposed to the reforms acquired more schooling and the probability that women marry before the age of 15 reduces. However, there are no significant effects of exposure to the policy on the overall age of marriage, or the likelihood of marriage before the age of 18 on average. I present evidence on other marriage outcomes - men’s education increases, as does the spousal education gap. Furthermore, women desire and have fewer children, and are also more likely to be engaged in paid work. However, I find no effects on the spousal age gap or the husband’s age. My third and final essay explores the long-term effects of exposure to violent conflict onfamily formation in developing countries. Using a difference-in-differences empirical design that exploits variation in the intensity of war exposure by ethnicity and age, I analyze the long-term impacts of the 1967-1970 Biafran War on the family formation outcomes of men and women who were exposed to the war during their pre-adolescent years. I find that conflict induces men to delay first marriage and first birth, but there are no significant impacts on the timing of these activities for women. Both men and women who are exposed to the war have fewer children, and women also desire fewer children overall. Additionally, women who were exposed to the war have a smaller age difference from their husbands and are less likely to be married to men who have other wives. They are also less likely to experience domestic violence, on average. War exposure has no effect on the education difference between spouses, but women’s educational attainment increases, on average, while that of men decreases. Finally, I find no effects of war exposure on women’s relational empowerment, in terms of their attitudes to domestic violence and intra-household decision-making, but they are less likely to be engaged in paid work. This study contributes new evidence on the long-term impact of armed conflict on family formation in sub-Saharan Africa and shows how these impacts vary by gender and the age and duration of war exposure.