Adding it up: Investing in Contraception and Maternal and Newborn Health, 2017
Publication date: 2017
■■ As of 2017, 1.6 billion women of repro- ductive age (15–49) live in developing regions. About half of them (885 million women) want to avoid a pregnancy; of this subset of women, about three- quarters (671 million) are using modern contraceptives (Figure 1). ■■ Yet 214 million women of reproduc- tive age in developing regions who want to avoid pregnancy are not using a modern contraceptive method. This includes 155 million who use no method of contraception and 59 mil- lion who rely on traditional methods. These women are considered to have an unmet need for modern contracep- tion. Their number has decreased from 225 million in 2014, as modern method use has increased. ■■ The proportion of women who have an unmet need for modern contracep- tion is highest in Sub-Saharan Africa (21%), while the largest absolute num- ber (70 million women) live in Southern Asia. Together, Sub-Saharan Africa and Southern Asia account for 39% of all women in developing regions who want to avoid pregnancy and 57% of women with an unmet need for mod- ern contraception. ■■ Of the estimated 206 million pregnan- cies in 2017 in developing regions, 43% are unintended (that is, they occur too soon or are not wanted at all). ■■ Women with an unmet need for mod- ern contraception account for 84% of all unintended pregnancies in develop- ing regions (Figure 2). Women using no method of contraception account for 74% of unintended pregnancies, while women using a traditional method account for 10%. ■■ Of the 127 million women who give birth each year in developing regions, many do not receive essential maternal and newborn health care. Overall, just 61% receive a minimum of four ante- natal care visits, and 73% give birth in a health facility (Figure 3). ■■ There are wide disparities in mater- nal and newborn health care across regions. For instance, only 56% of women giving birth in Africa deliver in a health facility, compared with 91% in Latin America and the Caribbean. ■■ Disparities among countries in con- traceptive and maternal and newborn health care follow economic lines. The proportion of women aged 15–49 whose need for family planning is sat- isfied with modern contraception is lowest (49%) in low-income countries, compared with 69% in lower-middle– income countries and 86% in upper- middle–income countries. Likewise, the proportion of women delivering in a health facility is lowest (55%) in low- income countries and highest (94%) in upper-middle–income countries. ■■ Among women who experience med- ical complications during pregnancy or delivery, only one in three (35%) ADDING IT UP: Investing in Contraception and Maternal and Newborn Health, 2017 FACT SHEET This fact sheet presents estimates for 2017 of the contraceptive, maternal and newborn health care needs of women in developing regions, critical gaps in service coverage, and the costs and benefits of fully meeting these needs. 155 1,600 million women of reproductive age, 2017 214 million women with unmet need 59 671 714 Unmet need (no method) Unmet need (traditional method) Modern method* Not in need of modern method† FIGURE 1: CONTRACEPTIVE NEED AND USE In developing regions, 214 million women want to prevent pregnancy but are not using modern contraception. *Modern methods include female and male sterilization, hormonal methods, IUDs, male and female condoms, modern fertility awareness–based methods, lactational amenorrhea method, emergency contraception and other supply methods. †Includes women who are unmarried and not sexually active, are infecund, want a child in the next two years, or are pregnant/ postpartum with an intended pregnancy. Corrected July 13, 2017. See note, page 4. GUTTMACHER INSTITUTE receive the care they or their newborns need. ■■ In 2017, an estimated 308,000 women in develop- ing countries will die from pregnancy-related causes, and 2.7 million babies will die in the first month of life. Most of these deaths could be prevented with full access to certain vital ser- vices: contraceptive care to help women avoid unin- tended pregnancies, and maternal and newborn health care to help mothers and newborns through preg- nancy and delivery. Benefits of modern contraceptive use ■■ Current modern contracep- tive use prevents an estimat- ed 307 million unintended pregnancies annually among all women of reproductive age in developing regions. ■■ If all unmet need for modern contraception were satisfied in developing regions, there would be approximately a three-quarters decline in unintended pregnancies (from the current 89 mil- lion to 22 million per year), unplanned births (from 30 million to seven million per year) and induced abortions FIGURE 2: UNINTENDED PREGNANCY AND UNMET NEED Women with unmet need for modern contraceptive methods account for 84% of unintended pregnancies. 89 million unintended pregnancies, 2017 74% 10% 14% Unmet need (no method) Unmet need (traditional method) Short-term reversible method Long-acting reversible method and sterilization *Per UN Population Division classifications, developing regions comprise Africa, Asia, Latin America and the Caribbean, and Oceania, excluding Australia, Japan and New Zealand. The 2017 estimates are based on data for 148 countries or territories, and estimates presented here for Asia include countries in Oceania. †Per World Bank classifications, low income corresponds to a 2015 GNI per capita of $1,025 or less, lower-middle to $1,026–4,035, and upper-middle and high-income to $4,036 or more. The analysis covers 96% of low- and middle-income countries: 100% of those that are low income, 98% of those that are lower- middle–income and 93% of those in the upper-middle–income category. To help decision makers evaluate the investments needed in developing regions, these 2017 estimates show the need for and costs and benefits of sexual and reproductive health services in two key areas: contraceptive services and maternal and newborn care, which includes the provision of antenatal, labor, delivery, postpartum and newborn care, and care for women who have stillbirths, miscarriages, ectopic pregnancies or induced abortions. For each key area, estimates are present- ed in this fact sheet for developing regions as a whole* and for major geographic regions. Estimates by geographic subregion and World Bank income group† and specific sources for data used in the 2017 estimates are available online at https://www. guttmacher.org/fact-sheet/adding-it-up-contraception-mnh-2017. The 2017 estimates build on prior Adding It Up reports that pro- vided estimates for 2003, 2008, 2012 and 2014. The 2017 esti- mates draw on new survey data and the most recent informa- tion on population and births, maternal mortality ratios, newborn mortality rates, maternal and newborn cause-of-death distribu- tions, estimates of induced abortion and unintended pregnancy, guidelines for contraceptive and maternal and newborn health services, estimates of health worker salary costs, and commod- ity and supplies costs. Where relevant, we adjusted estimates to pertain to the 2017 reference year. The 2017 estimates include a limited subset of the services covered in the 2014 report; they do not include services to prevent mother-to-child transmission of HIV, to protect the health of pregnant women living with HIV, or to treat STIs among women of reproductive age. Estimates of abortion assume no change in the safety of abortion provision. Overview of the study For each of the broad groups of sexual and reproductive health services included in the 2017 estimates, results are estimated for the numbers of women of reproductive age (15–49) and their newborns needing these services, the levels of services they currently receive, health benefits that accrue from current servic- es and that would accrue from meeting 100% of service needs, and the costs of current services and of fulfilling the unmet need for services (including the cost savings that would result from fully providing both contraceptive services and maternal and newborn health services, compared with maternal and newborn health services alone). Cost estimates (in 2017 U.S. dollars) include both direct and indirect costs. Direct costs are those related to personnel time, commodities and supplies for contraceptive services and ma- ternal and newborn medical care, and information and counsel- ing associated with these services. Indirect costs, also known as program and systems costs, are those related to program management, supervision and training of personnel, monitoring and evaluation, human resources development, transport and telecommunications, health education, outreach, and advocacy, infrastructure improvements, and health management informa- tion and commodity supply systems. GUTTMACHER INSTITUTE cost of pregnancy-related care would drop by $2.22. ■■ Fully meeting the needs for both modern contracep- tion and maternal and new- born care would cost $53.5 billion annually—$8.54 per person—in develop- ing regions. Investing in both contraceptive and maternal and newborn ser- vices together results in a net savings of $6.9 bil- lion compared with invest- ing in maternal and newborn health care alone. Need for greater investment ■■ An investment of $8.54 per person per year would help ensure that all women in developing regions receive essential mater- nal and newborn care and give women and couples effective means to prevent FIGURE 4: MATERNAL MORTALITY Fulfilling unmet need for modern contraceptive services and maternal health care would save women’s lives. NO. OF MATERNAL DEATHS (IN 000s), 2017 308 112 0 50 100 150 200 250 300 350 Deaths related to unintended pregnancies Deaths related to intended pregnancies 100% coverage of contraceptive and maternal care 100% coverage of maternal care, current level of contraceptive care 100% coverage of contraceptive care, current level of maternal care Current levels of contraceptive and maternal care 96 20 211 211 76 36 76 Deaths related to unintended pregnancies Deaths related to intended pregnancies 231 84 0 50 100 150 200 250 300 350 Deaths related to unintended pregnancies Deaths related to intended pregnancies 100% coverage of contraceptive and maternal care 100% coverage of maternal care, current level of contraceptive care 100% coverage of contraceptive care, current level of maternal care Current levels of contraceptive and maternal care NO. OF MATERNAL DEATHS (IN 000s), 2017 Deaths related to unintended pregnancies Deaths related to intended pregnancies 0 50 100 150 200 250 300 350 Deaths related to unintended pregnancies Deaths related to intended pregnancies Current levels of contraceptive and maternal care 100% coverage of contraceptive and maternal care 100% coverage of maternal care, current level of contraceptive care 100% coverage of contraceptive care, current level of maternal care NO. OF MATERNAL DEATHS (IN 000s), 2017 Deaths related to unintended pregnancies Deaths related to intended pregnancies 30896211 231211 20 1123676 76 84 billion annually (includ- ing both direct and indirect costs), or $1.90 per person per year. ■■ Maternal and newborn care at current levels costs an estimated $25.5 billion annually, of which $17.2 bil- lion is spent on care related to intended pregnancies and $8.3 billion on care related to unintended pregnancies. Fully meeting the needs for such care would cost $54.0 billion annually (or $8.63 per person per year). ■■ Because the cost of pre- venting an unintended pregnancy through use of modern contraception is far lower than the cost of providing care for an unin- tended pregnancy, for each additional dollar spent on contraceptive services above the current level, the (from 48 million to 13 million per year). ■■ The health benefits of preventing unintended pregnancies would be sub- stantial. Compared with the current situation, fully meeting the unmet need for modern contraception would result in an estimated 76,000 fewer maternal deaths each year (Figure 4). Preventing maternal and newborn deaths ■■ Maternal and newborn health care, by which we mean services that cover pregnancy and its outcomes (live birth, miscarriage, still- birth or abortion), currently prevents 197,000 mater- nal deaths and 2.0 million newborn deaths per year in developing countries. ■■ Providing all pregnant women and their infants with the level of maternal and newborn health care recommended by the World Health Organization would reduce maternal deaths by 64%, to 112,000 per year, assuming no change in con- traceptive use or in the number of unintended preg- nancies (Figure 4). Newborn deaths would drop by 76%, to 659,000. ■■ If full care for all pregnant women and newborns were combined with full provision of modern contraception to women who want to avoid pregnancy, maternal deaths would drop from 308,000 to 84,000 per year, and new- born deaths would drop from 2.7 million to 541,000 per year. Cost of contraception and maternal and newborn care ■■ The estimated current annual cost of modern con- traceptive services in devel- oping regions, covering 671 million women who are cur- rently using modern meth- ods, is $6.3 billion, including direct and indirect costs (Figure 5). This is one dollar per person per year in devel- oping regions ($1.01). ■■ Expanding and improving services to meet all wom- en’s needs for modern con- traception in developing regions would cost $11.9 FIGURE 3: USE OF MATERNAL HEALTH SERVICES Large gaps persist across regions in the receipt of essential maternal health services. 0 20 40 60 80 100 Give birth in a health facilityReceive ≥4 antenatal care visits % OF WOMEN GIVING BIRTH, 2017 Latin America and Caribbean AsiaAfricaAll developing countries 61 45 66 87 73 56 79 91 GUTTMACHER INSTITUTE NOTE The following changes were made to correct an error in the calculation of cost estimates related to contraceptive ser- vices in Adding It Up: Investing in Contraception and Maternal and Newborn Health, 2017. These corrections do not change the study’s summary findings or conclusions. The current annual total cost of modern contraceptive care is corrected from $5.5 billion ($0.88 per person per year) to $6.3 billion ($1.01 per person per year). The increase in this estimate means the following annual total costs shift as follows: • Cost of current levels of contraceptive and maternal and newborn health (MNH) care is corrected from $31.0 billion to $31.8 billion • Cost of 100% coverage of MNH care and current level of contraceptive care is corrected from $59.6 billion to $60.3 billion The current annual cost of 100% coverage of modern contraceptive care is corrected from $11.0 billion ($1.75 per person per year) to $11.9 billion ($1.90 per person per year). Therefore, annual total cost of services for 100% coverage of contraceptive and MNH care is corrected from $52.5 billion ($8.39 per person per year) to $53.5 billion ($8.54 per person per year). The net savings of investing in 100% coverage of both contraceptive and MNH care (versus investing in MNH care alone) is thus corrected from $7.1 billion to $6.9 billion. For each additional dollar spent on contraceptive services above the current level, the cost of pregnancy-related care would drop by $2.22 (corrected from $2.30). unintended pregnancies, time their births and have the number of children they want to have. ■■ Barriers to the provision of accessible and acceptable care must be tackled. These include policy restrictions, shortages of trained health personnel, poor-quality services, lack of outreach to marginalized groups of people, and social and eco- nomic factors that prevent people from obtaining or using needed services. ■■ Significant investment in contraceptive services and maternal and new- born health care is needed. Governments, donors, NGOs, households and individuals all need to contribute to closing the funding gap to improve and expand services. Investing in contraceptive services and maternal and new- born health care together, rather than in maternal and newborn care alone, saves money and has a larger impact in preventing deaths and improving the health and well-being of women and their families. ■■ The return on these invest- ments goes beyond the critical impacts on health to include broad social and economic benefits for women, families and soci- eties, such as increases in women’s and children’s education, increases in women’s earnings and reductions in poverty. 125 Maiden Lane New York, NY 10038 212.248.1111 email@example.com www.guttmacher.org Good reproductive health policy starts with credible research FIGURE 5: ANNUAL COST OF SERVICES Investments in modern contraceptive services help to reduce the costs of meeting the need for MNH* care. $31.8 $60.3 $53.5 0 10 20 30 40 50 60 70 Cost of modern contraceptive care Cost of MNH care for unintended pregnancies Cost of MNH care for intended pregnancies 100% coverage of contraceptive and MNH care 100% coverage of MNH care, current level of contraceptive care Current levels of contraceptive and MNH care Cost of modern contraceptive care Cost of MNH care for unintended pregnancies Cost of MNH care for intended pregnancies ANNUAL TOTAL (IN BILLIONS OF U.S. DOLLARS), 2017 6.3 8.3 17.2 6.3 11.9 37.2 4.3 16.8 37.2 DONOR SUPPORT The study on which this fact sheet is based was made possible by UK Aid from the UK Government, and grants from the Bill & Melinda Gates Foundation and the John D. and Catherine T. MacArthur Foundation. The views expressed are those of the authors and do not necessarily reflect the positions and policies of the donors. JULY 2017 *MNH=maternal and newborn health. ACKNOWLEDGMENTS This fact sheet is published as part of the study, Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health 2017, currently being conducted by the Guttmacher Institute. Additional data and sources can be found at https://www. guttmacher.org/fact-sheet/ adding-it-up-contraception- mnh-2017. The research team is led by Jacqueline E. Darroch with support from (in alphabetical order) Suzette Audam, Ann Biddlecom, Grant Kopplin, Taylor Riley, Susheela Singh and Elizabeth Sully, all of the Guttmacher Institute. The study benefited from input from Eva Weissman, independent consultant, and Karin Stenberg, World Health Organization.