fertility regulation behaviors and their costs elizabeth lule washington, dc july 16, 2008
TRANSCRIPT
Fertility Regulation Behaviors and Their Costs
Fertility Regulation Behaviors and Their Costs
Elizabeth LuleWashington, DC
July 16, 2008
Global Trends in fertility behavior
Unmet need for contraception and unintended pregnancies
Costs associated with Fertility Regulation
Recommendations and Policy Implications
Presentation Outline
Review existing research on global trends in fertility regulation behaviors, economic medical and social consequences, costs and cost effectiveness of interventions
Regional reviews of Africa and ECA with contrasting contexts to examine the role of contraception and induced abortion and supply and demand factors
Two country case studies to estimate costs to families, households, and national health systems
Nigeria: Survey in 8 states, household based survey interviews of women, interviews of hospital physicians and cost data collected
Kazakhstan: Three stage stratified sampling of health facilities to look at provider attitudes and gather direct and indirect costs and intervention costs
Identify study limitations and research gaps
Identify and discuss policy implications with governments
Study Methodology
Trends in Total Fertility Rate by Region, 1950 -2005
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
1950-1955
1955-1960
1960-1965
1965-1970
1970-1975
1975-1980
1980-1985
1985-1990
1990-1995
1995-2000
2000-2005
Year
TF
R
High income East Asia & Pacific Europe & Central AsiaLatin America & Caribbean South Asia Middle East & North AfricaEastern Africa Middle Africa Southern AfricaWestern Africa
Sources: UN 2004; World Bank 2007.
Trends in Contraceptive Prevalence Rates (modern methods) in Select African countries
Uganda
Zimbabwe
Tanzania
Madagascar
Ghana
Kenya
Zambia
Nigeria
Rwanda
0
5
10
15
20
25
30
35
40
45
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Uganda Zimbabwe Tanzania Madagascar Ghana
Kenya Zambia Nigeria Rwanda
NOTE: CPR represents women ages 15-49 years old using modern methods of contraceptionSource: Demographic and Health Surveys
Trends in Contraceptive Prevalence Rates (modern methods) in Select ECA Countries
Source: Westoff 2005
Mean ideal number of children, by current age of woman in ECA
Source: Westoff 2005
Contraceptive Prevalence Rate (CPR) by Region and Wealth Quintile
(DHS 1995-2005, most recent country data)
0
10
20
30
40
50
60
70
East Asia &Pacif ic
Europe &Central Asia
LatinAmerica &Caribbean
Middle East& NorthAfrica
South Asia Sub-SaharanAfrica
CP
R
(% w
om
en 1
5-4
9)
Poorest Quintile Richest Quintile
Note: Regional CPR averages are unweighted.Source: Demographic and Health Surveys
Unintended Pregnancy and Unmet Need for Contraception By region and
55%
3%8%
7%
27%
South & Southeast Asia Central Asia
Latin America & Caribbean North Africa & West Asia
Sub-Saharan Africa
Unmet need by Region
Source: Sedgh G. et al 2007
Pregnancy Outcomes
(205 million)
20%
16%
49%
15%
Induced abortions Unwanted or mistimed births Wanted births Spontaneous abortions
Mortality due to Unsafe Abortion
350
650
300
5010
0
100
200
300
400
500
600
700
All Developing Africa Asia Latin America Developed
Dea
ths
per
100
,000
ab
ort
ion
s, 2
003
Source: Ahman and Shah, 2007
Progress Towards MDGs: Inadequate
2.9 3.2 3.5 4.1 4.6 4.9
2
5.1
13.510.9
8.3 7 5.1 4.1
2.2
3
4.1
3.6
2.71.8
1.41.1
0.8
0.1
0
5
10
15
20
25
1960 1970 1980 1990 2000 2005 2015 withachievement of
MDGs
2015 withcurrent Trend
Africa Asia Other
Trend In Under-five Deaths, 1960-2015 (Millions Deaths Per Year)
Trends in skilled attendant at birth:off track
Source: UNICEF
Direct and Indirect Costs• Globally, cost to women’s health – 5 million suffer from
disability including infertility, poor mental health and stigma
• Transport costs are high especially for the poor• Loss of productivity and earnings• Hospitalization costs – mean per patient cost estimated
at US $96-$131• Cost to health systems – In Nigeria, 185,000 cases of
post abortion complications cost $19 million in 2005. In Kazakhstan, contraceptive use as an alternate to abortion is at least 3.2 times more cost-effective to avert one birth
Recommendations and Policy Implications (1)• Failure to provide access to convenient, safe, affordable
and acceptable choices for contraception appears to perpetuate unnecessary reliance on abortion
• To reach MDGs 4 and 5, countries and donors need to address unmet need and growing demand for contraception especially for young, poor and rural women and men in developing countries
• Given that contraception is more cost effective than abortion, countries and donors need to invest more in:– improving access to contraceptive knowledge and services,
particularly to young women
– ensuring commodity security in the long-term
Recommendations and Policy Implications (2)• Improve health systems and
overall family planning provision including supply chains
• Improve access to affordable, basic social and health services, particularly education for girls and labor participation for women
• More research on socio-economic impact of unsafe abortion on women, households and health systems and document benefits
Acknowledgements
• Donor support from the Swedish International Development Cooperation Agency (SIDA), UNFPA, and the Hewlett Foundation
• Co-authors Susheela Singh and Sadia Chowdhury and contributing authors
• Other institutions: Guttmacher Institute, Princeton University, UNFPA, and USAID
Thank You