Fertility Regulation Behaviors and Their Costs

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Fertility Regulation Behaviors and Their Costs

• Elizabeth LuleWashington, DC
• July 16, 2008

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Presentation Outline

• Global Trends in fertility behavior
• Unmet need for contraception and unintended
  pregnancies
• Costs associated with Fertility Regulation
• Recommendations and Policy Implications

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Study Methodology

• 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

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Trends in Total Fertility Rate by Region, 1950
-2005
Sources UN 2004 World Bank 2007.
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Trends in Contraceptive Prevalence Rates (modern
methods) in Select African countries
NOTE CPR represents women ages 15-49 years old
using modern methods of contraception Source
Demographic and Health Surveys
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Trends in Contraceptive Prevalence Rates (modern
methods) in Select ECA Countries
Source Westoff 2005
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Mean ideal number of children, by current age of
woman in ECA
Source Westoff 2005
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Contraceptive Prevalence Rate (CPR) by Region and
Wealth Quintile(DHS 1995-2005, most recent
country data)

Note Regional CPR averages are
unweighted. Source Demographic and Health Surveys
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Unintended Pregnancy and Unmet Need for
Contraception By region and
Pregnancy Outcomes (205 million)
Unmet need by Region
Source Sedgh G. et al 2007
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Mortality due to Unsafe Abortion
Source Ahman and Shah, 2007
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Progress Towards MDGs Inadequate
Trend In Under-five Deaths, 1960-2015 (Millions
Deaths Per Year)
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Trends in skilled attendant at birthoff track
Source UNICEF
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Direct and Indirect Costs

• Globally, cost to womens 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

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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

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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

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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

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Thank You
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