Guttmacher and UNFPA Report on the Costs and Benefits of Contraception

 

In June 2012, the Guttmacher Institute and the United Nations Population Fund (UNFPA) released their report, “Adding It Up: Costs and Benefits for Contraceptive Services,” with updated estimates for 2012. The goal of the report was to quantify the number of women with an unmet need for contraception and the cost and impact of meeting that need. With a growing concern over advancing maternal and reproductive health among developing countries, the authors hope that policymakers and governments will be able to use this new information to inform future decisions and evaluate their progress.[1]

 

While the need for contraception has plateaued since 2008, the amount of unmet need in the world is staggering. Developing countries are witnessing a historically significant widespread trend toward smaller family sizes. At the same time, women are delaying marriage but increasing sexual activity. In 2012, there were 867 million women of reproductive age in need of contraception, a figure that represents more than half of all the reproductive-age women in the developing world. The study defines a woman as “in need” if any of the following pertains:

 

 

As the report notes, meeting unmet need is crucial to avoiding unintended pregnancies.

 

Of the 867 million women of reproductive age in need of contraception, 222 million women worldwide have an unmet need for modern contraception. These women make up only 26 percent of women who want to avoid pregnancy, but will account for 79 percent of all unintended pregnancies. Furthermore, the report details that meeting the need for proper contraception coverage in developing countries would save 1.1 million infants who would otherwise die and prevent an additional 54 million unintended pregnancies and an additional 26 million abortions (of which 16 million would be unsafe).

 

Western Africa, Middle Africa, Eastern Africa, and Western Asia were cited as being the countries most desperately lacking contraception services, where unmet need ranges from 50-81 percent. And the 69 poorest countries in the world contain the largest percentage of women with unmet need at 73 percent. Even more alarming is that the unmet need for contraception in those countries has increased, from 153 million women to 162 million between 2008 and 2012.[2]

 

The authors estimate that to fully provide for all women who are in need of modern contraceptive methods the cost would be 8.1 billion dollars annually.[3] The estimates include direct costs, such as the actual contraception, as well as indirect costs, such as system costs to help existing healthcare systems provide contraceptive services.[4] To be sure, these are important cost implications in their own right. However, “money spent on contraceptive services to help women avoid unintended pregnancies has large health, social and economic benefits for women, families and society, and results in net savings to the health care system.”[5] Every dollar spent to satisfy all unmet need saves $1.40 in maternal and newborn health costs, and would total $11.3 billion in saved costs.[6]

 

The report recommends that policymakers, governments, and stakeholders revise laws, policies, and service-provision systems and practices in order to afford women easier access to contraceptive services. They must also integrate provisions for contraceptive services into their country budgets. Family planning will need to be successfully incorporated into sexual and reproductive health services, and supply must be able to keep up with the demand for such services. At the moment, planners and providers should be aware that the need could expand as a rising number of women decide to maintain smaller families. Furthermore, efforts to educate the public about the side effects of contraception and a commitment to improving the quality of care are essential to combating misinformation about contraception.[7]

 

On a broader level, the report explains that societal factors impeding women’s access to reproductive services need to be properly addressed. Women are often afforded little decision-making power over their own bodies and within their families, and have to struggle against religious pressure condemnation of modern contraception and the social stigma attached to premarital sex.[8] Demonstrating the difficulty faced by sexually active and unmarried women, 44% of never-married and sexually active women have an unmet need for modern contraception compared to 24% of married women with an unmet need.[9]

 

According to the report, a large scale comprehensive sex education intervention is also necessary to overcoming these entrenched social barriers.[10] It is the hope of the Guttmacher Institute and UNFPA that the research presented will motivate governments and donors to make the required contributions to improve the sexual and reproductive well-being of women that will ultimately raise their status and role within society.[11]

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