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