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Estimation Methodology Jacqueline E October 2011 Adding It Up: The Costs and Benefits of Investing In Family Planning and Maternal and Newborn Health Estimation Methodology Jacqueline E. Darroch and Susheela Singh October 2011 Adding It Up: The Costs and Benefits of Investing In Family Planning and Maternal and Newborn Health Estimation Methodology Jacqueline E. Darroch and Susheela Singh ACKNOWLEDGMENTS This report was written by Jacqueline E. Darroch and Susheela Singh, both of the Guttmacher Institute. The authors thank the following colleagues for their helpful comments and suggestions on drafts of the report: Akin Bankole and Michael Vlassoff, Guttmacher Institute; Stan Bernstein, Population Council; Suzanna Dennis, Population Action International; and Howard Friedman and Sharif Egal, United Nations Population Fund (UNFPA). The authors also thank UNFPA, particularly Howard Friedman, for providing access to the data sources and methodology used in the agency’s revision of cost estimates for the goals agreed to at the International Conference on Population and © Guttmacher Institute, 2011 Development. Suggested citation: Darroch JE and Singh S, The Guttmacher Institute gratefully acknowledges the Adding It Up: The Costs and Benefits of Investing in general support it receives from individuals and founda- Family Planning and Maternal and Newborn Health— tions—including major grants from The William and Flora Estimation Methodology , New York: Hewlett Foundation, The David and Lucile Packard Founda- Guttmacher Institute, 2011. tion and the Ford Foundation—which undergirds all of the Institute’s work. www.guttmacher.org CONTENTS I. INTRODUCTION ........................................................................... 1 VI. SERVICE COSTS ...................................................................... 20 A. Objectives of the report ........................................................ 1 A. Direct costs ......................................................................... 20 B. Other recent estimates ......................................................... 1 B. Program- and systems-related costs ............................ 25 C. Prior work contributing to this project ............................. 1 C. Comparison of family planning costs with earlier estimates ................................................................ 27 II. FRAMEWORK AND SCENARIOS ............................................ 2 VII. AIU ESTIMATES OF PREGNANCY-RELATED A. AIU-2008 framework ............................................................. 2 MORTALITY AND MORBIDITY .......................................... 28 B. Scenarios ............................................................................... 2 A. Maternal mortality .......................................................... 28 C. Time period of estimates .................................................... 3 B. Children who lose their mothers from D. Geographic coverage ........................................................... 3 pregnancy-related mortality ........................................ 31 E. Population numbers ...............................................................4 C. Neonatal (newborn) mortality ...................................... 31 D. Maternal DALYs .............................................................. 32 III. NEED FOR AND USE OF FAMILY PLANNING ......................5 E. Neonatal DALYs ............................................................... 32 A. AIU-2008 definitions .............................................................5 F. Impact of maternal and newborn interventions ....... 33 B. AIU-2008 data sources ........................................................ 6 C. AIU-2008 estimates of contraceptive use and SUMMARY COMPARISON OF AIU AND REVISED umet need for modern methods ....................................... 7 ICPD ESTIMATES .......................................................................... 36 D. UNFPA’s revised ICPD cost estimate sources A. Content .............................................................................. 36 for contraceptive use and definition of B. Time frame and scenarios ............................................ 37 unmet need .......................................................................... 10 FIGURES IV. AIU-2008 ESTIMATION OF PREGNANCIES, BY INTENTION STATUS AND OUTCOME .......................... 10 Figure 1. Adding It Up:The Costs and Benefits of Investing in Family Planning and Maternal and A. Current scenario numbers of pregnancies by Newborn Health—project framework ..................................... 39 intention status and outcome .......................................... 10 Figure 2. The increase in modern method users in B. Unintended pregnancies and outcomes across 2003–2008 reflects rising population, more women contraceptive use scenarios ........................................... 12 wanting to avoid pregnancy and more of them using modern methods ........................................................................... 40 V. NEED FOR AND RECEIPT OF MATERNAL AND NEWBORN MEDICAL CARE .................................................. 14 Figure 3. Program- and systems-related costs as a A. Antenatal care .................................................................... 14 percentage of total sexual and reproductive health costs, 2008–2015............................................................................ 41 B. Labor and delivery ............................................................. 16 C. Abortion complications .................................................... 18 TABLES ............................................................................................ 42 D. Newborns............................................................................. 19 REFERENCES ................................................................................. 60 TABLES Table 1. Data sources for country distributions of women by Table 10. Number of births; proportion of women who risk for unintended pregnancy, future childbearing intention received antenatal care, had a facility delivery and had a ce- and contraceptive use sarean delivery; the number needing care for complications; and the number with unmet need for care—all according to Table 2. Numbers of women aged 15–49 and percentage region, subregion and country income category, 2008 distribution, by region and subregion, according to country income category, 2008 Table 11. Number of births; proportion of newborns delivered in a health facility; number of newborns needing care for Table 3. Number of women aged 15–49 and percentage complications; and the numbers with unmet need for care— distributions by marital status, according to region and all according to region, subregion and country income subregion, 2008 category, 2008 Table 4. Proportion of women aged 15–49 in countries with Table 12. One-year commodity and supply costs; average available data on contraceptive use and proportion with staff minutes, by type of staff; and median average staff unmet need for modern contraceptives, by marital status, costs, by region and country income category–all according according to region and country income category, 2008 to method, 2008 Table 5. Number and percentage distribution of women aged Table 13. Average direct costs of maternal and newborn 15–49 by need for contraception, use of modern methods care per case receiving care, by type of care, under current and unmet need (using a traditional method or no method), conditions and a scenario with 100% of needs met, accord- by region, subregion and country income category, 2008 ing to region and country income group, 2008 Table 6. Number and percentage distribution of women aged Table 14. Program- and systems-related costs as a percent- 15–49, by need for and use of modern contraception and age of total sexual and reproductive health and family plan- with unmet need (using a traditional or no method), accord- ning costs, according to region, 2008–2015 ing to region and subregion, 2003, and percentage change 2003–2008 Table 15. Estimated costs to meet the total need for modern contraception, according to type of cost, 2003 and 2008 Table 7. Estimates of the number of women currently using modern contraceptives and the number who would move to Table 16. Average costs per user of modern contraceptives modern methods under the scenario in which 100% of need in a scenario in which 100% of needs are met, 2003 and 2008, for modern contraception is met, by method, according to and percentage difference, by cost item and region region, subregion and country income category, 2008 Table 17. Estimated reduction in mortality and DALY ratios Table 8. Estimated annual number of pregnancies, by out- from receiving care, according to type of maternal and come and intention status, according to region, subregion newborn complication and country income category, 2008 Table 9. Unintended pregnancy rate and proportion of preg- nancies and births that are unintended, of unintended births that were mistimed and unwanted and the percentages of all pregnancies and unintended pregnancies that end in abortion, according to region and subregion and country income category, 2008 Guttmacher Institute I. INTRODUCTION A. Objectives of the report This report provides methodological details on the estimates presented in Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health (AIU-2008)1,* and related publications.2–11 We describe the analytic framework, sources
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