This is an archived report from 2004. Please note that more recent information on metholdology is available in the 2011 publication: http://www.guttmacher.org/pubs/AIU-methodology.pdf Assessing Costs and Benefits Of Sexual and Reproductive Health Interventions Michael Vlassoff, Susheela Singh, Jacqueline E. Darroch, Erin Carbone and Stan Bernstein Occasional Report No. 11 December 2004 Acknowledgments This report was written by Michael Vlassoff, inde- colleagues who made many helpful suggestions: Arnab pendent consultant, Susheela Singh, vice president for J. Acharya, Research Triangle Institute; David Bloom, research at the Alan Guttmacher Institute (AGI), Harvard University; Kwesi Botchwey, Harvard Uni- Jacqueline E. Darroch, former senior vice president versity; Lynn Freedman, Columbia University; Barbara and vice president for science, Erin Carbone, research Janowitz, Family Health International; and Thomas associate and Stan Bernstein, United Nations Popula- Merrick, the World Bank. tion Fund. Akinrinola Bankole, associate director for In addition, the authors appreciate the advice, infor- international research, with the assistance of Rubina mation and materials provided by the following indi- Hussain, senior research assistant, contributed to data viduals: Lori Bollinger, Futures Group International; analyses; Kathleen Randall, with the assistance of John Cleland, London School of Hygiene and Tropical Michael Greelish and Judith Rothman, was responsi- Medicine; Helga Fogstadt, World Health Organization; ble for production of the report and Rose MacLean pro- Gaverick Matheny, The Johns Hopkins University; Bill vided editorial support. McGreevy, Futures Group International; Anthony The authors are grateful to the following colleagues Measham, the World Bank; Anne Mills, London who reviewed an earlier draft of the report and made School of Economics; Philip Musgrove, George Wash- many helpful suggestions: John Stover, Futures Group ington University; Malcom Potts, University of Cali- International; John Bongaarts, Population Council; fornia, Berkeley; Iqbal Shah, World Health Organiza- Rudolfo Bulatao, independent consultant; and John tion; Eva Weissman, UNFPA; George Zeidenstein, Ross, Futures Group International, who deserves spe- Harvard University; and Hania Zlotnick, United Na- cial thanks for reviewing this report and for providing tions Population Division. advice, data and information for the estimates present- Finally, special thanks are due to Stirling Scruggs, ed in Chapter 3. UNFPA, whose initiative and vision were essential to The final version of this report benefits from com- the creation of this report. The research for and prepa- ments provided by our colleagues on AGI’s recently ration of this report were supported by a grant from published report, Adding It Up: The Benefits of Invest- UNFPA. The views expressed in this publication are ing in Sexual and Reproductive Health Care, which those of the authors and do not necessarily represent presents the main findings from this Occasional Re- the views of UNFPA, the United Nations or any of its port. Special thanks go to the following individuals: affiliated organizations. Sara Seims, who inspired and guided the development Suggested citation: Vlassoff M, et al., Assessing of the report, and AGI colleagues Ann Biddlecom, Costs and Benefits of Sexual and Reproductive Health Susan Cohen, Beth Fredrick, Dore Hollander and Cory Interventions: Occasional Report, New York: The Alan Richards, who reviewed and provided comments on Guttmacher Institute, 2004, No. 11. drafts. The authors are also grateful to the following Table of Contents Chapter I: Introduction . 5 2.12 Elements of Clinical Services Component of Essential Package .32 Benefits of Interventions: 2.13 Resource Requirements for the ICPD Program of Action . .33 Medical versus Nonmedical Perspectives . 5 2.14 Estimated Average Costs per contraceptive user by Cost-benefit Methodology . 6 major region . .33 Plan of This Report . 6 2.15 Resource Requirements by Major Region . .34 2.16 Resource Requirements for Global HIV/AIDs Program . .34 Chapter 2: Major Approaches to Evaluating the 2.17 Interventions Included in the Mother-Baby Package . .34 Costs and Benefits of Sexual and Reproductive 2.18 Recent Cost-benefit and Cost-effectiveness Models in Health Programs . 9 Reproductive Health . .35 The Global Burden of Disease . 9 2.19 Savings in Government expenditures in Thailand . .35 Disease Control Priorities in Developing Countries (DCP-1) . .13 World Development Report 1993: Investing in Health . .16 Chapter 3: A New Look at the Benefits Macroeconomics and Health . .17 And Costs of Contraceptive Services in Current and Ongoing Research . .19 Developing Countries . .37 Cairo 1994: The Cost of Reproductive Health . .20 Methodology . .37 UNFPA Costing Initiative . .21 Estimates . .43 The Effect of Family Planning Programs . .21 Tables: UNAIDS Cost Estimates . .21 3.1 Estimated number and percent of women with unmet WHO Mother-Baby Package . .22 need and using no contraceptive, 2003 . .49 Cost-Savings Analyses by The Alan Guttmacher Institute . .22 3.2 Married women of reproductive age . .50 Cost-Benefit and Cost-Effectiveness Models in 3.3 Number of unintended pregnancies by region . 51 Reproductive Health . .23 3.4 Estimated distribution of unplanned pregnancies Selected Country-Level Cost-Benefit Studies of according to outcome . .52 Family Planning Services . .24 Tables: Chapter 4: A Broader Approach to Measuring 2.1 Burden of Disease related to Reproductive Health . .27 Benefits and Costs . .53 2.2 Percentage of DALYs, YLLs and YLDs by WHO Regions, 2001 . .27 Benefits of Sexual and Reproductive Health Services 2.3 HIV/AIDS has become a major cause of sexual and Measurement of costs: how can it be improved? . .54 reproductive ill health worldwide . .28 Conclusion . .60 2.4 Deaths and DALYs in Developing Countries Due to Unsafe Key Points . .60 Sex and Lack of Contraception, 2000 . .28 2.5 Savings per Birth Averted . .28 Chapter 5. Summary and Conclusions . 61 2.6 Costs of Averting a Birth through Family Planning, 1980 . .29 2.7 Benefits verses Costs in Three Hypothetical Countries . .29 Appendix: Definitions, Methodology and 2.8 Components of Two Obstetric Care Models . .30 Data Sources . .65 2.9 Costs and benefits of five hypothetical programs in “Himort”, a country with a population of one million and high mortality . 31 Appendix Tables: . .68 2.10 Estimates of the cost effectiveness of selected interventions, 1.1. Methods of economic evaluation . .68 World Health Report 1993 . .32 2.1. Diseases/conditions included in the Global Burden of 2.11 Elements of Public Health Component of Essential Package . .32 Disease (1990) . .70 2.2. Codes from the International Classification of Disease 3.16.Est. total annual costs to provide contraceptive services to 9th edition used in the 1996 Global Burden of Disease . 71 women currently with unmet need, by type of method . .102 2.3. World Health Organization regional classification . .72 3.17. Est. annual unintended pregnancies to women with unmet 2.4. Summary tables of the UNFPA Costing Initiative . 74 need, no. estimated to occur if they all used modern 3.1a.List of countries by geographic regions and subregions . .82 contraceptive methods and no. averted if all used modern 3.1b.List of countries according to income level. .84 contraceptive methods . .103 3.2. Est. total population and no. and percent distribution of 3.18.Est. no. of unintended pregnancies averted if women with females (15-49) by union status, risk for unintended unmet need all used modern contraceptive methods, by pregnancy and fertility-prefererence . .86 outcome and fertility-preference status . .104 3.3. Est. annual no. of pregnancies by outcome and intention 3.19.Est. maternal and infant deaths averted if women with unmet status, and % of all unintended pregnancies and births that need used modern contraceptive methods; % distribution of are unintended . .87 deaths averted; children who would not lose their mothers; 3.4 Est. annual no. of maternal deaths, % distribution and mortality no. of maternal and infant DALYs averted . .105 rates per 100,000 events, by pregnancy intention status and 4.1 Interventions: information and services . .106 non-abortion or abortion-related cause, deaths to infants by 4.2. Examples of medical benefits of sexual and reproductive pregnancy intention status and rate per 1,000 births . .88 health services . .107 3.5. Est. no. of DALYs, YLLs and YLDs from maternal causes, by 4.3 Examples of nonmedical benefits of contraceptive services . .108 non-abortion and abortion-related pregnancies and perinatal causes . .89 References . .109 3.6. Est. no of women at risk of unintended pregnancy, by contraceptive method use and fertility-preference status . .90 3.7. Percentage distribution of women (15-49) at risk for unintendedpregnancy by contraceptive method and fertility- preference status . .93 3.8. Est. annual service costs for current modern contraceptive users, by type of cost and average total cost per user . .94 3.9. Est. no. of unintended pregnancies to current modern contraceptive users, by type of outcome, % they represent of all unintended pregnancies, births and abortions; no. of unintended pregnancies occuring if they were not using any contraceptive method . .95 3.10.Est. annual no. of unintended pregnancies averted by current use of modern contraceptive methods, type of pregnancy outcome, est. no. of deaths, children losing their mothers and DALYs averted