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  1. Fertility Regulation Behaviors and Their Costs Elizabeth LuleWashington, DC July 16, 2008

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

  3. 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

  4. Trends in Total Fertility Rate by Region, 1950 -2005 Sources: UN 2004; World Bank 2007.

  5. 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

  6. Trends in Contraceptive Prevalence Rates (modern methods) in Select ECA Countries Source: Westoff 2005

  7. Mean ideal number of children, by current age of woman in ECA Source: Westoff 2005

  8. 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

  9. Unintended Pregnancy and Unmet Need for Contraception By region and Pregnancy Outcomes (205 million) Unmet need by Region Source: Sedgh G. et al 2007

  10. Mortality due to Unsafe Abortion Source: Ahman and Shah, 2007

  11. Progress Towards MDGs: Inadequate Trend In Under-five Deaths, 1960-2015 (Millions Deaths Per Year)

  12. Trends in skilled attendant at birth:off track Source: UNICEF

  13. 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

  14. 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

  15. 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

  16. 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

  17. Thank You