Table 4.
Changes in maternal health indices, predicted averted deaths and associated costs (or savings) that accompanied a stepwise reduction in the unmet need for contraception
|
Maternal Health Index |
Status quo |
Primary analysis on benefits of family planning |
Secondary analysis on benefits of family planning |
||||||
|---|---|---|---|---|---|---|---|---|---|
| |
|
Reducing the unmet need for contraception |
Increasing use of modern contraceptive method |
||||||
| by 25% | by 50% | by 75% | by 100% | by 25% | by 30% | by 40% | by 50% | ||
|
National analysis |
|
|
|
|
|
|
|
|
|
| Prevalence of modern methods of contraception (average) a |
9.7% |
14.8% |
19.8% |
24.9% |
29.9% |
34.7% |
39.7% |
49.7% |
59.7% |
| Reduction in maternal deaths (%) |
- |
5.9% |
9.7% |
13.5% |
17.4% |
24.2% |
29.1% |
39.1% |
49.9% |
| Total fertility rates |
5.90 |
5.60 |
5.30 |
5.10 |
4.90 |
4.40 |
4.11 |
3.55 |
2.96 |
| Lifetime risk of maternal deaths |
1 in 26 |
1 in 28 |
1 in 29 |
1 in 31 |
1 in 32 |
1 in 36 |
1 in 38 |
1 in 44 |
1 in 53 |
| Proportionate mortality risk |
14% |
13% |
12% |
12% |
11% |
10% |
10% |
8% |
7% |
| Maternal deaths averted per 100,000 |
- |
221 |
367 |
512 |
659 |
897 |
1,080 |
1,449 |
1,814 |
| Additional costs per woman over lifetime (US$) |
$0.00 |
$2.46 |
$4.81 |
$7.18 |
$9.55 |
$16.50 |
$19.84 |
$26.55 |
$33.30 |
| Additional cost to cohort over lifetime (million US$) b |
- |
$85.26 |
$166.89 |
$248.81 |
$331.02 |
$527.12 |
$687.92 |
$920.56 |
$1,154.59 |
| Cost effectiveness ratio (rounding) (US$ per YLS) |
- |
6.40/YLS |
6.50/YLS |
6.60/YLS |
6.70/YLS |
6.90/YLS |
7.10/YLS |
7.30/YLS |
7.60/YLS |
|
Zonal analysis (Southwest zone) |
|
|
|
|
|
|
|
|
|
| Prevalence of modern methods of contraception (average) a |
21.0% |
24.6% |
28.1% |
31.7% |
35.2% |
46.0% |
51.0% |
61.0% |
71.0% |
| Reduction in maternal deaths (%) |
- |
4.3% |
8.5% |
12.9% |
17.1% |
30.2% |
36.3% |
48.5% |
60.8% |
| Total fertility rates |
4.60 |
4.40 |
4.20 |
4.00 |
3.80 |
3.20 |
2.92 |
2.36 |
1.80 |
| Lifetime risk of maternal deaths |
1 in 128 |
1 in 134 |
1 in 140 |
1 in 147 |
1 in 155 |
1 in 184 |
1 in 201 |
1 in 249 |
1 in 328 |
| Proportionate mortality risk |
3.1% |
2.9% |
2.8% |
2.7% |
2.6% |
2.2% |
2.0% |
1.6% |
1.2% |
| Maternal deaths averted per 100,000 |
- |
34 |
67 |
100 |
133 |
236 |
283 |
378 |
474 |
| Additional costs per woman over lifetime (US$) |
$0.00 |
-$0.72 |
-$1.44 |
-$2.18 |
-$2.90 |
-$5.13 |
-$6.17 |
-$8.26 |
-$10.36 |
| Additional cost to cohort over lifetime (million US$) b |
- |
-$4.49 |
-$9.00 |
-$13.65 |
-$18.18 |
-$32.20 |
-$38.72 |
-$51.80 |
-$64.96 |
| Cost effectiveness ratio (rounding) (US$ per YLS) | - | 8.20/YLS | 8.10/YLS | 8.10/YLS | 8.10/YLS | 8.00/YLS | 7.90/YLS | 7.80/YLS | 7.70/YLS |
Each step is in comparison with current conditions. YLS = Year or life saved.
a In the model, age specific rates for use of contraception [13] were used in the national analysis, hence the average values are presented above. For the zonal analysis, average contraceptive rates were used and are presented above.
b Cohort here is made up of the estimated number of women aged 15–45 years old. This amounts to 34.67 million nationally, 6.27 million in Southwest zone, and 3.95 million in the Northeast zone. National figures were derived from the UN World Population Projections [56], and the zonal figures from the 2006 census (here, the estimated proportion of women aged 15–45 years in each zone [18.5% and 11.7% in the Southwest and Northeast respectively] were applied to the UN World Population Projection). Additionally, negative costs imply cost savings. Results from the Northeast zonal analysis are in the supplemental text.