The case for investing in family planning in the Pacific: costs and benefits of reducing unmet need in Vanuatu and Solomon Islands Dr Elissa Kennedy Principal for Maternal and Child Health Centre for International Health, Burnet Institute

Acknowledgments: Sean Mackesy-Buckley, Family Planning International Sumi Subramaniam, Family Planning International Apisai Tokon, Vanuatu Ministry of Health Judith Seke, Solomon Islands Ministry of Health Annette Sachs Robertson, UNFPA Rufina Latu, WHO Arthur Jorari, Statistics and Demography Programme, SPC Kabwea Tiban, IPPF ESEAOR Andreas Demmke, population specialist

The ability to decide freely the number, spacing and timing of children is a fundamental human right It is also one of the most cost-effective global health and development interventions

Prevalence of modern contraception is lower than the average for less developed regions Source: Demographic and Health Surveys Marshall Islands, Solomon Islands, Nauru, Tuvalu, Kiribati, Papua New Guinea, and Samoa; UNFPA KAP study Vanuatu; UNFPA State of World Population 2012.

Unmet need for family planning is among the highest in the world Source: Demographic and Health Surveys Marshall Islands, Solomon Islands, Nauru, Tuvalu, Kiribati, Papua New Guinea, and Samoa; UNFPA KAP study Vanuatu; UNFPA State of World Population 2012.

A significant proportion of pregnancies are unintended Source: Demographic and Health Surveys Marshall Islands, Solomon Islands, Nauru, Tuvalu, Kiribati, Papua New Guinea, and Samoa; UNFPA KAP study Vanuatu; UNFPA State of World Population 2012.

Aims and objectives To estimate the costs and health, demographic and economic impacts of reducing unmet need for family planning in Vanuatu and Solomon Islands Assist Ministries of Health, NGOs, service providers and other stakeholders to advocate for increased funding for family planning Assist governments to develop reproductive health and population policies and resource these adequately Contribute to the evidence-base for family planning in the Pacific

Methods Three scenarios: 1.No change in unmet need for family planning 2.All family planning needs met by All family planning needs met by 2050 Population models were created for , using Spectrum, to estimate: –Contraceptive prevalence and number of users –Family planning costs and commodities required –Health outcomes for women and children (unintended pregnancies, births, induced abortions, births with any risk, and maternal and infant deaths) –Total fertility rate and population growth –Health and education expenditure and required resources (infrastructure and human resources)

Meeting all the need for family planning by 2020 would result in 25,000 more women using a modern method of contraception Contraceptive prevalence rate (modern methods) 2025

The average annual number of unintended pregnancies would fall by 69% on Vanuatu and 50% in Solomon Islands Average number of unintended pregnancies per year

The number of avoidable high risk births, including births to adolescent girls, would decrease by 54% in Vanuatu Total births: 7,298 Total births: 4,542 High risk births: 4,049 High risk births: 1,940 No change in unmet needAll needs met by 2020

… and by 20% in Solomon Islands Total births: 16,280 Total births: 14,402 High risk births: 8,922 High risk births: 7,185 No change in unmet needAll needs met by 2020

More than 2,500 maternal and infant deaths would be averted between VanuatuSolomon Islands

Satisfying the demand for family planning would reduce TFR and slow population growth Vanuatu

Satisfying the demand for family planning would reduce TFR and slow population growth Solomon Islands

Preventing unwanted fertility would result in less demand on scarce public sector resources Vanuatu: projected health and education resources required by 2025

Preventing unwanted fertility would result in less demand on scarce public sector resources Solomon Islands: projected health and education resources required by 2025

Preventing unwanted fertility would reduce the youth dependency ratio, resulting in less demand on household resources

US$8.6 million would be required over the next 16 years to meet all family planning needs Cumulative family planning costs (direct costs) between

Vanuatu: –$1.47 per capita to meet all needs by 2020 –$104 to prevent an unintended pregnancy –$3,928 to avert a maternal or infant death Solomon Islands: –$0.40 per capita to meet all needs by 2020 –$101 to prevent an unintended pregnancy –$2,762 to avert a maternal or infant death

Reducing unintended pregnancies would result in US$112 million in public sector savings between Total family planning costs and public sector savings (US$ millions) between 2010 and 2025

For every $1 spent to reduce unmet need by 2020, $9-16 would be saved in health and education expenditure making other development goals more attainable and more affordable

Conclusions Reducing unmet need for family planning in Vanuatu and the Solomon Islands would have substantial benefits for the health of women and children It would also have considerable economic benefits, reducing the demand on household and national resources and saving $112 million in public sector spending between

Recommendations Reducing unmet need for family planning should be given greater priority in reproductive, maternal and child health, and population and development policies Increased and long term financial commitment is required to meet the needs of women and couples (at least $1.5 million for Vanuatu and $1 million for Solomon Islands over the next 5 years) Improved information systems are needed to support planning and monitor progress towards universal access to reproductive health

Resources Full reports and summary reports available at: Contact: