Achieving the Millennium Development Goals The contribution of family planning

Achieving the Millennium Development Goals The contribution of family planning Scott Moreland, Constella Futures Sandra Talbird, University of North Carolina, Chapel Hill

Countries Modeled

The number of women of reproductive age is large and growing. Source: SPECTRUM 2.38 Projections

The number of pregnancies will continue to increase each year. Source: SPECTRUM 2.38 Projections

A significant percentage of these pregnancies are unintended or mistimed. Source: SPECTRUM 2.38 Projections Total pregnancies Nigeria 2003 Mali 2001

Many women want to space or limit their births but do not use family planning. Source: DHS Users defined as married women of reproductive age (MWRA) currently using contraception Unmet need represents those who want to use family planning but are not currently doing so

TraditionalModern Nigeria35%65% Mali30%70% Ghana26%74% Madagascar32%68% Percentage distribution of users by type of family planning method used Use of less effective, traditional contraceptive methods is high. Source: DHS, married women (Nigeria 2003, Mali 2001, Ghana 2003, Madagascar 2003/2004)

Meeting the unmet need for family planning will increase the percentage of women using family planning. Source: Nigeria DHS 2003, Mali DHS 2001, married women

The number of women using family planning will increase when unmet need is met. Source: SPECTRUM 2.38 Projections

Meeting the unmet need for family planning will reduce unintended pregnancies… Source: SPECTRUM 2.38 Projections

…as well as reduce the number of abortions. Source: Henshaw et al., 1999, and SPECTRUM 2.38 Projections

…and therefore reduce the number of unintended births. Source: Calculated by authors based on unintended pregnancies, abortions, and spontaneous abortions

1.Eradicate extreme poverty and hunger 2.Achieve universal primary education 3.Promote gender equality and empower women 4.Reduce child mortality 5.Improve maternal health 6.Combat HIV/AIDS, malaria and other diseases 7.Ensure environmental sustainability 8.Develop a global partnership for development

Reducing unmet need for family planning can help countries to meet the MDGs by reducing the cost of achieving the goals. Liz Gilbert, the David & Lucile Packard Foundation Chamberlain Diala, JHU/CCP

Focus on 5 Millennium Development Goals Achieve universal primary education Achieve universal primary education Reduce child mortality Reduce child mortality Improve maternal health Improve maternal health Combat HIV/AIDS, malaria and other diseases Combat HIV/AIDS, malaria and other diseases Ensure environmental sustainability Ensure environmental sustainability

Calculating savings in the costs of meeting the MDGs due to increased contraceptive use 1. Project the population with constant FP use and with unmet need fulfilled 2. Calculate the costs of meeting the MDGs for each projection 3. Compare the cost projections and calculate the difference

Contraceptive prevalence rate assumptions used to calculate population scenarios Source: MEASURE DHS, Stat Compiler * Represents all women, not only married women

Unit costs applied to population projections for each of the MDGs SectorParameterUnit Cost (US$) Family PlanningCost per couple-year of protection $11.2 EducationCost per pupil$30-$75 ImmunizationCost per fully immunized child $17.0 Maternal HealthCost per birth$28.2-$37.3 Water/SanitationCost per beneficiary$4.6 Malaria - ITNCost per treated-net- year $4.4

Achieve universal primary education Ensure that by 2015, children everywhere, boys and girls alike, will be able to complete the course of primary schooling.

Millennium Development Goals and Targets Source: United Nations Statistics Division, 2000

Family planning use reduces the number of school-aged children.

…which reduces the costs of meeting the primary education MDG. $35.8m $37.8m Note: Costs discounted by 3 percent

Reduce child mortality Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.

Millennium Development Goals and Targets Source: United Nations Statistics Division, 2000

Fulfilling unmet need reduces the number of children needing vaccinations.

Fulfilling unmet need generates cost savings by reducing the costs of meeting the immunization target. $13 m$52 m Note: Costs discounted by 3 percent

Fulfilling unmet need reduces the number of child deaths by reducing the number of high- risk births. Source: Child Survival Model, John Stover, Futures Group

Improve maternal mortality Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.

Millennium Development Goals and Targets Source: United Nations Statistics Division, 2000

Fulfilling unmet need can reduce the number of births over the next 10 years.

Reducing the number of births generates savings for maternal health costs. $39 m $127 m Note: Costs discounted by 3 percent

Fulfilling unmet need saves lives by reducing the number of maternal deaths.

Ensure environmental sustainability By 2015, reduce by half the proportion of people without sustainable access to safe drinking water and sanitation.

Millennium Development Goals and Targets Source: United Nations Statistics Division, 2000

Fulfilling unmet need reduces the number of people needing safe water and sanitation.

The costs of achieving the safe water and sanitation goals are reduced by fulfilling unmet need. $54 m Note: Costs discounted by 3 percent $21 m

Combat HIV/AIDS, malaria and other diseases By 2015, halt and begin to reverse the incidence of malaria and other major diseases

Millennium Development Goals and Targets Source: United Nations Statistics Division, 2000

Fulfilling unmet need reduces the number of mosquito nets needed to reach the Abuja target of 60% coverage.

Reducing the number of mosquito nets needed makes reaching the Abuja target more affordable. $12.7m $4.2m Note: Costs discounted by 3 percent

Weighing the Benefits and Costs of Meeting the MDGs by Fulfilling Unmet Need for Family Planning

The costs savings for the MDGs outweigh the costs of reducing unmet need. FP Costs (Millions) MDG Savings B/C Ratio FP Costs (Millions) MDG Savings B/C Ratio Burkina Faso $27.5$ Mali$35.8$ Cameroon$14.7$ Niger$28.6$ Chad$4.7$ Nigeria$139.5$ Ethiopia$102.8$ Rwanda$6.1$ Ghana$54.0$ Senegal$42.7$ Guinea$20.8$ Tanzania$71.6$ Kenya$71.4$ Uganda$97.4$ Madagascar$25.5$ Zambia$27.2$

Fulfilling unmet need leads to health benefits as well as cost savings. Maternal Deaths Averted Child Deaths Averted Abortions Averted Maternal Deaths Averted Child Deaths Averted Abortions Averted Burkina Faso 4,962240,753199,603Mali6,512284,576371,372 Cameroon1,95496,357N/ANiger6,821280,203652,384 Chad1,15156,857151,557Nigeria18,8491,080,1561,207,568 Ethiopia12,7821,144,7671,953,170Rwanda2,12072,75138,554 Ghana3,962199,952430,739Senegal4,007213,277406,135 Guinea1,987119,227212,698Tanzania18,688495,7861,065,044 Kenya14,040434,3061,242,254Uganda16,877796,2961,176,963 Madagascar2,918185,960391,037Zambia4,474244,241397,982

Achieving the MDGs will be a major challenge. Achieving the MDGs will be a major challenge. These goals will be easier and cheaper to achieve if contraceptive use increases as a result of fulfilling unmet need. These goals will be easier and cheaper to achieve if contraceptive use increases as a result of fulfilling unmet need. The additional costs of reducing unmet need for family planning are offset by substantial MDG cost savings by The additional costs of reducing unmet need for family planning are offset by substantial MDG cost savings by In Conclusion

Meeting the unmet need for family planning in Africa can help countries reach the MDGs.