1. A Next Step: Estimating Impact from CYP
New Developments in the Calculation and Use of CYP
Washington, D.C. — September 8, 2011
Jacqueline E. Darroch, Ph.D.

2. CYP translate contraceptives into protection from unintended pregnancy
Contraceptive procedures
and
commodities
CYP
Units per year +
Adjustments

3. Estimation of impacts from CYP requires additional estimation
Contraceptive procedures
and
commodities
Impacts:
Demographic,
health,
cost, etc.
CYP

4. Unintended pregnancy is the link between contraception and impact
Contraceptive procedures
and
commodities
Impacts:
Demographic,
health,
cost, etc.
CYP
Unintended
pregnancies
Averted

5. Unintended pregnancies have multiple impacts
Unintended pregnancies averted
Unplanned births averted
Abortions averted
Miscarriages averted
Safe abortions averted
Unsafe abortions averted
Health care services
Deaths averted
DALYs averted

6. Unintended pregnancy is the link between contraception and impact
Contraceptive procedures
and
commodities
Impacts:
Demographic,
health,
cost, etc.
CYP
Impact estimation
factors from available
studies and best
guesses
Unintended
pregnancies
Averted

7. Unintended pregnancy is the link between contraception and impact
Contraceptive procedures
and
commodities
Impacts:
Demographic,
health,
cost, etc.
CYP
Impact estimation
factors from available
studies and best
guesses
Unintended
pregnancies
Averted

8. What would be the (unintended) pregnancy rate without CYP?
Biological pregnancy rates (~85%, Trussell)
From fertile couples, frequent sexual activity, trying to get pregnant
Results in too high pregnancy numbers
Average population pregnancy rates
Include intended pregnancies and those to contraceptive users
Hard to estimate because of missing/poor data on induced abortion
Women with unmet need for modern contraception
Sexually active, fertile, do not want child in next 2 years
Using traditional or no method

9. Definitional issues: Contraceptive use
CYP try to estimate “active” and “effective” coverage from unintended pregnancy, adjusting for low fecundity, non-exposure, incorrect/inconsistent use; applied to all types of users
Survey data on contraceptive use try to capture “real-life” use, among all user types and situations and levels of correct and consistent use

10. Measuring impacts of specific services is more complicated
Sexual
activity/
Fecundity
CYP: Sterilization
IUD
Implants
Injections
Patches
Rings
Pills
Condoms
Other
Impacts:
Demographic,
health,
cost, etc.
Childbearing
intention
Unintended
pregnancies
Averted
Method use
Context of CYP provision: method choice, counseling, etc.
Availability and
accessibility of
needed services
Selection
of users
Substitution – methods
and/or sources

11. Unintended pregnancy is the link between contraception and impact
Contraceptive procedures
and
commodities
Impacts:
Demographic,
health,
cost, etc.
CYP
Impact estimation
factors from available
studies and best
guesses
Unintended
pregnancies
Averted

12. February December 2009
In December 2009, the Guttmacher Institute and the United Nations Population Fund (UNFPA) launched a major report—Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health—that is unique in many ways. Previous reports have documented the impact of providing family planning or maternal and newborn health services on their own. This report documents what happens when you provide both services simultaneously.
We found that these interventions are synergistic: Providing both simultaneously is more effective, in terms of maternal and newborn lives saved, and less costly than focusing on either intervention alone.
In 2010, new estimates of maternal and neonatal mortality became available. These new data have been incorporated into these slides and into publications available at <
Source: Singh S et al., Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health, New York: Guttmacher Institute and United Nations Population Fund, 2009.

13. Method users x pregnancy rates = unintended pregnancies
818M women in need x Pregnancy rates = 75M unint. pregs.
Modern
Tubal ligation
Vasectomy
IUD
Injection/Implant
Pills
Condoms/other
Traditional
Withdrawal
Per. Abst.
Other
In need, no method
Modern
Tubal ligation
Vasectomy
IUD
Injection/Implant
Pills
Condoms/other
Traditional
Withdrawal
Per. Abst.
Other
In need, no method
Unintended
Pregnancies x =

14. Women at risk for unintended pregnancy, 2008 (818 million)
215 million women want to avoid pregnancy but have unmet need for modern methods
No method,
140 million
Modern
methods,
603 million
Traditional
methods,
75 million
Women at risk for unintended pregnancy, 2008 (818 million)
Adding It Up, 2009 14

15. Meeting developing country unmet need for modern methods would yield
53 million fewer unintended pregnancies
22 million fewer unplanned births
25 million fewer abortions
680,000 fewer deaths among women (94,000) and newborns (586,000)
390,000 fewer children who would lose their mothers
Today, 215 million women in developing nations still have an unmet need for modern contraceptive methods. Providing all of them access to contraceptives could result in a 71% drop in unintended pregnancies, from 75 million to 22 million.
Sources: Singh S et al., Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health, New York: Guttmacher Institute and UNFPA, 2009; WHO, Trends in Maternal Mortality: 1990 to 2008: Estimates Developed by WHO, UNICEF, UNFPA and The World Bank, Geneva: WHO, 2010; and
Rajaratnam JK et al., Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, : a systematic analysis of progress towards Millennium Development Goal 4, Lancet, 2010, 375(9730):1988–2008.
Adding It Up, 2009

16. Data for estimating relative relationship among pregnancy rates
Reversible method users
12-month use-failure rates, women in union,
DHS data from 18 developing countries
Sterilization users
Trussell review of available research
Nonusers
US: ~40%; lower sexual activity; lower fecundity?; conservative estimate

17. Made model output consistent with external estimates
75 million unintended pregnancies in developing countries in 2008
Births: Number -UN Population Prospects; Intention status – DHS and other surveys
Induced abortion – Guttmacher Institute, Abortion Worldwide
Miscarriage – estimated
Method-specific pregnancy rates were adjusted downward to yield 75 million unintended pregnancies
Average adjustment was 0.88
Regional adjustments: 0.83 for Asia; 0.95 for Africa and 1.05 for Latin America and the Caribbean.

18. Rates of unintended pregnancies and pregnancies averted
Women with unmet need for modern methods, i.e. using no method or traditional method: 288/1,000
If these women used modern methods: 39/1,000
Unintended pregnancies that would be averted if women with unmet need used modern methods: (288-39)/1,000 = 249/1,000

19. Impact factors
For CYP that use conversion factors that adjust for use-effectiveness:
288/1,000 or .288 per user per year
For CYP that use conversion factors that do not adjust for use-effectiveness:
249/1,000 or per user per year

20. Some key assumptions
Ratio of unintended pregnancies prevented per modern method user is the same as per CYP
Relative relationships among contraceptive and no-method use-effectiveness rates are reflected by available data
CYP, and estimated impacts, are defined and measured the same across organizations and programs

21. Further considerations
Since CYP use global conversion factors, use global estimate for estimating unintended pregnancies averted
Specify what CYP conversion factors are used and adjustments they contain

22. Unintended pregnancies have multiple impacts
Unintended pregnancies averted
Unplanned births averted
Abortions averted
Miscarriages averted
Safe abortions averted
Unsafe abortions averted
Health care services
Deaths averted
DALYs averted

23. Data to estimate further outcomes of unintended pregnancies
Unplanned births, miscarriages, induced and unsafe abortions for regions and countries (unsafe abortions): Guttmacher Institute
Mortality for countries (maternal, stillbirth, infant) and regions (unsafe abortion): WHO and IHME*
DALYs: WHO and IHME*
*Institute for Health Metrics and Evaluation

24. For more information, visit www.guttmacher.org
This presentation was developed with support from PATH through Reproductive Health Supplies Coalition
For more information, visit