Fertility Regulation Behaviors and Their Costs : Contraception and Unintended Pregnancies in Africa and Eastern Europe & Central Asia

Abstract

The report consists of three parts: global trends in fertility contraceptive use and unintended pregnancies; studies of two regions (Africa and Eastern Europe/Central Asia) and two countries (Nigeria and Kazakhstan) on the costs of fertility regulation behaviors and provider attitudes towards contraceptive use. Fertility levels have declined steadily over the last three decades but the pace of decline varies among regions. Countries that have achieved a high level of contraceptive use have reached a lower fertility level. A gap continues to exist between actual and desired family size resulting in unintended pregnancies. More than one-third of the pregnancies that occur are unintended and one in five pregnancies ends in induced abortion. Almost half of all induced abortions are unsafe and the proportion of all abortions that are unsafe has increased during the last decade. Sixty-six percent of unintended pregnancies occur among women who are not using any method of contraception. Findings from the Kazakhstan study suggest that providers biases towards certain contraceptive methods lead to a reduction in the quality of family planning services and choice of methods. The costing survey suggests that contraceptives are almost 3.2 times more cost-effective than abortion services in terms of birth averted. Abortion services accounted for almost 1% of total public health spending in 2004. Findings from the Nigeria study suggest that the annual cost of post-abortion care (estimated at $19 million) is approximately four times the cost of contraceptive services (estimated at $4.5 million) to prevent induced abortions; and it consumes about 3.4% of total health expenditures. Investing in quality family planning programs is a cost-effective way to address unmet need for contraception and reduce the risks of unsafe abortion thereby improving maternal health. If contraception were provided to the 137 million women who lack access maternal mortality would decline by 25%-35%. (authors)