Facts and Benefits of Family Planning

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,The definitive study and set of data on how investments and family planning and RH are cost-effective and beneficial to women and families. Cost-benefit analyses are outlined, as are health benefits …

,The definitive study and set of data on how investments and family planning and RH are cost-effective and beneficial to women and families. Cost-benefit analyses are outlined, as are health benefits using global and Philippine data.

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  • 1. October 2008 The Health Benefits of Family Planning & Reproductive HealthFACT SHEET KEY FACTS: • More than 400,000 women suffer from maternal morbidities every year. • Women suffer more from maternal morbidities than any other illness. • Around 200,000 maternal morbidities—up to half the total— can be prevented through effective family planning. • Eleven women die each day from pregnancy and birth complications. Most of these deaths are preventable. • Proper birth spacing reduces by half the risk of death for newborns and infants. More than 7,800 infant deaths can be prevented yearly through family planning. • Poor women and infants carry the most risk of death and disability from lack of access to reproductive health services. • For every peso spent in family planning, around 3 to 100 pesos will be saved in maternal care costs for unintended pregnancies. • At least 5.5 B (billion) pesos are spent each year in health care costs for managing unintended pregnancies and its complications. An annual budget of 2 to 3 B pesos for FP is a cost-effective public health measure. LIKHAAN
  • 2. More than 400,000 women ventions like caesarean sec- tions that are often unpre-suffer from maternal mor- tion (CS) deliveries and blood dictable and require life-sav-bidities every year in the transfusion require second- ing access to quality obstetricPhilippines. ary to tertiary level facili- services.” *(1997, pp. 3-4)These are life-threatening ties (UN Millennium Projectcomplications from pregnan- 2005, pp. 83-84).cies and deliveries that often Women suffer more fromrequire hospital care. The The Department of Health maternal morbidities than2005 World Health Report of and international health au- any other illness.the WHO (p. 62) has stated thorities agree on the mag- If the estimated number ofthat globally, around 80% of nitude and severity of this morbidities is compared withall maternal deaths are the problem. The DOH (2005a, the Department of Health’stragic end results of the fol- pp. 207-208) estimates that list of notifiable diseases, thenlowing complications: there are three million preg- maternal morbidities clearly nancies every year, each one surpass the number of females • hemorrhage or severe of which “entails risks to both that are sick each year with bleeding; the mother and the unborn.” other serious illnesses like • sepsis (bloodstream UNICEF, WHO and UNFPA pneumonias, bronchitis, diar- infection); estimate that “at least 15 per rheas, hypertension, influenza, • hypertensive disorders of cent of all pregnant women or tuberculosis (see Figure 1). pregnancy like eclamp- develop serious complica- sia and pre-eclampsia; • prolonged or obstructed Figure 1. Maternal Morbidities Compared to the Top Ten labor; and Female Morbidities of 2005 • complications of unsafe abortion. Maternal Morbidities 400,000The remaining 20% of ma- ALRI and Pneumonia 328,956ternal deaths are caused by Bronchitis/Bronchiolitis 308,930existing illnesses that are Acute Watery Diarrhea 278,958exacerbated by pregnancy orits management. Examples Hypertension 214,220common in the Philippines Influenza 205,419include anemia, tuberculo-sis, malaria, cardiovascular TB Respiratory 44,440disorders and diabetes (DOH Diseases of the Heart 15,3242005a, p. 208 & 248). Malaria 15,003Most of these morbidities Chickenpox 14,748require life-saving emergency Dengue Fever 9,434obstetric care from primarylevel hospitals. Other inter- Source: DOH 2005 b* 15% x 3 million pregnancies = 450,000 estimated maternal complications. This estimate is consistent with another esti- mate shown in Table 2.The Health Benefits of Family Planning and Reproductive Health 2 Likhaan
  • 3. Around 200,000 maternal morbidities—up to half the total— Eleven women die each daycan be prevented through effective family planning. from pregnancy and birthWhen unintended pregnancies occur, some women resort to complications. Most of theseinduced abortion while others carry their pregnancy to term. A deaths are preventable.proportion of all these pregnancies lead to serious obstetric com- An estimated 4,100 mater-plications. Using data from a study by the Guttmacher Institute nal deaths occurred in the(Singh S et al. 2006) and the estimate of the UNICEF, WHO and Philippines in 2000 (WHO,UNFPA that at least 15 per cent of all pregnant women develop UNICEF & UNFPA 2004). Thisserious complications, the following table shows that half of all is equivalent to one out ofmaternal morbidities are from women with unintended pregnan- every seven deaths of womencies, and are therefore preventable through family planning. of reproductive age (National Statistics Office - NSO 2004), making maternal death aTable 1. Maternal Morbidities from Intended & Unintended grave risk for women in this Pregnancies age group. Maternal Morbidities No. % Most of these deaths are preventable: up to half byIntended/Planned Pregnancies reducing unintended preg-• carried to term (1,209,000 x 15% complication rate) 181,350 nancies through family• hospitalized for spontaneous pregnancy loss 26,092 planning as discussed in the previous point; and the other Subtotal 207,442 48% half substantially reducedUnintended Pregnancies (Preventable Through FP) by making each pregnancy• carried to term (961,000 x 15% complication rate) 144,150 and childbirth safer, through• hospitalized for induced abortion 78,901 key interventions like skilled birth attendance and access Subtotal 223,051 52% to emergency obstetric care. Total 430,493 100% Many progressive countriesSources: Singh S et al. 2006 and calculations from UNICEF, WHO, UNFPA 1997 have succeeded through these approaches. For ex- ample, total maternal deathsThe WHO provides a similar, global analysis in its 2005 World in all the developed regions—Health Report, where it states that which includes Europe, Canada, US, Japan, AustraliaUnintended and unwanted pregnancies—owing to unmet need for and New Zealand—numbercontraception, to contraceptive failure, or to unwanted sex—if brought only 2,500. In the Southeastto term, carry at least the same risks as those that are desired and Asia region, Malaysia, Thai-deliberate. It is estimated that up to 100 000 maternal deaths could be land and Vietnam—with aavoided each year if women who did not want children used effective combined population morecontraception. When maternal illnesses are also taken into account, than twice that of the Phil-preventing unwanted pregnancies could avert, each year, the loss of 4.5 ippines—had a total of onlymillion disability-adjusted life years. 2,740 maternal deaths.The Health Benefits of Family Planning and Reproductive Health 3 Likhaan
  • 4. Table 2. Maternal Mortality in Selected Countries compared to those with an Number of Maternal Lifetime Risk interval of three years. Data Population Country/Region Maternal Mortality of Maternal from the NSO’s 2003 NDHS (2000, in M) Deaths Ratio Death, 1 in (p. 110) support this finding: infants born with a previous Developed Regions 1,194 2,500 20 2,800 birth interval of less than two Malaysia 22 220 41 660 years had a mortality rate of Thailand 61 520 44 900 39 per thousand live births compared to 19—a reduction Vietnam 80 2,000 130 270 by half—for those with three Philippines 76 4,100 200 120 years of interval. Sources: WHO, UNICEF & UNFPA 2004; UN Population Division 2004 How many infant deaths can be prevented through birth spacing? The 2003 NDHS The lifetime risk of maternal the recommended interval (p. 115) had estimated that death combines the impact before attempting the next 23.5% of births were of less of the frequency of preg- pregnancy is at least 24 months than 24 months interval, and nancies and the danger of in order to reduce the risk of the NSO registered 1.71 mil- each pregnancy. Using this adverse maternal, perinatal and lion live births in 2004 (NSO measure, the risk faced by infant outcomes. 2008). Putting all these data women in the Philippines is together, at least 7,800 infant five to seven times that faced … To summarize, BTP [birth- deaths a year can be pre- by women in Malaysia and to-pregnancy] intervals of six vented through proper birth Thailand. The Philippines is a months or shorter are associated spacing.* disproportionate contributor with elevated risk of mater- of maternal deaths in South- nal mortality. BTP intervals of east Asia and the world. around 18 months or shorter are Poor women and infants associated with elevated risk of carry the most risk of death Proper birth spacing reduces infant, neonatal and perinatal and disability from lack by half the risk of death for mortality, low birth weight, small of access to reproductive newborns and infants. More size for gestational age, and pre- health services. than 7,800 infant deaths can term delivery. Women want fewer children be prevented yearly through than they actually get. The family planning. Two of the WHO-reviewed poorer they are, the larger A recent review of birth studies show that BTP inter- the gap between wanted spacing studies published by vals of less than 18 months and actual fertility. On aver- the WHO in 2006 states that are linked to a two-fold age, every 10 women from after a live birth, increase (1.9-2.6) in neo- the wealthiest quintile will natal and infant mortality end up with three extra, * 1.71 M (registered live births only; NDHS 2003 data on fertility rates combined with NSO population projections indicate that 2.1 M live births occurred in 2000, according to Singh S et al 2006) x 23.5% (proportion of all births with <24 months interval) x 39/1000 (mortality rate of infants with < 24 months interval) x 50% (mortality risk reduction if birth spacing of less than 2 years is increased to 3 years) The Health Benefits of Family Planning and Reproductive Health 4 Likhaan
  • 5. unplanned births, while those from the poorest will end up with and the availability and use21. A key factor is the inability of poor women to control their of emergency obstetric carefertility through effective FP. Looking at the demand and use of (EmOC) as key strategiesall methods, surveys reveal a pattern of inequity—the poorer to reduce maternal deaths.women are, the larger the unmet need for FP, and the greater the Available indicators for thesenumber of unplanned births. two strategies clearly show that poorer women have lessFigure 2. Unmet Need for FP and the Wanted vs. Actual Fertility Gap access to life-saving services. Women among the wealthi- 26.7 est quintile have already 19.6 surpassed the 2015 MDG 15.0 21 target of 90% for skilled birth 12.3 13.4 attendance while the poor- % Unmet Need for FP 15 est have only reached 25%. 9 For EmOC, a widely availableExtra, Unplanned Births 6 statistic is the percentage of (for every 10 women) 3 caesarean section (CS) deliv- Wealthiest Fourth Middle Second Poorest eries, wherein it is estimated that usage beyond 15% Source: NSO & ORC Macro, NDHS 2003 indicates overuse while rates below 5% signals a dangerousThe calculation of unmet The World Health Organi- lack of access (UNICEF, WHO,need for FP was done during zation (2005) and the UN UNFPA 1997). Data from thethe period when the pub- Millennium Project (2005) 2003 NDHS show that thelic health system was still Task Force on Maternal and poorest 40% of women havedistributing donated com- Child Health both recom- below-standard access to CSmodities for free. As a result, mend the increase in the use deliveries.equitable access and use of of skilled birth attendancesome FP supplies, like contra-ceptive pills, were ensured. Table 3. Use of Tubal Ligation, Skilled Birth Attendants & CS DeliveryThis is a success story that by Asset Quintilemay now be rolled back afterFP donations have ended. % Caesarean Section DeliveryAccess to FP supplies mayend up like the inequitable Wealthiest 11.5 92.4 20.3access to the costlier, for-pay Fourth 13.4 84.4 10.8tubal ligation which results Middle 11.2 72.4 6.8in poorer women havinglesser rates of use. If pills Second 7.9 51.4 3.4and other previously donated Poorest 3.9 25.1 1.7commodities will no longerbe available as free or lowcost health supplies, then the poorest 40% poorest 60% poorest 40%unmet need and unplanned had way below below MDG target below minimumbirths of poorer women will average use (10.5%) for 2005 (80%) recommended by UNICEF, WHO, UNFPA (5%)rise further. Sources: NSO & ORC Macro (NDHS 2003); UNICEF, WHO, UNFPA 1997The Health Benefits of Family Planning and Reproductive Health 5 Likhaan
  • 6. For every peso spent in fam- (Festin M 2003). PhilHealth injectables; less than P600ily planning, around 3 to 100 also published a scenario in a for a year’s supply of con-pesos will be saved in mater- 2003 circular wherein it will doms; P500 for vasectomynal care costs for unintended pay up to P19,490 plus P300 and P1,500 for tubal ligationpregnancies. per day of confinement in a in a public hospital (AquinoThe reimbursement rates of secondary hospital for total V, 2008). Concretely, an IUDPhilHealth provide a good hysterectomy due to post- worth P200 can prevent aindicator of the average partum haemorrhage. These hysterectomy that wouldcosts of maternal care. For amounts do not even rep- amount to at least P20,000 innormal spontaneous de- resent the total health care public health costs plus addi-liveries, PhilHealth (2003) costs since PhilHealth esti- tional out-of-pocket spendingcurrently pays P4,500. The mates that the benefits they by the patient and her family.costs predictably escalate for provide to members comprisepregnancy and delivery com- only 30 to 70 percent of the The DOH is aware of thisplications. Published figures total costs per confinement analysis and has stated inby PhilHealth include average (Fajardo L 2006). its National Objectives forbenefits amounting to P4,974 Health (2005 a, p. 9) thatfor dilatation and curet- Compared to maternal care “a reduction in the actualtage for abortions (Festin M expenses, family planning number of births reduces the2003); P13,413 for hyperten- costs are low. For example, it need for obstetrical care, im-sion complicating pregnancy costs around P200 to provide munization and other mater-and labor (Wagner A et al. an IUD which can last up to nal and child health interven-2006); and around P16,000 ten years; less than P400 tions.”for caesarean section delivery for a year’s supply of pills orFigure 3. Family Planning versus Maternal Care Costs for Unintended Pregnancies Family Planning Costs (per person) IUD (good for up to 10 years) Injectables (supply for 1 year) Pills (supply for 1 year) Vasectomy (at PGH) Condoms (10 pcs/mo, for 1 year) Tubal ligation (at PGH) Maternal Care Costs (per person) Normal spontaneous delivery/birthD&C for abortion (spontaneous & induced) Hypertensive disorders of pregnancy Cesarean section deliveryHysterectomy for postpartum hemorrhage PHP 0 5,000 10,000 15,000 20,000 Sources: Aguino V 2008; Festin M 2003; Wagner A et al 2006; PhilHealth 2003The Health Benefits of Family Planning and Reproductive Health 6 Likhaan
  • 7. At least 5.5 B (billion) pesos are spent each year in healthcare costs for managing unintended pregnancies and itscomplications.Singh et al (2006) estimates that around the year 2000, therewere 78,901 hospitalizations for induced abortions and 961,000unintended pregnancies carried to term. The 2003 NDHS esti-mates that 7.3% of births were done via caesarean section. Usingonly these two types of maternal complications (induced abor-tion and CS deliveries) and the benefit rates of PhilHealth (whichexcludes out-of-pocket co-payments by patients), the minimumhealth care costs for managing unintended pregnancies and itscomplications can be estimated as follows:Table 4. Minimum Health Care Costs for Managing Unintended Pregnancies Number PhilHealth Total Cost Description of Cases Benefit Rate per Year per Case (B Pesos) Hospitalized for abor- 78,901 4,974 0.392 tion complications Unintended pregnancy 70,153 16,000 1.122 carried to term, caesarean section delivery (7.3% of births) Unintended pregnancy 890,847 4,500 4.009 carried to term, no caesarean section delivery TOTAL 5.523 Sources: Singh et al 2006; NSO & ORC Macro 2004; PhilHealth 2003; Festin M 2003Aquino (2008, p. 31) estimates that from 2.0 to 3.5 B pesos ofpublic funds are needed in 2009 to finance a range of voluntaryfamily planning services. Such levels of public health spendingwill clearly be cost-effective, resulting in health care savings ofseveral billion pesos.The Health Benefits of Family Planning and Reproductive Health 7 Likhaan
  • 8. REFERENCESAquino V. (2008). Completing the Family Planning Equation to Achieve Contraceptive Self-Reliance. PLCPDDepartment of Health. (2005a). National Objectives for Health, Philippines, 2005-2010.Department of Health. (2005b). Field Health Information System Annual Report 2005. National Epidemiology Center.Fajardo L. (2006 February 24). PhilHealth pays P17.5B in health insurance benefits. PhilHealth News. Retrieved 2 October 2008 from http://www.philhealth.gov.ph/ media/news/2006/022406a.htmFestin M. (2003). Are we doing too many caesarean sections? The HTA Forum, Vol. 1 No. 2National Statistics Office. (2004). Table 2. Number of Deaths by Age Group by Sex and Sex Ratio, Philippines: 2000. Retrieved 26 September 2008 from http://www. census.gov.ph/data/sectordata/2000/ds0002.htmNational Statistics Office. (2008). Live Birth Statistics: 2004. Retrieved 30 September 2008 from http://www.census.gov.ph/data/sectordata/sr08321tx.htmlNational Statistics Office and ORC Macro. (2004). National Demographic and Health Survey 2003. Calverton, Maryland: NSO and ORC Macro.PhilHealth - Philippine Health Insurance Corp. (2003). PhilHealth Circular 25 s. 2003: Supplement to the rules on PhilHealth’s maternity care benefits for hospitals and non-hospital facilities.Singh S, Juarez F, Cabigon J, Ball H, Hussain R and Nadeau J. (2006). Unintended Pregnancy and Induced Abortion in the Philippines: Causes and Consequences. New York: Guttmacher Institute.UNICEF, WHO, UNFPA. (1997). Guidelines for Monitoring the Availability and Use of Obstetric Services.UN Millennium Project. (2005). Who’s Got the Power? Transforming Health Systems for Women and Children. Task Force on Child Health and Maternal Health.UN Population Division. (2004). World Population to 2300. Available at http://www. un.org/esa/population/publications/longrange2/WorldPop2300final.pdfWagner A, Ross-Degnan D, Valera M, Laviña S, Sia I and Galang R. (2006). An Outpatient Prescription Drug Benefit for PhilHealth Members with Hypertension. p. 5.WHO, UNICEF & UNFPA. (2004). Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. Available at http://www.who.int/reproductive-health/ publications/maternal_mortality_2000/index.htmlWorld Health Organization. (2005). The World Health Report: 2005: Make Every Mother and Child Count. Available at http://www.who.int/whr/2005/en/index.htmlWorld Health Organization. (2006). Report of a WHO Technical Consultation on Birth Spacing. Available at http://who.int/reproductive-health/publications/ birthspacing/index.html Likhaan 88 Times St., West Triangle Homes Quezon City 1104 Philippines Tel: (63 2) 926-6230 Fax: (63 2) 411-3151 E-mail: office@likhaan.org office@likhaan.net