Family planning contribution to maternal mortality ver 28 may 2017 3
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Family planning contribution to maternal mortality decline in Indonesia, decomposition analysis 1970-2015 ver 28 may 2017 3
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Family planning contribution to maternal mortality ver 28 may 2017 3
- 1. Family Planning Contribution to the Maternal Mortality Decline, Indonesia, 1970-2015 Decomposition Analysis University of Indonesia UNFPA Jakarta, 2017
- 2. Objectives • Examine the extent of family planning contribution to the maternal mortality decline in Indonesia, 1970-2015
- 3. Analytical Framework WRA GFR MMR Number of Maternal deaths Family planning Non FP: changing age of first marriage, full breastfeeding, After 15 years through fertility Reduced high risk births – reduced ‘four toos’ 75-85% 15-25%
- 4. Methods • Maternal deaths = WRA*GFR*MMR – WRA Number of women of reproductive age – GFR General Fertility Rate defined as the number of live births per number of women of reproductive age – MMR defined as the number of maternal deaths per number of WRA
- 5. Scenario • No/unsuccessful family planning program – to calculate how many maternal deaths have been averted – WRA from 2000 onward would be much higher – At least 80% less decline of fertility 1970-2015 (FP contribute to at least 80% of fertility decline) – MMR would be much higher due to unchanging pattern of ‘four toos’ – related to high risk births • Optimized FP program – how many maternal deaths can be further reduced in the next 20 years – 1970-2015 • Optimized FP program (future)– how many maternal deaths can be further reduced in the next 10 years – 2015-2025 – Increased CPR leads to reduced fertility and reduce high risk births – more reduction of GFR and MMR
- 6. Levels and trends of WRA, GFR, and MMR, Indonesia 1970-2015 185 79 583 270259.7 691.2 - 100 200 300 400 500 600 700 800 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 GFR MMR WRA/100ribu
- 7. Trends of CPR and TFR, Indonesia 1970-2015 5.9 2.60.9 66.2 - 10.0 20.0 30.0 40.0 50.0 60.0 70.0 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 TFR CPR
- 8. Non-FP factor affecting fertility: trends of age at first marriage 15.12 20.25 - 5.00 10.00 15.00 20.00 25.00 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014
- 9. Non-FP factor affecting fertility: Proportion of never married women (aged 45 years+) 1.46 2.74 - 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 1960 1970 1980 1990 2000 2010 2020 smooting real
- 10. Non-FP factor affecting fertility: Trends of breastfeeding, Indonesia 1970-2015 99.0 95.5 29.0 19.6 4.5 2.9 - 20.0 40.0 60.0 80.0 100.0 120.0 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 ever breastfeed any breastfeeding exclusive breastfeeding
- 11. Non-FP factor affecting fertility: trends of too young and too old 162 50 57 24 18 6- 20 40 60 80 100 120 140 160 180 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 15-19 40-44 45-49
- 12. Reduced four tools: Trends of average number of children ever born by age of mother, Indonesia 1970- 2015 0.3 0.1 6.6 2.9 - 1.0 2.0 3.0 4.0 5.0 6.0 7.0 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 15-19 20-24 25-29 30-34 35-39 40-44 45-49
- 13. Estimated number of maternal deaths, Indonesia 1970-2015 597,141 210,070 808,951 - 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1970-2000 2000-2015 1970-2015 Actual maternal deaths
- 14. Scenario 1: No/ unsuccessful FP program • Much less decline of fertility • Less decline of MMR
- 15. Scenario 1: Much less decline of GFRs 79.3 185.5 101.2 - 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 180.0 200.0 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 2015 GFR GFR, No FP
- 16. Scenario 1: Less decline of MMR [FP through reduced four too might contribute around 15% of MMR decline] 270 583 317 - 100 200 300 400 500 600 700 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 2015 MMR MMR, No FP
- 17. Scenario 1: Less increase of WRA [No FP through increased of WRA] - 10,000,000 20,000,000 30,000,000 40,000,000 50,000,000 60,000,000 70,000,000 80,000,000 90,000,000 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 2015 WRA WRA, No FP
- 18. Trend of number of maternal deaths per year - 5,000 10,000 15,000 20,000 25,000 30,000 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 2015 Actual No FP
- 19. Number of maternal death based on actual and scenario 1 Year Actual maternal deaths scenario 1 Difference 1970-1985 374,616 403,337 28,721 1985-2000 261,706 304,414 42,708 2000-2015 224,075 330,965 106,891 1970-2015 826,928 998,222 171,294
- 20. Number of maternal death based on scenario 1 and years period: actual vs difference - 200,000 400,000 600,000 800,000 1,000,000 1,200,000 1970-1985 1985-2000 2000-2015 1970-2015 Actual maternal deaths Difference
- 24. Scenario 2: Optimized FP program • how many maternal deaths can be further reduced in the next 10 years – 2015-2025 – Increased CPR leads to reduced fertility and reduce high risk births – more reduction of GFR and MMR
- 25. Scenario 2: Much less decline of GFRs - 20 40 60 80 100 120 140 160 180 200 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 2015 GFR GFR, Optimized FP
- 26. Scenario 2: Decline of MMR - 100 200 300 400 500 600 700 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 2015 MMR MMR, Optimized FP
- 27. Scenario 2: Less increase of WRA - 10,000,000 20,000,000 30,000,000 40,000,000 50,000,000 60,000,000 70,000,000 80,000,000 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 2015 WRA WRA, Optimized FP
- 28. Number of maternal death based on actual and scenario 2 Year Actual maternal deaths scenario 2 Difference 1970-2000 597,141 660,330 63,189 2000-2015 210,070 185,357 (24,713) 1970-2015 808,951 845,730 36,779
- 29. Number of maternal death based on scenario 2 and years period: actual vs difference (100,000) - 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1970-2000 2000-2015 1970-2015 Actual maternal deaths Difference
- 30. Next Step 1. Continuing and exploring for scenario 3 (optimized FP program, 2015-2025) • Increased CPR leads to reduced fertility and reduce high risk births – more reduction of GFR and MMR 2. Report writing