Health and economic benefits of achieving contraceptive and maternal health targets in Small Island Developing States in the Pacific and Caribbean

• Published in: BMJ global health Vol. 8; no. 2; p. e010018
• Main Authors: Kelly, Sherrie L, Walsh, Tom, Delport, Dominic, ten Brink, Debra, Martin-Hughes, Rowan, Homer, Caroline SE, Butler, Jennifer, Adedeji, Olanike, De Beni, Davide, Maurizio, Federica, Friedman, Howard S, Di Marco, Doretta, Tobar, Federico, de la Corte Molina, Maria Pilar, Richards, Andre S, Scott, Nick
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.02.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Birth control; Births; Caribbean Region; Child health; Contraceptive Agents; Coronaviruses; Cost control; COVID-19; Emergency medical services; Empowerment; Epidemiology; Estimates; Family planning; Female; GDP; Gross Domestic Product; Health economics; Health policy; Health services; Humans; Infant, Newborn; Intervention; Islands; Maternal & child health; Maternal Death; Maternal Health; Maternal mortality; Original Research; Pandemics; Population; Pregnancy; Public Health; Regions; Reproductive health; Return on investment; Stillbirth; Stillbirth - epidemiology; Womens health; Caribbean Region; Vanuatu; Barbados; United States > US; St Lucia; Guyana; Jamaica; Kiribati; Samoa; Solomon Islands; Public Health; Health economics; Health policy; Maternal health; Child health
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2022-010018

IntroductionReducing unmet need for modern contraception and expanding access to quality maternal health (MH) services are priorities for improving women’s health and economic empowerment. To support investment decisions, we estimated the additional cost and expected health and economic benefits of achieving the United Nations targets of zero unmet need for modern contraceptive choices and 95% coverage of MH services by 2030 in select Small Island Developing States.MethodsFive Pacific (Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu) and four Caribbean (Barbados, Guyana, Jamaica and Saint Lucia) countries were considered based on population survey data availability. For each country, the Lives Saved Tool was used to model costs, health outcomes and economic benefits for two scenarios: business-as-usual (BAU) (coverage maintained) and coverage-targets-achieved, which scaled linearly from 2022 (following COVID-19 disruptions) coverage of evidence-based family planning and MH interventions to reach United Nations targets, including modern contraceptive methods and access to complete antenatal, delivery and emergency care. Unintended pregnancies, maternal deaths, stillbirths and newborn deaths averted by the coverage-targets-achieved scenario were converted to workforce, education and social economic benefits; and benefit–cost ratios were calculated.ResultsThe coverage-targets-achieved scenario required an additional US$12.6M (US$10.8M−US$15.9M) over 2020–2030 for the five Pacific countries (15% more than US$82.4M to maintain BAU). This additional investment was estimated to avert 126 000 (40%) unintended pregnancies, 2200 (28%) stillbirths and 121 (29%) maternal deaths and lead to a 15-fold economic benefit of US$190.6M (US$67.0M−US$304.5M) by 2050. For the four Caribbean countries, an additional US$17.8M (US$15.3M−US$22.4M) was needed to reach the targets (4% more than US$405.4M to maintain BAU). This was estimated to avert 127 000 (23%) unintended pregnancies, 3600 (23%) stillbirths and 221 (25%) maternal deaths and lead to a 24-fold economic benefit of US$426.2M (US$138.6M−US$745.7M) by 2050.ConclusionAchieving full coverage of contraceptive and MH services in the Pacific and Caribbean is likely to have a high return on investment.