Thank you very much for the invitation to appear today. Let me dive right in.
If we could convince the world community, developing as well as donor country governments, to double current investments in both family planning and maternal newborn health, we could reduce maternal mortality by 70%, cut nearly in half newborn deaths, and generate a range of other development benefits.
The Guttmacher Institute, with financial and technical support from the United Nations Population Fund, estimated the cost and benefits of three alternative investment strategies for reducing maternal deaths.
In the first scenario, we calculated the cost-effectiveness of increasing investments in family planning alone to a level sufficient to address 100% of the unmet need for modern contraception. We estimate that about 215 million women worldwide have an unmet need; that is, they don't want to become pregnant any time soon but are not using any effective method of contraception.
In the second scenario, we calculated the cost-effectiveness of making new investments only in maternal newborn health to a level sufficient to provide the WHO-recommended package of basic maternal newborn care to all those women and newborns needing it.
In the third scenario, we calculated the cost-effectiveness of combining both the additional investments in family planning and those in maternal newborn care. Here are the results.
If you'll turn your attention to the sets of graphs I'm holding in English and French, you'll see that the stacked bar to the left shows current expenditures of $11.8 billion U.S. for contraceptive services—those are in red—and maternal newborn care, split between intended pregnancies in green and unintended pregnancies in grey.
The two taller bars compare the cost-effectiveness of making additional investments in maternal newborn health alone and the cost-effectiveness of making additional investments in both family planning and maternal newborn care simultaneously. By investing an additional $3.6 billion U.S. in family planning, we reduce the annual cost for caring for unintended pregnancies—those that women may not have wanted and certainly didn't plan for—from $6.9 billion a year to $1.8 billion, a savings of over $5 billion U.S. This in turn reduces the overall cost of providing universal access to comprehensive family planning and maternal newborn care by roughly $1.5 billion U.S. a year.
Now let's look at the impact on maternal health.
I'd like to thank my two volunteers. The easels didn't show up, so I have human easels.
On this chart, the first bar represents the current situation. Based on 2005 United Nations figures, we started with an estimate of 550,000 largely preventable maternal deaths in 2008, a major share of those resulting from pregnancies that the women did not want or plan, and many of them ending in unsafe abortion. Addressing the unmet need for family planning alone would save lives, as you can see from the next bar. So, of course, would the much larger investment required to provide universal access to a basic package of maternal newborn care.
But look at the impact of making both investments together: a whopping 70% reduction in maternal deaths, from 550,000 to 160,00 in a single year. In the Guttmacher model, that would save the lives of 390,000 women, with most of them in the prime of their lives and most of them already mothers of young children. And we know that the death of a mother puts the lives of her young children in serious jeopardy.
Next week, at the World Health Assembly, WHO, the World Bank, the UN Population Fund, and UNICEF--known as the H-4--will release new UN estimates of maternal deaths for 2008. We now expect that they will be lower than the estimates used in these Guttmacher calculations. But the basic results of the cost-benefit analysis do not change, even if we start with lower numbers of maternal deaths.
Doubling investments in both family planning and maternal/newborn health from the current level of under $12 billion U.S. a year to roughly $24.6 billion would cut maternal deaths by at least 70% and newborn deaths by 44%. The combined investment strategy would save more lives. It is also $1.5 billion a year less expensive than investing in maternal and newborn health alone.
It's also the approach that provides the greatest development benefits outside the health field, including higher education levels, especially for women; higher labour force productivity, including greater female labour force participation; increases in household wealth resulting in reductions in poverty; and slower rates of population growth, resulting in less pressure on renewable natural resources. If you know your MDGs, that's seven out of the eight, I believe.
This, I submit, is smart government at its best.
Thank you very much for your time.