How Increased Contraceptive Use has Reduced Maternal Mortality
- 1.6k Downloads
It is widely recognized that family planning contributes to reducing maternal mortality by reducing the number of births and, thus, the number of times a woman is exposed to the risk of mortality. Here we show evidence that it also lowers the risk per birth, the maternal mortality ratio (MMR), by preventing high-risk, high-parity births. This study seeks to quantify these contributions to lower maternal mortality as the use of family planning rose over the period from 1990 to 2005. We use estimates from United Nations organizations of MMRs and the total fertility rate (TFR) to estimate the number of births averted—and, consequently, the number of maternal deaths directly averted—as the TFR in the developing world dropped. We use data from 146 Demographic and Health Surveys on contraceptive use and the distribution of births by risk factor, as well as special country data sets on the MMR by parity and age, to explore the impacts of contraceptive use on high-risk births and, thus, on the MMR. Over 1 million maternal deaths were averted between 1990 and 2005 because the fertility rate in developing countries declined. Furthermore, by reducing demographically high-risk births in particular, especially high-parity births, family planning reduced the MMR and thus averted additional maternal deaths indirectly. This indirect effect can reduce a county’s MMR by an estimated 450 points during the transition from low to high levels of contraceptive use. Increases in the use of modern contraceptives have made and can continue to make an important contribution to reducing maternal mortality in the developing world.
KeywordsFamily planning Birth spacing Maternal mortality ratio
Thanks to Mary Ellen Stanton and Marge Koblinsky for their assistance in identifying relevant literature and data sources and to Jacqueline Bell for providing data for Burkina Faso, Kim Streatfield for Bangladesh, and Edgar Kestler for Guatemala and Honduras. This research was funded by the U.S. Agency for International Development (USAID) | Health Policy Initiative, Task Order 1. The views expressed do not necessarily reflect the views of USAID or the U.S. Government.
- 1.Antarsh, L. (2004). The case for family planning. Report submitted to the UN Population Fund (UNFPA).Google Scholar
- 2.Rinehart, W., & Kols, A. (1984). Family planning programs. Population Reports, Series J no. 27, Vol. 12, p. 3.Google Scholar
- 4.Berelson, B. (1972). 18–35 in place of 15–45? Population Council Annual Report 1971, pp. 19–27. New York: The Population Council.Google Scholar
- 5.Nortman, D. (1974). Parental age as a factor in pregnancy outcome and child development. Reports on Population/Family Planning, No. 16. New York: The Population Council.Google Scholar
- 6.Pathmanathan, I., et al. (2003). Investing in maternal health: Learning from Malaysia and Sri Lanka. Washington, DC: World Bank. Human Development Network.Google Scholar
- 7.National Institute of Population Research and Training (NIPORT), ORC Macro, Johns Hopkins University, and the ICDDR,B. (2003) Bangladesh Maternal Health Services and Maternal Mortality Survey 2001. Dhaka, Bangladesh, and Calverton, MD (USA).Google Scholar
- 8.Danel, I., & Rivera, A. (2003) Honduras, 1990–1997. In M. A. Koblinsky (Ed.), Reducing maternal mortality: Learning from Bolivia, China, Egypt, Honduras, Indonesia, Jamaica, and Zimbabwe. World Bank. Human Development Network.Google Scholar
- 9.Bell, J. S., et al. (2008). The epidemiology of pregnancy outcomes in rural Burkina Faso. Tropical Medicine and International Health, 13(Suppl. I), 1–13. Table 4.Google Scholar
- 10.Population Reference Bureau (PRB). (2008). World population data sheet. Washington, DC: PRB.Google Scholar
- 11.WHO, UNICEF. (1996). Revised 1990 estimates of maternal mortality: A new approach by WHO and UNICEF. Geneva: WHO. For 1990.Google Scholar
- 12.AbouZahr, C., Wardlaw, T., & Hill, K. (2001). Maternal mortality in 1995: Estimates developed by WHO. Geneva: WHO, UNICEF, and UNFPA. For 1995.Google Scholar
- 13.AbouZahr, C., & Wardlaw, T. Maternal mortality in 2000: Estimates developed by WHO, UNICEF, and UNFPA. Geneva: WHO.For 2000.Google Scholar
- 14.AbouZahr, C., & Wardlaw, T. (2007). Maternal mortality in 2005: Estimates developed by WHO. Geneva: WHO, UNICEF, UNFPA, and the World Bank. For 2005.Google Scholar
- 15.National Institute of Population Research and Training (NIPORT), ORC Macro, Johns Hopkins University (JHU), & The ICDDR,B. (2003). Bangladesh maternal health services and maternal mortality survey 2001. Dhaka, Bangladesh, and Calverton, MD: NIPORT, ORC Macro, JHU, and the ICDDR,B Centre for Health and Population Research.Google Scholar
- 16.Demographic and Health Surveys. Individual reports are available from Macro International, Calverton, MD, at: http://www.MeasureDHS.com.
- 17.Stover, J., & Kirmeyer, S. (2007). DemProj: A computer program for making population projections. (Part of the spectrum software package). Washington, DC: Constella Futures, POLICY Project. http://www.PolicyProject.com.
- 19.Ross, J., & Stover, J. (2005). How does contraceptive use affect infant and child mortality? Presented at the 2005 annual meeting of the population association of America, Philadelphia, March 31–April 2, 2005.Google Scholar
- 21.United Nations Population Division. (2005). World population prospects: The 2004 revision. New York: United Nations.Google Scholar