The case for investing in family planning in the Pacific: costs and benefits of reducing unmet need for contraception in Vanuatu and the Solomon Islands

Abstract

BackgroundUnmet need for family planning in the Pacific is among the highest in the world. Better understanding of required investments and associated benefits of increased access to family planning in the Pacific may assist prioritisation and funding.MethodsWe modelled the costs and associated health, demographic and economic impacts of reducing unmet need for family planning between 2010–2025 in Vanuatu and the Solomon Islands. Baseline data were obtained from census reports, Demographic and Health Surveys, and UN agency reports. Using a demographic modelling program we compared a scenario of “no change in unmet need” with two distinct scenarios: 1) all family planning needs met by 2020; and, 2) all needs met by 2050.ResultsMeeting family planning needs by 2020 would increase prevalence of modern contraception in 2025 from 36.8 to 65.5% in Vanuatu and 28.5 to 37.6% in the Solomon Islands. Between 2010–2025 the average annual number of unintended pregnancies would decline by 68% in Vanuatu and 50% in the Solomon Islands, and high-risk births would fall by more than 20%, averting 2,573 maternal and infant deaths. Total fertility rates would fall from 4.1 to 2.2 in Vanuatu and 3.5 in the Solomon Islands, contributing to slowed population growth and lower dependency ratios. The direct cost of reducing unmet need by 2020 was estimated to be $5.19 million for Vanuatu and $3.36 million for the Solomon Islands between 2010–2025. Preventing unintended pregnancies would save $112 million in health and education expenditure.ConclusionsIn small island developing states such as Vanuatu and the Solomon Islands, increasing investment in family planning would contribute to improved maternal and infant outcomes and substantial public sector savings.

Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review

“…From the included studies, six articles assessed the cost effectiveness of improving family planning interventions in Mexico [25], India [26], Afghanistan [27], Nigeria [28], Uganda [29] and Pacific islands [30], of which four were evaluating family planning as one of several interventions to reduce maternal mortality [25–28]. The remaining three studies assessed strategies to reduce the unmet meet of family planning for HIV-infected women by means of providing integrated family planning and HIV services in multiple countries in Africa [24,31,32].…”

“…While most of the studies considered a lifetime time horizon for the analysis, the studies in HIV-positive women considered a relatively short (1 year) time horizon for their analysis. Despite the fact that many studies applied a lifetime time horizon, only very few mentioned or reported the discount rates for both cost and health outcome [26,29,30]. Detailed information about categories of included costs was provided in Table 3.…”

“…The projected health benefits associated with an increased investment to reduce the unmet need for family planning were modeled by Kennedy, et al for Vanuatu and the Solomon islands, small developing states in the Pacific Islands [30]. Demographic modeling was used in the analysis to assess the economic consequences of the strategy.…”

“…The analysis took a service delivery perspective, and included all direct costs associated with providing family planning. Increased investment in family planning in these small states was estimated to result in considerable public sector savings [30]. …”

Closing the gaps in child health in the Pacific: An achievable goal in the next 20 years

“…This has been measured recently in two Pacific nations, Vanuatu and Solomon Islands, where the unmet need for family planning is estimated to be 28–33% and 11–12%, respectively. Estimated effects of the reduced fertility (down to 2.1% in Vanuatu and 3.5% in Solomon Islands) are substantial falls in maternal and infant deaths and substantial net cost savings . Substantial levels of unmet family planning needs are also reported from demographic and health surveys (DHSs) in Samoa (45.6%) and Tuvalu (24.6%)…”