EA - Family Planning: A Significant Opportunity for Impact by Sarah H

Link to original articleWelcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Family Planning: A Significant Opportunity for Impact, published by Sarah H on August 12, 2022 on The Effective Altruism Forum. Summary 218 million women in low- and middle-income countries (LMICs) lack access to modern contraceptives. Lack of contraceptive access resulted in 85 million unintended pregnancies in 2019. Pregnancy-related complications are a major cause of death and disability in LMICs, with around 300,000 women and girls dying of pregnancy-related complications each year. Other negative outcomes of unwanted pregnancies include health risks for newborns, decreased autonomy, and negative economic impacts for families and communities. There are several highly cost-effective existing interventions in this space, such as radio messaging and integrating family planning services into postpartum care, that are comparable or even more cost-effective than existing GiveWell top charities. While there is substantial investment in this space by non-EA actors, there remain highly neglected geographies and significant outstanding opportunities, particularly for a funder focused on maximising impact and cost-effectiveness. Importance 1 in 10 women of reproductive age worldwide want to postpone or avert a pregnancy but are not using modern contraception (UN DESA, 2020). This unmet need for family planning means that an estimated 218 million women in low- and middle-income countries (LMICs) lack access to modern contraceptives (Guttmacher, 2020). Unmet need results from a range of reasons, including limited access to services, particularly among young, poor, and unmarried women; misinformation concerning side effects; and cultural or religious opposition (WHO, 2020). Lack of contraceptive access resulted in 85 million unintended pregnancies in 2019 (Sedgh et al., 2014). Unintended pregnancies lead to a number of negative effects. They are associated with higher maternal and neonatal death and disability from pregnancy and childbirth (Dehingia et al., 2020), as well as higher rates of unsafe abortions (Kantorová, 2020). Unintended pregnancies also lead to significant losses in autonomy. This has a knock-on effect on their income due to decreased earnings and increased expenses (Schultz, 2009), with consequent negative effects on national economies (Canning et al., 2012). Maternal and neonatal health impacts Pregnancy-related complications continue to be a leading cause of preventable death among both mothers and children, with almost 300,000 women and girls dying due to pregnancy and childbirth in 2017 (WHO, 2017). The risk is particularly concentrated in sub-Saharan Africa, which accounts for more than 2/3 of global maternal deaths (Our World in Data, 2013). Contraceptive use reduces the DALYs lost through pregnancy-related complications by reducing the total number of births, allowing adolescents to delay births, and allowing for birth spacing. Pregnancy and childbirth are more dangerous for those aged 10-19, with particular dangers for girls under 15 years old. However, pregnancy remains common among adolescents in LMICs, with complications from pregnancy and childbirth constituting the leading cause of death for women aged 15 to 19 (Chandra-Mouli et al., 2014). These pregnancies also pose risks to newborns, as rates of preterm birth and low birth weight are much higher among babies born to young mothers (Neal et al., 2018). Contraceptive access mitigates these risks by allowing young women to delay births until the risks are lower (WHO, 2017). Short-spaced pregnancies – when women give birth within 2 years of their most recent birth – present substantial health risks to both mother and child, yet are fairly common in LMICs. Although the exact mechanisms aren’t clear, giving birth within a shorter timeframe compromises the mother and child’s nutrition (Wendt et al., 2...