,The definitive study and set of data on how investments and family planning and RH are cost-effective and beneficial to women and families. Cost-benefit analyses are outlined, as are health benefits using global and Philippine data.

1. October 2008
The Health Benefits of
Family Planning
& Reproductive
Health
FACT SHEET
KEY FACTS:
• More than 400,000 women suffer from maternal morbidities
every year.
• Women suffer more from maternal morbidities than any other
illness.
• Around 200,000 maternal morbidities—up to half the total—
can be prevented through effective family planning.
• Eleven women die each day from pregnancy and birth
complications. Most of these deaths are preventable.
• Proper birth spacing reduces by half the risk of death for
newborns and infants. More than 7,800 infant deaths can be
prevented yearly through family planning.
• Poor women and infants carry the most risk of death and
disability from lack of access to reproductive health services.
• For every peso spent in family planning, around 3 to 100
pesos will be saved in maternal care costs for unintended
pregnancies.
• At least 5.5 B (billion) pesos are spent each year in health
care costs for managing unintended pregnancies and its
complications. An annual budget of 2 to 3 B pesos for FP is a
cost-effective public health measure.
LIKHAAN

2. More than 400,000 women ventions like caesarean sec- tions that are often unpre-
suffer from maternal mor- tion (CS) deliveries and blood dictable and require life-sav-
bidities every year in the transfusion require second- ing access to quality obstetric
Philippines. ary to tertiary level facili- services.” *(1997, pp. 3-4)
These are life-threatening ties (UN Millennium Project
complications from pregnan- 2005, pp. 83-84).
cies and deliveries that often Women suffer more from
require hospital care. The The Department of Health maternal morbidities than
2005 World Health Report of and international health au- any other illness.
the WHO (p. 62) has stated thorities agree on the mag- If the estimated number of
that globally, around 80% of nitude and severity of this morbidities is compared with
all maternal deaths are the problem. The DOH (2005a, the Department of Health’s
tragic end results of the fol- pp. 207-208) estimates that list of notifiable diseases, then
lowing complications: there are three million preg- maternal morbidities clearly
nancies every year, each one surpass the number of females
• hemorrhage or severe of which “entails risks to both that are sick each year with
bleeding; the mother and the unborn.” other serious illnesses like
• sepsis (bloodstream UNICEF, WHO and UNFPA pneumonias, bronchitis, diar-
infection); estimate that “at least 15 per rheas, hypertension, influenza,
• hypertensive disorders of cent of all pregnant women or tuberculosis (see Figure 1).
pregnancy like eclamp- develop serious complica-
sia and pre-eclampsia;
• prolonged or obstructed
Figure 1. Maternal Morbidities Compared to the Top Ten
labor; and
Female Morbidities of 2005
• complications of unsafe
abortion. Maternal Morbidities 400,000
The remaining 20% of ma- ALRI and Pneumonia 328,956
ternal deaths are caused by Bronchitis/Bronchiolitis 308,930
existing illnesses that are
Acute Watery Diarrhea 278,958
exacerbated by pregnancy or
its management. Examples Hypertension 214,220
common in the Philippines
Influenza 205,419
include anemia, tuberculo-
sis, malaria, cardiovascular TB Respiratory 44,440
disorders and diabetes (DOH Diseases of the Heart 15,324
2005a, p. 208 & 248).
Malaria 15,003
Most of these morbidities Chickenpox 14,748
require life-saving emergency
Dengue Fever 9,434
obstetric care from primary
level hospitals. Other inter- Source: DOH 2005 b
* 15% x 3 million pregnancies = 450,000 estimated maternal complications. This estimate is consistent with another esti-
mate shown in Table 2.
The Health Benefits of Family Planning and Reproductive Health 2 Likhaan

3. Around 200,000 maternal morbidities—up to half the total— Eleven women die each day
can be prevented through effective family planning. from pregnancy and birth
When unintended pregnancies occur, some women resort to complications. Most of these
induced abortion while others carry their pregnancy to term. A deaths are preventable.
proportion of all these pregnancies lead to serious obstetric com- An estimated 4,100 mater-
plications. Using data from a study by the Guttmacher Institute nal deaths occurred in the
(Singh S et al. 2006) and the estimate of the UNICEF, WHO and Philippines in 2000 (WHO,
UNFPA that at least 15 per cent of all pregnant women develop UNICEF & UNFPA 2004). This
serious complications, the following table shows that half of all is equivalent to one out of
maternal morbidities are from women with unintended pregnan- every seven deaths of women
cies, and are therefore preventable through family planning. of reproductive age (National
Statistics Office - NSO 2004),
making maternal death a
Table 1. Maternal Morbidities from Intended & Unintended
grave risk for women in this
Pregnancies
age group.
Maternal Morbidities
No. % Most of these deaths are
preventable: up to half by
Intended/Planned Pregnancies
reducing unintended preg-
• carried to term (1,209,000 x 15% complication rate) 181,350 nancies through family
• hospitalized for spontaneous pregnancy loss 26,092 planning as discussed in the
previous point; and the other
Subtotal 207,442 48%
half substantially reduced
Unintended Pregnancies (Preventable Through FP) by making each pregnancy
• carried to term (961,000 x 15% complication rate) 144,150 and childbirth safer, through
• hospitalized for induced abortion 78,901
key interventions like skilled
birth attendance and access
Subtotal 223,051 52%
to emergency obstetric care.
Total 430,493 100% Many progressive countries
Sources: Singh S et al. 2006 and calculations from UNICEF, WHO, UNFPA 1997 have succeeded through
these approaches. For ex-
ample, total maternal deaths
The WHO provides a similar, global analysis in its 2005 World in all the developed regions—
Health Report, where it states that which includes Europe,
Canada, US, Japan, Australia
Unintended and unwanted pregnancies—owing to unmet need for and New Zealand—number
contraception, to contraceptive failure, or to unwanted sex—if brought only 2,500. In the Southeast
to term, carry at least the same risks as those that are desired and Asia region, Malaysia, Thai-
deliberate. It is estimated that up to 100 000 maternal deaths could be land and Vietnam—with a
avoided each year if women who did not want children used effective combined population more
contraception. When maternal illnesses are also taken into account, than twice that of the Phil-
preventing unwanted pregnancies could avert, each year, the loss of 4.5 ippines—had a total of only
million disability-adjusted life years. 2,740 maternal deaths.
The Health Benefits of Family Planning and Reproductive Health 3 Likhaan

4. Table 2. Maternal Mortality in Selected Countries compared to those with an
Number of Maternal Lifetime Risk
interval of three years. Data
Population
Country/Region Maternal Mortality of Maternal from the NSO’s 2003 NDHS
(2000, in M)
Deaths Ratio Death, 1 in (p. 110) support this finding:
infants born with a previous
Developed Regions 1,194 2,500 20 2,800
birth interval of less than two
Malaysia 22 220 41 660 years had a mortality rate of
Thailand 61 520 44 900
39 per thousand live births
compared to 19—a reduction
Vietnam 80 2,000 130 270 by half—for those with three
Philippines 76 4,100 200 120 years of interval.
Sources: WHO, UNICEF & UNFPA 2004; UN Population Division 2004 How many infant deaths can
be prevented through birth
spacing? The 2003 NDHS
The lifetime risk of maternal the recommended interval (p. 115) had estimated that
death combines the impact before attempting the next 23.5% of births were of less
of the frequency of preg- pregnancy is at least 24 months than 24 months interval, and
nancies and the danger of in order to reduce the risk of the NSO registered 1.71 mil-
each pregnancy. Using this adverse maternal, perinatal and lion live births in 2004 (NSO
measure, the risk faced by infant outcomes. 2008). Putting all these data
women in the Philippines is together, at least 7,800 infant
five to seven times that faced … To summarize, BTP [birth- deaths a year can be pre-
by women in Malaysia and to-pregnancy] intervals of six vented through proper birth
Thailand. The Philippines is a months or shorter are associated spacing.*
disproportionate contributor with elevated risk of mater-
of maternal deaths in South- nal mortality. BTP intervals of
east Asia and the world. around 18 months or shorter are Poor women and infants
associated with elevated risk of carry the most risk of death
Proper birth spacing reduces infant, neonatal and perinatal and disability from lack
by half the risk of death for mortality, low birth weight, small of access to reproductive
newborns and infants. More size for gestational age, and pre- health services.
than 7,800 infant deaths can term delivery. Women want fewer children
be prevented yearly through than they actually get. The
family planning. Two of the WHO-reviewed poorer they are, the larger
A recent review of birth studies show that BTP inter- the gap between wanted
spacing studies published by vals of less than 18 months and actual fertility. On aver-
the WHO in 2006 states that are linked to a two-fold age, every 10 women from
after a live birth, increase (1.9-2.6) in neo- the wealthiest quintile will
natal and infant mortality end up with three extra,
* 1.71 M (registered live births only; NDHS 2003 data on fertility rates combined with NSO population projections indicate
that 2.1 M live births occurred in 2000, according to Singh S et al 2006) x 23.5% (proportion of all births with <24 months
interval) x 39/1000 (mortality rate of infants with < 24 months interval) x 50% (mortality risk reduction if birth spacing of
less than 2 years is increased to 3 years)
The Health Benefits of Family Planning and Reproductive Health 4 Likhaan

5. unplanned births, while those from the poorest will end up with and the availability and use
21. A key factor is the inability of poor women to control their of emergency obstetric care
fertility through effective FP. Looking at the demand and use of (EmOC) as key strategies
all methods, surveys reveal a pattern of inequity—the poorer to reduce maternal deaths.
women are, the larger the unmet need for FP, and the greater the Available indicators for these
number of unplanned births. two strategies clearly show
that poorer women have less
Figure 2. Unmet Need for FP and the Wanted vs. Actual Fertility Gap access to life-saving services.
Women among the wealthi-
26.7 est quintile have already
19.6 surpassed the 2015 MDG
15.0 21 target of 90% for skilled birth
12.3 13.4 attendance while the poor-
% Unmet Need for FP 15 est have only reached 25%.
9 For EmOC, a widely available
Extra, Unplanned Births 6 statistic is the percentage of
(for every 10 women) 3 caesarean section (CS) deliv-
Wealthiest Fourth Middle Second Poorest eries, wherein it is estimated
that usage beyond 15%
Source: NSO & ORC Macro, NDHS 2003
indicates overuse while rates
below 5% signals a dangerous
The calculation of unmet The World Health Organi- lack of access (UNICEF, WHO,
need for FP was done during zation (2005) and the UN UNFPA 1997). Data from the
the period when the pub- Millennium Project (2005) 2003 NDHS show that the
lic health system was still Task Force on Maternal and poorest 40% of women have
distributing donated com- Child Health both recom- below-standard access to CS
modities for free. As a result, mend the increase in the use deliveries.
equitable access and use of of skilled birth attendance
some FP supplies, like contra-
ceptive pills, were ensured. Table 3. Use of Tubal Ligation, Skilled Birth Attendants & CS Delivery
This is a success story that by Asset Quintile
may now be rolled back after
FP donations have ended. % Caesarean Section
Delivery
Access to FP supplies may
end up like the inequitable Wealthiest 11.5 92.4 20.3
access to the costlier, for-pay Fourth 13.4 84.4 10.8
tubal ligation which results
Middle 11.2 72.4 6.8
in poorer women having
lesser rates of use. If pills Second 7.9 51.4 3.4
and other previously donated Poorest 3.9 25.1 1.7
commodities will no longer
be available as free or low
cost health supplies, then the poorest 40% poorest 60% poorest 40%
unmet need and unplanned had way below below MDG target below minimum
births of poorer women will average use (10.5%) for 2005 (80%) recommended by
UNICEF, WHO, UNFPA (5%)
rise further.
Sources: NSO & ORC Macro (NDHS 2003); UNICEF, WHO, UNFPA 1997
The Health Benefits of Family Planning and Reproductive Health 5 Likhaan

6. For every peso spent in fam- (Festin M 2003). PhilHealth injectables; less than P600
ily planning, around 3 to 100 also published a scenario in a for a year’s supply of con-
pesos will be saved in mater- 2003 circular wherein it will doms; P500 for vasectomy
nal care costs for unintended pay up to P19,490 plus P300 and P1,500 for tubal ligation
pregnancies. per day of confinement in a in a public hospital (Aquino
The reimbursement rates of secondary hospital for total V, 2008). Concretely, an IUD
PhilHealth provide a good hysterectomy due to post- worth P200 can prevent a
indicator of the average partum haemorrhage. These hysterectomy that would
costs of maternal care. For amounts do not even rep- amount to at least P20,000 in
normal spontaneous de- resent the total health care public health costs plus addi-
liveries, PhilHealth (2003) costs since PhilHealth esti- tional out-of-pocket spending
currently pays P4,500. The mates that the benefits they by the patient and her family.
costs predictably escalate for provide to members comprise
pregnancy and delivery com- only 30 to 70 percent of the The DOH is aware of this
plications. Published figures total costs per confinement analysis and has stated in
by PhilHealth include average (Fajardo L 2006). its National Objectives for
benefits amounting to P4,974 Health (2005 a, p. 9) that
for dilatation and curet- Compared to maternal care “a reduction in the actual
tage for abortions (Festin M expenses, family planning number of births reduces the
2003); P13,413 for hyperten- costs are low. For example, it need for obstetrical care, im-
sion complicating pregnancy costs around P200 to provide munization and other mater-
and labor (Wagner A et al. an IUD which can last up to nal and child health interven-
2006); and around P16,000 ten years; less than P400 tions.”
for caesarean section delivery for a year’s supply of pills or
Figure 3. Family Planning versus Maternal Care Costs for Unintended Pregnancies
Family Planning Costs (per person)
IUD (good for up to 10 years)
Injectables (supply for 1 year)
Pills (supply for 1 year)
Vasectomy (at PGH)
Condoms (10 pcs/mo, for 1 year)
Tubal ligation (at PGH)
Maternal Care Costs (per person)
Normal spontaneous delivery/birth
D&C for abortion (spontaneous & induced)
Hypertensive disorders of pregnancy
Cesarean section delivery
Hysterectomy for postpartum hemorrhage
PHP 0 5,000 10,000 15,000 20,000
Sources: Aguino V 2008; Festin M 2003; Wagner A et al 2006; PhilHealth 2003
The Health Benefits of Family Planning and Reproductive Health 6 Likhaan

7. At least 5.5 B (billion) pesos are spent each year in health
care costs for managing unintended pregnancies and its
complications.
Singh et al (2006) estimates that around the year 2000, there
were 78,901 hospitalizations for induced abortions and 961,000
unintended pregnancies carried to term. The 2003 NDHS esti-
mates that 7.3% of births were done via caesarean section. Using
only these two types of maternal complications (induced abor-
tion and CS deliveries) and the benefit rates of PhilHealth (which
excludes out-of-pocket co-payments by patients), the minimum
health care costs for managing unintended pregnancies and its
complications can be estimated as follows:
Table 4. Minimum Health Care Costs for Managing Unintended Pregnancies
Number PhilHealth Total Cost
Description of Cases Benefit Rate
per Year per Case (B Pesos)
Hospitalized for abor- 78,901 4,974 0.392
tion complications
Unintended pregnancy 70,153 16,000 1.122
carried to term,
caesarean section
delivery (7.3% of
births)
Unintended pregnancy 890,847 4,500 4.009
carried to term, no
caesarean section
delivery
TOTAL 5.523
Sources: Singh et al 2006; NSO & ORC Macro 2004; PhilHealth 2003; Festin M 2003
Aquino (2008, p. 31) estimates that from 2.0 to 3.5 B pesos of
public funds are needed in 2009 to finance a range of voluntary
family planning services. Such levels of public health spending
will clearly be cost-effective, resulting in health care savings of
several billion pesos.
The Health Benefits of Family Planning and Reproductive Health 7 Likhaan

8. REFERENCES
Aquino V. (2008). Completing the Family Planning Equation to Achieve Contraceptive
Self-Reliance. PLCPD
Department of Health. (2005a). National Objectives for Health, Philippines, 2005-2010.
Department of Health. (2005b). Field Health Information System Annual Report 2005.
National Epidemiology Center.
Fajardo L. (2006 February 24). PhilHealth pays P17.5B in health insurance benefits.
PhilHealth News. Retrieved 2 October 2008 from http://www.philhealth.gov.ph/
media/news/2006/022406a.htm
Festin M. (2003). Are we doing too many caesarean sections? The HTA Forum, Vol. 1 No. 2
National Statistics Office. (2004). Table 2. Number of Deaths by Age Group by Sex and
Sex Ratio, Philippines: 2000. Retrieved 26 September 2008 from http://www.
census.gov.ph/data/sectordata/2000/ds0002.htm
National Statistics Office. (2008). Live Birth Statistics: 2004. Retrieved 30 September
2008 from http://www.census.gov.ph/data/sectordata/sr08321tx.html
National Statistics Office and ORC Macro. (2004). National Demographic and Health
Survey 2003. Calverton, Maryland: NSO and ORC Macro.
PhilHealth - Philippine Health Insurance Corp. (2003). PhilHealth Circular 25 s. 2003:
Supplement to the rules on PhilHealth’s maternity care benefits for hospitals and
non-hospital facilities.
Singh S, Juarez F, Cabigon J, Ball H, Hussain R and Nadeau J. (2006). Unintended
Pregnancy and Induced Abortion in the Philippines: Causes and Consequences.
New York: Guttmacher Institute.
UNICEF, WHO, UNFPA. (1997). Guidelines for Monitoring the Availability and Use of
Obstetric Services.
UN Millennium Project. (2005). Who’s Got the Power? Transforming Health Systems for
Women and Children. Task Force on Child Health and Maternal Health.
UN Population Division. (2004). World Population to 2300. Available at http://www.
un.org/esa/population/publications/longrange2/WorldPop2300final.pdf
Wagner A, Ross-Degnan D, Valera M, Laviña S, Sia I and Galang R. (2006). An Outpatient
Prescription Drug Benefit for PhilHealth Members with Hypertension. p. 5.
WHO, UNICEF & UNFPA. (2004). Maternal mortality in 2000: Estimates developed by
WHO, UNICEF and UNFPA. Available at http://www.who.int/reproductive-health/
publications/maternal_mortality_2000/index.html
World Health Organization. (2005). The World Health Report: 2005: Make Every Mother
and Child Count. Available at http://www.who.int/whr/2005/en/index.html
World Health Organization. (2006). Report of a WHO Technical Consultation on
Birth Spacing. Available at http://who.int/reproductive-health/publications/
birthspacing/index.html
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