Maternal Deaths Averted by Contraceptive Use

Family planning can lower the number of maternal deaths by reducing the likelihood of pregnancy and its associated complications and lowering the risk of having an unsafe abortion. More than 99% of maternal deaths occur in developing countries where contraceptive use is low. The Safe Motherhood Initiative identified family planning as 1 of 4 strategies recommended to reduce maternal mortality in developing countries. The unmet need for contraception in many of these countries is higher than the prevalence of contraceptive use. The aim of this study was to systematically assess the effect of contraceptive use on the rate of maternal death at regional and country levels and to estimate the expected reduction in maternal deaths if unmet needs for contraception were fulfilled. Relevant data were obtained from 3 sources: The Maternal Mortality Estimation Inter-Agency Group database, the UN World Contraceptive Use 2010 database, and the UN World Population Prospects 2010 database. Two analytical models were applied to estimate the number of maternal deaths averted by contraceptive use. In model 1, a counterfactual modeling approach was used (replicating the Maternal Mortality Estimation Inter-Agency Group World Health Organization maternal mortality estimation method) to estimate maternal deaths averted in 172 countries by use of contraceptives. With model 2, the same estimate was made for 167 countries, and the effect of satisfying unmet need for contraception was assessed. Sensitivity analysis assessed the robustness and reliability of the models. Agreement between the models for country-wide estimates was compared. In 2008, about 722 million of the 1.2 billion women of reproductive age who were married or sexually active were using contraception. Model 1 estimates showed that among the 342,203 women who died of maternal causes in 2008, contraceptive use averted 272,040 maternal deaths (95% uncertainty range, 127,937–407,134), representing a 44% reduction. Without use of contraceptives, the number of maternal deaths would have been 1.8 times higher (614,243 deaths). Model 2 estimates showed that another 104,000 maternal deaths per year (29% reduction) could be prevented by satisfying unmet need for contraception. Adding these 104,000 preventable deaths from satisfaction of unmet needs for contraception to the 272,000 maternal deaths avoided by use of contraception (shown in model 1) suggests that up to 376,000 maternal deaths per year may be averted by contraceptive use. These findings provide substantial evidence that contraceptive use is an effective prevention strategy to reduce maternal mortality in developing countries. The data demonstrate the critical need to accelerate access to contraception in these counties.