Maternal deaths averted by contraceptive use: an analysis of 172 countries.
BACKGROUND
Family planning is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. We aimed to estimate the effect of contraceptive use on maternal mortality and the expected reduction in maternal mortality if the unmet need for contraception were met, at country, regional, and world levels.


METHODS
We extracted relevant data from the Maternal Mortality Estimation Inter-Agency Group (MMEIG) database, the UN World Contraceptive Use 2010 database, and the UN World Population Prospects 2010 database, and applied a counterfactual modelling approach (model I), replicating the MMEIG (WHO) maternal mortality estimation method, to estimate maternal deaths averted by contraceptive use in 172 countries. We used a second model (model II) to make the same estimate for 167 countries and to estimate the effect of satisfying unmet need for contraception. We did sensitivity analyses and compared agreement between the models.


RESULTS
We estimate, using model I, that 342,203 women died of maternal causes in 2008, but that contraceptive use averted 272,040 (uncertainty interval 127,937-407,134) maternal deaths (44% reduction), so without contraceptive use, the number of maternal deaths would have been 1·8 times higher than the 2008 total. Satisfying unmet need for contraception could prevent another 104,000 maternal deaths per year (29% reduction).


CONCLUSIONS
Numbers of unwanted pregnancies and unmet contraceptive need are still high in many developing countries. We provide evidence that use of contraception is a substantial and effective primary prevention strategy to reduce maternal mortality in developing countries.


BACKGROUND
Bill and Melinda Gates Foundation.
Department of Population, Family and Reproductive Health, Bill and Melinda Gates Institute for Population and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. sahmed@jhsph.edu
Saifuddin
S
Ahmed
Qingfeng
Q
Li
Li
L
Liu
Amy O
AO
Tsui
D000293:Adolescent; D000328:Adult; D001723:Birth Rate; D003267:Contraception / Q000706:statistics & numerical data*; D003906:Developing Countries; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D020380:Needs Assessment; D011322:Primary Prevention; D012307:Risk Factors; D055815:Young Adult