title: Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa.
abstract: BACKGROUND
  Family planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa.
  
  
  METHODS
  The Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030.
  
  
  RESULTS
  If CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers.
  
  
  CONCLUSIONS
  Maternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception.
authors.affiliation: PRICELESS-MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Lumbwe
authors.initials: L
authors.lastname: Chola
authors.affiliation: PRICELESS-MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Shelley
authors.initials: S
authors.lastname: McGee
authors.affiliation: PRICELESS-MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Aviva
authors.initials: A
authors.lastname: Tugendhaft
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Eckhart
authors.initials: E
authors.lastname: Buchmann
authors.affiliation: PRICELESS-MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Hofman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D046688:Child Mortality / Q000639:trends*; D003267:Contraception / Q000191:economics* / Q000401:mortality / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000523:psychology; D005193:Family Planning Services / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D063130:Maternal Death / Q000639:trends*; D008875:Middle Aged; D011247:Pregnancy; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult