Satisfying unmet need for contraception could reduce maternal deaths by 30%

The LancetJul 10 2012

New research published as part of The Lancet Series on family planning provides startling new estimates of the effect that contraceptive use has on the number of mothers who die every year, suggesting that satisfying the global unmet need for contraception of women who want to limit or space their pregnancies but are not using contraception could reduce maternal deaths by 30%, saving around 104000 lives per year.

While maternal death rates have declined in recent decades in most high- and middle-income countries, around 300000 women and 3 million newborn babies are thought to die each year because of complications relating to pregnancy and childbirth.  Nearly all of these deaths occur in developing countries. 

Dr Saifuddin Ahmed from the Bloomberg School of Public Health, Johns Hopkins University, USA, and colleagues used data from the WHO and UN to develop a detailed new model estimating the annual number of maternal deaths in each of 172 countries, as well as the number of deaths likely to have been averted by contraceptive use.  

The estimates show that Greece has the world’s lowest maternal mortality rate, with just three mothers dying per 100000 live births.  By contrast, Chad in central Africa has the world’s highest rate of maternal mortality according to the authors’ calculations, with a staggering 1465 deaths per 100000 live births.  Afghanistan suffers from the second highest mortality rates, with 1365 mothers dying per 100000 live births. Without contraceptive use, the number of maternal deaths would have been 1·8 times higher globally.

The authors explain how contraceptive use reduces maternal deaths in a number of ways:

• Reducing the exposure to pregnancy and its associated complications
• Lowering the risk of unsafe abortions, thought to be responsible for around 13% of all maternal deaths in developing countries
• Delaying first pregnancy, which carries higher risk,  in very young women
• Reducing the hazards associated with pregnancies that are too closely spaced or in women who have had many pregnancies

The unmet need for contraception is most prevalent in sub-Saharan Africa, where only 22% of women who are married or sexually active use contraception, compared to 75% in developed countries.   According to Dr Ahmed, “Promotion of contraceptive use is an effective primary prevention strategy for reducing maternal mortality in developing countries. Our findings reinforce the need to accelerate access to contraception in countries with a low prevalence of contraceptive use where gains in maternal mortality prevention could be greatest.”  To Dr Ahmed, “Vaccination prevents child mortality, contraception prevents maternal mortality.”