A Next Step: Estimating Impact from CYP

1. A Next Step:Estimating Impact from CYP New Developments in the Calculation and Use of CYP Washington, D.C. — September 8, 2011 Jacqueline E. Darroch, Ph.D.

2. CYP translate contraceptives into protection from unintended pregnancy Contraceptive procedures and commodities CYP Units per year + Adjustments

3. Estimation of impacts from CYP requires additional estimation Contraceptive procedures and commodities Impacts: Demographic, health, cost, etc. CYP

4. Unintended pregnancy is the link between contraception and impact Contraceptive procedures and commodities Impacts: Demographic, health, cost, etc. CYP Unintended pregnancies Averted

5. Unintended pregnancies have multiple impacts Unintended pregnancies averted Unplanned births averted Abortions averted Miscarriages averted Safe abortions averted Unsafe abortions averted Health care services Deaths averted DALYs averted

6. Unintended pregnancy is the link between contraception and impact Contraceptive procedures and commodities Impacts: Demographic, health, cost, etc. CYP Impact estimation factors from available studies and best guesses Unintended pregnancies Averted

7. Unintended pregnancy is the link between contraception and impact Contraceptive procedures and commodities Impacts: Demographic, health, cost, etc. CYP Impact estimation factors from available studies and best guesses Unintended pregnancies Averted

8. What would be the (unintended) pregnancy rate without CYP? • Biological pregnancy rates (~85%, Trussell) • From fertile couples, frequent sexual activity, trying to get pregnant • Results in too high pregnancy numbers • Average population pregnancy rates • Include intended pregnancies and those to contraceptive users • Hard to estimate because of missing/poor data on induced abortion • Women with unmet need for modern contraception • Sexually active, fertile, do not want child in next 2 years • Using traditional or no method

9. Definitional issues:Contraceptive use • CYP try to estimate “active” and “effective” coverage from unintended pregnancy, adjusting for low fecundity, non-exposure, incorrect/inconsistent use; applied to all types of users • Survey data on contraceptive use try to capture “real-life” use, among all user types and situations and levels of correct and consistent use

10. Measuring impacts of specific services is more complicated Sexual activity/ Fecundity CYP: Sterilization IUD Implants Injections Patches Rings Pills Condoms Other Impacts: Demographic, health, cost, etc. Childbearing intention Unintended pregnancies Averted Method use Context of CYP provision: method choice, counseling, etc. Availability and accessibility of needed services Selection of users Substitution – methods and/or sources

11. Unintended pregnancy is the link between contraception and impact Contraceptive procedures and commodities Impacts: Demographic, health, cost, etc. CYP Impact estimation factors from available studies and best guesses Unintended pregnancies Averted

12. February 2003 December 2009

13. Method users x pregnancy rates = unintended pregnancies 818M women in need x Pregnancy rates = 75M unint. pregs. Modern Tubal ligation Vasectomy IUD Injection/Implant Pills Condoms/other Traditional Withdrawal Per. Abst. Other In need, no method Modern Tubal ligation Vasectomy IUD Injection/Implant Pills Condoms/other Traditional Withdrawal Per. Abst. Other In need, no method Unintended Pregnancies x =

14. 215 million women want to avoid pregnancy but have unmet need for modern methods No method, 140 million Modern methods, 603 million Traditional methods, 75 million Women at risk for unintended pregnancy, 2008 (818 million) Adding It Up, 2009

15. Meeting developing country unmet need for modern methods would yield • 53 million fewer unintended pregnancies • 22 million fewer unplanned births • 25 million fewer abortions • 680,000 fewer deaths among women (94,000) and newborns (586,000) • 390,000 fewer children who would lose their mothers Adding It Up, 2009

16. Data for estimating relative relationship among pregnancy rates • Reversible method users • 12-month use-failure rates, women in union, DHS data from 18 developing countries • Sterilization users • Trussell review of available research • Nonusers • US: ~40%; lower sexual activity; lower fecundity?; conservative estimate

17. Made model output consistent with external estimates • 75 million unintended pregnancies in developing countries in 2008 • Births: Number -UN Population Prospects; Intention status – DHS and other surveys • Induced abortion – Guttmacher Institute, Abortion Worldwide • Miscarriage – estimated • Method-specific pregnancy rates were adjusted downward to yield 75 million unintended pregnancies • Average adjustment was 0.88 • Regional adjustments: 0.83 for Asia; 0.95 for Africa and 1.05 for Latin America and the Caribbean.

18. Rates of unintended pregnancies and pregnancies averted • Women with unmet need for modern methods, i.e. using no method or traditional method: 288/1,000 • If these women used modern methods: 39/1,000 • Unintended pregnancies that would be averted if women with unmet need used modern methods: (288-39)/1,000 = 249/1,000

19. Impact factors • For CYP that use conversion factors that adjust for use-effectiveness: • 288/1,000 or .288 per user per year • For CYP that use conversion factors that do not adjust for use-effectiveness: • 249/1,000 or 0.249 per user per year

20. Some key assumptions • Ratio of unintended pregnancies prevented per modern method user is the same as per CYP • Relative relationships among contraceptive and no-method use-effectiveness rates are reflected by available data • CYP, and estimated impacts, are defined and measured the same across organizations and programs

21. Further considerations • Since CYP use global conversion factors, use global estimate for estimating unintended pregnancies averted • Specify what CYP conversion factors are used and adjustments they contain

22. Unintended pregnancies have multiple impacts Unintended pregnancies averted Unplanned births averted Abortions averted Miscarriages averted Safe abortions averted Unsafe abortions averted Health care services Deaths averted DALYs averted

23. Data to estimate further outcomes of unintended pregnancies • Unplanned births, miscarriages, induced and unsafe abortions for regions and countries (unsafe abortions): Guttmacher Institute • Mortality for countries (maternal, stillbirth, infant) and regions (unsafe abortion): WHO and IHME* • DALYs: WHO and IHME* *Institute for Health Metrics and Evaluation

24. This presentation was developed with support from PATH through Reproductive Health Supplies Coalition For more information, visit www.guttmacher.org