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How Increased Contraceptive Use has Reduced Maternal Mortality

An Erratum to this article was published on 01 January 2014

Abstract

It is widely recognized that family planning contributes to reducing maternal mortality by reducing the number of births and, thus, the number of times a woman is exposed to the risk of mortality. Here we show evidence that it also lowers the risk per birth, the maternal mortality ratio (MMR), by preventing high-risk, high-parity births. This study seeks to quantify these contributions to lower maternal mortality as the use of family planning rose over the period from 1990 to 2005. We use estimates from United Nations organizations of MMRs and the total fertility rate (TFR) to estimate the number of births averted—and, consequently, the number of maternal deaths directly averted—as the TFR in the developing world dropped. We use data from 146 Demographic and Health Surveys on contraceptive use and the distribution of births by risk factor, as well as special country data sets on the MMR by parity and age, to explore the impacts of contraceptive use on high-risk births and, thus, on the MMR. Over 1 million maternal deaths were averted between 1990 and 2005 because the fertility rate in developing countries declined. Furthermore, by reducing demographically high-risk births in particular, especially high-parity births, family planning reduced the MMR and thus averted additional maternal deaths indirectly. This indirect effect can reduce a county’s MMR by an estimated 450 points during the transition from low to high levels of contraceptive use. Increases in the use of modern contraceptives have made and can continue to make an important contribution to reducing maternal mortality in the developing world.

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Notes

  1. 1.

    Differentials by birth intervals, rather than age and parity, are reviewed in World Health Organization. Department of Making Pregnancy Safer (MPS) and Department of Reproductive Health and Research (RHR). Report of a WHO technical consultation on birth spacing, Geneva, Switzerland, 13–15 June 2005. “After a live birth, the recommended interval before attempting the next pregnancy is at least 24 months in order to reduce the risk of adverse maternal, perinatal, and infant outcomes.” (Note that this produces a birth interval of 33 months.)

  2. 2.

    Excluding New York City.

  3. 3.

    1997 RAMOS study and 2001 Honduras Reproductive Health Survey (ENESF – Encuesta Nacional de Epidemiologia y Salud Familiar).

  4. 4.

    2000 mortalidad materna segun paridad, courtesy of Edgar Kestler.

  5. 5.

    For the developing world, weighting country CPRs by population size, approximately 53% of married/in-union women (or spouses) were using contraception in 1990, and approximately 61%, in 2005. Sources: UN Population Division. (1996) Levels and tends of contraceptive use as assessed in 1994. New York: United Nations. Also Carl Haub, C. and Kent, M. 2008 world population data sheet. Washington, DC: Population Reference Bureau. The 2008 data sheet figure is based on surveys of earlier dates and approximates the 2005 level of use.

  6. 6.

    Parity data and MMR from a survey published in 1997. In 2001 the CPR in Honduras was 62 (65% in 2005).

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Acknowledgments

Thanks to Mary Ellen Stanton and Marge Koblinsky for their assistance in identifying relevant literature and data sources and to Jacqueline Bell for providing data for Burkina Faso, Kim Streatfield for Bangladesh, and Edgar Kestler for Guatemala and Honduras. This research was funded by the U.S. Agency for International Development (USAID) | Health Policy Initiative, Task Order 1. The views expressed do not necessarily reflect the views of USAID or the U.S. Government.

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Correspondence to John Stover.

Appendix I

Appendix I

See Table 4.

Table 4 MMR values and patterns, by age

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Stover, J., Ross, J. How Increased Contraceptive Use has Reduced Maternal Mortality. Matern Child Health J 14, 687–695 (2010). https://doi.org/10.1007/s10995-009-0505-y

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Keywords

  • Family planning
  • Birth spacing
  • Maternal mortality ratio