An estimated 272,000 maternal deaths were averted worldwide by contraceptive use in 2008, according to an analysis of data from 172 developing and developed countries.1 Globally, more than 342,000 women aged 15–49 died in 2008 because of complications related to pregnancy and childbirth; without contraceptive use, however, that number would have increased by 80%, to 614,000. If women’s unmet need for contraception had been fully satisfied, an additional 104,000 maternal deaths would have been averted.
Data for the analysis were drawn from several World Health Organization (WHO) and United Nations databases, as well as from country population surveys. The researchers used two techniques to estimate maternal deaths averted by contraceptive use: counterfactual modeling and linear regression. The first approach replicated the method that WHO’s Maternal Mortality Estimation Inter-Agency Group used previously to estimate maternal mortality in 172 countries. The second method was used to estimate maternal mortality in 167 countries (five small countries for which contraceptive rates were unavailable, but had been imputed in the first analysis, were excluded from this analysis); in addition, the method was applied to estimate the number of maternal deaths that would have been averted if unmet need for contraception had been fully met—that is, if all married or sexually active single women aged 15–49 who were not using a contraceptive, but wanted to space or limit their childbearing, had used a method.
On the basis of their first analytic model, the researchers estimated that, in 2008, roughly 342,000 married or sexually active single women aged 15–49 died worldwide because of complications related to pregnancy and childbirth. Some 722 million of the 1.2 billion women included in the analysis practiced contraception. Without contraceptive use, an additional 272,000 maternal deaths would have occurred that year—for a total of 614,000 maternal deaths, a number 80% higher than in actuality. Nearly all of those extra deaths—270,000—would have been in developing regions, notably Asia (163,000); in fact, India alone accounted for nearly a third (86,000) of the averted deaths.
Overall, the use of contraceptives led to a 44% reduction in maternal deaths worldwide. In regions with a high contraceptive prevalence rate, such as East Asia (85%) and Latin America (75%), the reduction was about 60%. By contrast, in regions with a low contraceptive prevalence, the reduction was smaller: For example, in Sub-Saharan Africa, where contraceptive prevalence was 22%, the reduction in maternal deaths caused by contraceptive use was only 32%. The proportion of potential maternal deaths averted by contraceptive use varied widely by individual country, ranging from 7% in Chad to 61% in most developed countries and many developing countries, including Brazil, China, Iran, Mauritius, Russia and Thailand. (Additional analyses indicated that once a country’s contraceptive prevalence reaches 65%, the proportion of potential maternal deaths prevented by contraceptive use tends to plateau around 60%.)
Estimates from the second analytical model were similar to those from the first: In 2008, approximately 359,000 maternal deaths occurred worldwide and 299,000 maternal deaths were averted by contraceptive use. If all unmet need for contraception had been satisfied, an additional 104,000 maternal deaths would have been averted—mostly in Sub-Saharan Africa (59,000) and South Asia (32,000).
The authors note several limitations of their study, such as the uncertain quality of the underlying data (particularly in developing countries) and their reliance on modeled fertility and mortality outcomes. Nevertheless, they conclude that their results provide evidence that "contraceptive use is a substantive and effective primary prevention strategy to reduce maternal mortality in developing countries." The findings also point to a need for "increased access to contraception in countries with a low prevalence of contraceptive use, where gains in maternal mortality prevention stand to be the greatest." —J. Rosenberg
1. Ahmed S et al., Maternal deaths averted by contraceptive use: an analysis of 172 countries, Lancet, 2012, 380(9837):111–125.