There is also a mental health benefit to averting unwanted pregnancy. A meta-analysis by Wang et al. (2021)found that women with an unplanned pregnancy were 62% more likely (28% vs. 17%) to suffer postpartum depression compared to women with a planned pregnancy. We don’t have good data on depression prevalence among women whose unplanned pregnancy was averted, but it seems probable that an unplanned pregnancy increases the risk of mental illness, even if only by adding another life stressor. It is very hard to measure, but I suspect that the wellbeing benefits ofnot having one’s education cut short / career & income disrupted / living with stigma of being a single mother or with a partner you didn’t choose to have a child with / etc. are high.
For us, high-impact clients include adolescents (under the age of 20), individuals living in multi-dimensional poverty, those who aren’t using or have never used contraception, and those who have no other options for the services we provide. Collectively, we aim for over 80% of our clients to be from one or more of these high-impact groups.
I think this is a good way of trying to secure strong counterfactual impact. I notice that your cost-effectiveness estimates imply that you prevent 200 maternal deaths per 100,000 averted pregnancies.How do you arrive at this figure, given the lack of maternal mortality data for your specific demographic(unwanted pregnancy, rural, underserved, low-income country)? Nigeria has the 2nd-worst maternal mortalityratein the world, at 112 per 100,000 - but your Nigeria numbers suggest something like 500 per 100,000.
Another interesting thing is that you avert a maternal death for $3,353 - which means maybe $70-100 per extra year of life that these women get—and you avert a DALY for $4.77. This implies that averted maternal deaths only account for ~5% of the health benefits you are measuring.Where are the other 95% coming from?Importantly, are any coming from the infant or from non-health benefits converted into DALYs—because counting these would be moral assumptions worth flagging.
Thank you so much for your thoughtful comment and for sharing the research on post-partum depression which we look forward to reviewing. Thanks also for your questions about DALYs and maternal deaths averted. We will provide more information shortly!
Great summary!
There is also a mental health benefit to averting unwanted pregnancy. A meta-analysis by Wang et al. (2021) found that women with an unplanned pregnancy were 62% more likely (28% vs. 17%) to suffer postpartum depression compared to women with a planned pregnancy. We don’t have good data on depression prevalence among women whose unplanned pregnancy was averted, but it seems probable that an unplanned pregnancy increases the risk of mental illness, even if only by adding another life stressor. It is very hard to measure, but I suspect that the wellbeing benefits of not having one’s education cut short / career & income disrupted / living with stigma of being a single mother or with a partner you didn’t choose to have a child with / etc. are high.
I think this is a good way of trying to secure strong counterfactual impact. I notice that your cost-effectiveness estimates imply that you prevent 200 maternal deaths per 100,000 averted pregnancies. How do you arrive at this figure, given the lack of maternal mortality data for your specific demographic (unwanted pregnancy, rural, underserved, low-income country)? Nigeria has the 2nd-worst maternal mortality rate in the world, at 112 per 100,000 - but your Nigeria numbers suggest something like 500 per 100,000.
Another interesting thing is that you avert a maternal death for $3,353 - which means maybe $70-100 per extra year of life that these women get—and you avert a DALY for $4.77. This implies that averted maternal deaths only account for ~5% of the health benefits you are measuring. Where are the other 95% coming from? Importantly, are any coming from the infant or from non-health benefits converted into DALYs—because counting these would be moral assumptions worth flagging.
Thank you so much for your thoughtful comment and for sharing the research on post-partum depression which we look forward to reviewing. Thanks also for your questions about DALYs and maternal deaths averted. We will provide more information shortly!