Investing in sexual and reproductive health in low- and middle-income countries

Chair of the International Committee, Dr Nicky Morgan, summaries a recent report from the Guttmacher Institute which looks at the impact and cost of investing in reproductive healthcare in low- and middle-income countries.

An important new report by the Guttmacher Institute, focusing on low and middle-income countries (LMIC), presents the need for, impacts of and costs associated with providing high quality Sexual and Reproductive Health (SRH) services. It states that investing in these services improves an individual's health and well-being as well as saving billions of dollars in healthcare costs.

The report suggests that, in LMIC, there is an unmet need for modern contraception in 218 million women, especially in young women aged 15-19 years. These are women who want to avoid pregnancy but are unable to access modern contraceptives due to various barriers including attitudes, knowledge and availability of services. This lack of access to high-quality SRH care puts women at risk. In LMICs annually:

• 35 million have abortions in unsafe conditions
• 299,000 die from causes related to pregnancy and childbirth
• 133 million do not receive the treatment they need for chlamydia, gonorrhoea, syphilis and trichomoniasis

Impacts of expanded services

The report estimates that if there was increased investment in high-quality SRH services in LMICs and if all pregnant women and their newborns were to receive care at the standards recommended by the World Health Organization (WHO), the impacts would be dramatic:

• Unintended pregnancies would drop by 68%
• Unsafe abortions would drop by 72%
• Maternal deaths would drop by 62%

It goes on to estimate that:

• A package of SRH care that would meet all women’s needs for modern contraception, maternal and newborn care, abortion services and treatment for the major curable STIs would cost $69 billion annually in LMICs.
• This total represents a $31 billion (83%) annual increase over the current cost of sexual and reproductive health care.

However, every dollar spent on contraceptive services beyond the current level would save $3 in the cost of maternal, newborn and abortion care because the use of contraceptives would reduce the number of unintended pregnancies.

Elizabeth Sully, a senior research scientist at Guttmacher remarked: “What we’ve shown is that it’s affordable to put SRH as a part of a universal health coverage program.”

This report is especially relevant during the COVID-19 pandemic where access to SRH services have been affected globally by lockdown and resources have been diverted to control the pandemic. However, the SRH need is still just as great as ever.

In a recent Reuters article entitled 'Providing women with contraception could save poor countries billions', Patrick Segawa, a team leader with the youth-led organisation Public Health Ambassadors Uganda said:

“Irrespective of the lockdown, young people are still having sex,”. He went on to say, “If the government does not take initiative or be proactive... we’ll find that by the time we go into the post-COVID-19 era we will be having lots of cases of teenage pregnancies,”.

The report concludes that:

• The interventions that make up this package of care have proven feasible to implement in diverse settings around the world.
• Investing in them provides national and local governments, the private sector and international development partners with good value for money.
• By saving lives and improving women’s health and well-being, high-quality SRH care benefits individuals and families and contributes to countries’ social and economic development. Such care would enable people to exercise their sexual and reproductive rights.