At least 52% of married women in Pakistan aged 15–49 who want to avoid a pregnancy have an unmet need for modern contraception, said a report by US-based Guttmacher Institute.

If all unmet needs for modern contraception among married women in the country were met, overall unintended pregnancies would be reduced by an estimated 82% or 3.1 million annually, said the report titled Adding It Up: Investing in Contraception and Maternal and Newborn Health in Pakistan.

Unplanned births, abortions and miscarriages would decline by the same proportion, said the report by the Guttmacher Institute which is a leading research and policy organisation committed to advancing reproductive health in the United States and globally.

Fully meeting married women’s need for contraception would lead to an estimated reduction of nearly 1,000 maternal deaths annually. Even more lives would be saved if all women’s needs for maternal and newborn health care were fully met simultaneously.

Cost of meeting reproductive health needs

Satisfying the unmet need for modern contraception among married women would increase the annual cost of services (based on public-sector costs) from an estimated Rs8.91 billion to Rs19.03 billion. The total cost would cover contraceptive commodities, staff salaries, health infrastructure upgrades, contraceptive counselling, outreach activities, and improvements to programmes and systems.

If contraceptive services were to stay at current levels, providing all pregnant women each year with a comprehensive package of maternal and newborn health care would cost Rs207.9 billion.

Because the cost of preventing an unintended pregnancy through the use of modern contraceptives is far lower than the cost of providing care for an unintended pregnancy, expanding modern contraceptive services and maternal and newborn care simultaneously would result in cost savings compared with expanding maternal and newborn services alone.

Healthy communities

Modern contraceptive services and maternal and newborn health care are essential for promoting the well-being of women, their families and communities.

Contraceptive use enables couples to plan the number and timing of their children, while maternal and newborn care — along with contraceptive use — greatly improves women’s chances of having a healthy pregnancy and delivering a healthy newborn.

Providing a comprehensive package of maternal and newborn care that includes antenatal, delivery, postpartum and postabortion services is costly and can pose a challenge for low and middle-income countries.

One way to manage such costs is to reduce the number of unintended pregnancies — that is pregnancies that occur among women who want to postpone pregnancy or stop childbearing altogether.

Need for modern contraception based on 2017 data, there are an estimated 10.1 million pregnancies in Pakistan each year, 3.8 million (37%) of which are unintended. Twenty per cent of these unintended pregnancies end in unplanned births and 69% end in induced abortion (and the remainder end in miscarriage).

Nationally, 52% of married women aged 15–49 who want to avoid a pregnancy have an unmet need for modern contraception, which means they are not using contraceptives at all or are using a traditional method.

Most unintended pregnancies result from unmet need for modern contraception. Unmet need for modern contraception is substantial in every province and region of Pakistan. It is highest in Balochistan and Federally Administrated Tribal Areas (FATA), where about two-thirds of married women wanting to avoid a pregnancy have an unmet need, and lowest in Islamabad Capital Territory, where the proportion is nearly half.

Need for maternal and newborn health care

Maternal mortality in Pakistan is estimated at 178 maternal deaths per 100,000 live births in 2015 — approximately equivalent to the average for the Southern Asia region as a whole (176). This mortality ratio translates to the death of an estimated 10,000 women in 2017. The country’s neonatal mortality rate of 42 deaths in the first 28 days of life per 1,000 live births is well above the median rate for Southern Asia (28).

Millions of women in Pakistan do not receive the maternal and newborn care they need to prevent and manage health complications that may arise during pregnancy, delivery and the postpartum period.

According to recent national data, half of pregnant women obtain the recommended minimum of four antenatal care visits with a health care professional, and about two-thirds (69%) of births take place in a health facility. While these maternal health care indicators have improved significantly in recent years, large disparities persist in Pakistan by region.