The burden of unintended pregnancies in Brazil: a social and public health system cost analysis

Abstract

BackgroundUnintended pregnancy (UP) is an unmet medical need with consequences worldwide. We evaluate the costs of UP based on pregnancies in Brazil from for the year 2010.MethodsThe consequences of UP were evaluated using decision analysis based on pregnancy rates and outcomes as miscarriage, induced abortion, and live birth, which were factored into the analysis. The model discriminated between maternal and child outcomes and accounted for costs (in Brazilian currency [Real$, R$]) within the Brazilian public health service attributed to preterm birth, neonatal admission, cerebral palsy, and neonatal and maternal mortality. Event probabilities were obtained from local resources.ResultsWe estimate that 1.8 million UPs resulted in 159,151 miscarriages, 48,769 induced abortions, 1.58 million live births, and 312 maternal deaths, including ten (3%) attributed to unsafe abortions. The total estimated costs attributed to UP are R$4.1 billion annually, including R$32 million (0.8%) and R$4.07 billion (99.2%) attributed to miscarriages and births and complications, respectively. Direct birth costs accounted for approximately R$1.22 billion (30.0%), with labor and delivery responsible for most costs (R$988 million; 24.3%) for the year 2010. The remainder of costs were for infant complications (R$2.84 billion; 72.3%) with hospital readmission during the first year accounting for approximately R$2.15 billion (52.9%). Based on the national cost, we estimate the cost per UP to be R$2,293.ConclusionDespite weaknesses in precise estimates in annual pregnancies and induced abortions, our estimates reflect the costs of UP for different pregnancy outcomes. The main costs associated with UP are in those carried to parturition. The health cost of abortion represents a small proportion of total costs as these are paid for outside of the public health system. Consequently, reductions in UP will generate not only cost savings, but reductions in woman and child morbidity and mortality.

Contraceptive sales in the setting of the Zika virus epidemic

“…However among the users, 90% use contraceptives with low typical use effectiveness. Consequently, there are high rates of unplanned pregnancies in Brazil, which are estimated to account for ~55% of all pregnancies (Le et al ., 2014) and are possibly associated with the high number of sales of EC pills (Rocha et al ., 2010). The unmet need for contraception is likely to rise further if, in near future, fewer women decide to get pregnant in response to ZIKV epidemic.…”

Magnitude and associated factors of unintended pregnancy in Ethiopia: a multilevel analysis using 2016 EDHS data

“…Tackling unintended pregnancy has a huge benefit in saving the costs of abortion and its complications, as well as reducing the morbidity and mortality of mothers and children [30]. Given the paramount negative consequences of unintended pregnancy for both the mother and the fetus, up to our knowledge, there was a limited study on unintended pregnancy that is based on nationally representative data in Ethiopia.…”

The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil

“…The cardiac group had higher parity, probably due to increased maternal age. As heart disorder was previously known in the majority of cases, it can thus be assumed that family planning counseling had failed for them [ 21 , 22 ].…”