Irum Aisha, Naz Olan, Ibrahim Muhammad, Khan Adnan Ahmad
Research and Development Solutions (RADS), Islamabad, Pakistan.
Front Public Health. 2025 May 19;13:1563721. doi: 10.3389/fpubh.2025.1563721. eCollection 2025.
Unintended pregnancies, which account for 19.4 to 38.2% of all births, present a significant and pressing public health challenge in Pakistan. Beyond the adverse effects of women's agency and choice, unsafe abortions, delayed prenatal care, and poor maternal health, they impose substantial economic costs on essential services such as education, healthcare, water, sanitation, and housing infrastructure. We quantified the economic cost of unintended pregnancies and the benefits of investing in family planning. Our findings directly challenge the rationale behind population-based revenue distribution formulas and provide compelling economic evidence for increased family planning budget allocations at both national and provincial levels.
This secondary data analysis employs a rigorous methodology, triangulating data from various national and international sources to conduct a comprehensive cost-benefit analysis. Using trend analysis with linear extrapolation, the study projects the economic impact of unintended pregnancies from 2018 to 2035 across key domains, such as schooling, immunization, safe motherhood, and access to safe water and sanitation. Key variables include contraceptive prevalence rate, unmet need for family planning, general fertility rate, under-five mortality rates, social costs per child, school enrollment rates, and per-user cost of family planning.
Our analysis reveals that the additional programming costs in health, education, and water provision from unintended pregnancies outweigh the investment required for family planning interventions aimed at averting them. Specifically, for every dollar invested in family planning, there is an estimated return of approximately USD $23 in combined cost savings. Education costs represent the largest proportion (51%) of these savings, followed by safe motherhood costs (36%), immunization costs (11%), and water/sanitation costs (2%).
We show substantial cost savings from investing in family planning. Some provincial governments have argued that since national revenue distribution is population-based, they would lose funds if they instituted FP programs. We show that these losses are in a few percentage points while their cost savings in social programs would be in hundreds of percentage points while achieving healthier and flourishing populations. Cost-benefit analysis is a powerful tool for policymakers and may be institutionalized in health, population, planning, and finance ministries.
意外怀孕占巴基斯坦所有分娩的19.4%至38.2%，给该国带来了重大且紧迫的公共卫生挑战。除了对女性自主权和选择权、不安全堕胎、产前护理延迟以及孕产妇健康产生不利影响外，意外怀孕还给教育、医疗、水、卫生和住房基础设施等基本服务带来了巨大经济成本。我们对意外怀孕的经济成本以及投资计划生育的收益进行了量化。我们的研究结果直接挑战了基于人口的收入分配公式背后的基本原理，并为在国家和省级层面增加计划生育预算拨款提供了有力的经济证据。
这项二次数据分析采用了严谨的方法，对来自各种国家和国际来源的数据进行三角测量，以进行全面的成本效益分析。该研究使用线性外推趋势分析，预测了2018年至2035年意外怀孕在关键领域（如教育、免疫、安全孕产以及获得安全水和卫生设施）的经济影响。关键变量包括避孕普及率、未满足的计划生育需求、总生育率、五岁以下儿童死亡率、每个孩子的社会成本、入学率以及计划生育的人均成本。
我们的分析表明，意外怀孕在卫生、教育和供水方面产生的额外项目成本超过了旨在避免意外怀孕的计划生育干预措施所需的投资。具体而言，每投资1美元用于计划生育，估计可节省约23美元的综合成本。教育成本占这些节省成本的最大比例（51%），其次是安全孕产成本（36%）、免疫成本（11%）和水/卫生成本（2%）。
我们表明，投资计划生育可大幅节省成本。一些省级政府认为，由于国家收入分配是基于人口的，如果他们实施计划生育项目，就会失去资金。我们表明，这些损失仅为几个百分点，而他们在社会项目中的成本节省将达到数百个百分点，同时还能实现人口更健康、更繁荣。成本效益分析是政策制定者的有力工具，可在卫生、人口、规划和财政部实现制度化。
