New estimates produced jointly by the Guttmacher Institute and the Population Council reveal critical gaps in reproductive health services for women of reproductive age (15–49) in Pakistan. The new report examines the current needs for contraceptive services for married women and for maternal and newborn health care for all women of reproductive age, quantifies the health benefits of investing in these services, and provides estimates of the cost of fully meeting these needs. The research shows that simultaneously expanding both modern contraceptive services and maternal and newborn care would not only maximize benefits to women but would also be an efficient use of funds.

Ensuring access to and provision of contraceptive services is essential for women to be able to make decisions about whether and when to have a child. Currently, about half of the 16.8 million married women in Pakistan who want no more children or want to postpone having a child for at least two years are not using a modern contraceptive method. These women have an unmet need for modern contraception. Further, only half of pregnant women in Pakistan obtain four antenatal care visits (the minimum level of care recommended by the World Health Organization), and only two-thirds of births take place in a health facility. These components of care are crucial for preventing and managing health complications that could arise during pregnancy and delivery for both mother and child.

Providing modern contraception to all married women in Pakistan who need it would yield large benefits. Compared with 2017 levels, increased contraceptive services alone would result in:

• 3.1 million fewer unintended pregnancies (an 82% decline)
• 2.1 million fewer induced abortions (an 82% decline)
• Nearly 1,000 fewer maternal deaths (a 9% decline)

According to the report, the current cost of providing modern contraceptive services in Pakistan is $81 million per year. Expanding those services to cover all married women with an unmet need for modern contraception would cost an estimated $173 million annually. The current cost of maternal and newborn health care is $1.22 billion, and the cost of expanding these services while keeping contraception at current levels would be $1.89 billion. (All costs are expressed in U.S. dollars.)

Importantly, simultaneous investment in meeting the needs for modern contraception and maternal and newborn health care would cost less compared with focusing on maternal and newborn health care alone—reducing the cost of maternal and newborn care to $1.65 billion from $1.89 billion. This is because the cost of preventing an unintended pregnancy through use of modern contraception is far lower than the cost of providing care related to an unintended pregnancy. In this scenario, each additional dollar spent on expanding modern contraceptive use would save more than $2.50 on maternal and newborn health care, thereby allowing the country to reduce maternal and infant deaths and disability more affordably than if it were to expand maternal and newborn services alone.

In recent years, the Pakistan government introduced specific policies to increase the use of contraceptives by all married women of reproductive age and increase the amount of funding allocated to family planning. The government also committed to improving the mix of contraceptives available to women, expanding the use of long-acting reversible methods, improving counseling services and using public education messages for general information.

According to Zeba Sathar, country director at the Population Council’s Pakistan office and a coauthor of the report, "This study provides robust evidence that makes the case for additional financing for family planning services in Pakistan. Doing so, especially within the public health system, will produce a much-needed boost in meeting both family planning and maternal health goals, support the 2018 Council of Common Interests recommendations on family planning, and lead to overall savings by reducing the additional costs of unintended pregnancies."

"Comprehensive strategies to improve reproductive health care are vital for ensuring the well-being of women and their families," says Susheela Singh, vice president for international research at the Guttmacher Institute. "Fully meeting the need for modern contraception while simultaneously providing high-quality maternal and newborn health care to all who need it should be prioritized."

The authors recommend engaging stakeholders—including provincial governments, the federal government, the private sector and international development partners—in fulfilling the demand for modern contraceptive care and in fully meeting the need for maternal and newborn care.