Lack of access to family planning is a widespread problem with harmful consequences for health, economic well-being, and other outcomes. Despite its importance, it is comparatively neglected by EAs. Charity Entrepreneurship (CE) proposes to tackle this problem by launching a new nonprofit that would provide postpartum family planning counseling in priority countries. Contact us at email@example.com if you’re interested in getting involved, or apply to our 2021 Incubation Program (deadline: April 15, 2021).
1. Why family planning?
Each year, over 300,000 women die from pregnancy-related causes. Maternal mortality is particularly high in sub-Saharan Africa, with two-thirds of all maternal deaths in 2015. A higher number of births per woman is also strongly associated with higher rates of child mortality. Short-spaced pregnancies, in particular, pose a greater risk to both mother and child.
There are over 120 million unintended pregnancies each year. Data from the UN shows that 10% of all women of reproductive age worldwide have unmet needs for family planning, meaning that although they do not want to fall pregnant, nor are they using contraception. Unmet family planning needs are particularly high in sub-Saharan Africa.
Health isn’t the only casualty of inadequate family planning. Lack of access to family planning impacts a whole range of outcomes, from education and economic wellbeing to climate change. The supplementary report for our cost-effectiveness analyses discusses these in more depth and explains how we modeled them. Depending on how you consider flow-through effects, we believe that this area could be as effective or more so than direct delivery health interventions.
Due to its importance, family planning receives a good amount of attention in terms of both research and availability of (often counterfactually strong) funding. However, it remains neglected in two important ways. Despite extensive research into the barriers to family planning, little prioritization work has been done. Additionally, family planning is a less common cause area of focus among applicants to the CE Incubation Program.
To address the lack of prioritization work, Charity Entrepreneurship has conducted hundreds of hours of research to compare interventions and identify the most impactful. Progressive stages of our extensive research process whittled down to two recommended charity ideas for family planning: mass media campaigns and postpartum family planning. These top ideas are highly cost-effective, with strong evidence of impact.
Prioritization is an important first step, but to realize the change we need implementation. In 2020, Kenneth Scheffler and Anna Christina Thorsheim launched Family Empowerment Media, working on mass media campaigns. They recently launched their proof of concept campaign with two radio stations in Kano State in Nigeria, and are reaching around 2.5-3 million beneficiaries. Through Charity Entrepreneurship’s 2021 Incubation Program, we hope to launch the second of our top family planning ideas – postpartum family planning.
2. Why postpartum family planning?
2.1 The intervention
The period up to ~24 months after a woman has given birth (i.e. the postpartum) is a crucial time for family planning. A new charity would help integrate family planning counseling services into postpartum care, providing training and support to health workers.
Becoming pregnant soon after giving birth risks the health of both mother and child, yet the data show that contraceptive use among postpartum women is lower than average. Contributing factors include misconceptions around how quickly a woman returns to fertility after giving birth and stigma surrounding contraception use. Compounding the issue, family planning is frequently not offered during postpartum care. Yet many women are only in contact with the healthcare system during pregnancy and delivery, which makes this a particularly good opportunity to discuss family planning options.
We estimate that each year, 23 million postpartum women in sub-Saharan Africa are not using contraception. Surveying 22 LMIC countries, Moore et al. (2015) found that over half of pregnancies occur at too-short intervals in 9 countries.
Conversations with experts and our survey of the evidence base (detailed below) highlighted that the immediate postpartum is the optimal time for family planning counseling. As an add-on, broaching the topic during antenatal care can ensure that a woman has the time to weigh her options and discuss her decision with her partner.
This intervention would be most effective in countries where contraception is available, but misinformation prevents uptake. Based on our analysis, Senegal and Ghana look to be particularly promising countries; Benin, Sierra Leone, and Cameroon also hold promise.
A new charity would begin by establishing relationships with local nonprofit and public actors. This would allow them to build their knowledge of the context and work on their proof of concept. Contextual knowledge is key to understanding the barriers to contraception uptake, so working with local stakeholders and being immersed in the context will be essential for a new charity. In the longer term, the charity would achieve scale by partnering with the local government.
Below is a theory of change for this new nonprofit:
2.2 Evidence & cost-effectiveness
This spreadsheet summarizes the nineteen studies on postpartum family planning, including eight RCTs and two systematic reviews. Find more discussion of the evidence of effectiveness for this intervention in section 5.3 of our report.
Based on the evidence, we estimate a 4.7 percentage point increase in uptake of contraceptives. This spreadsheet contains our cost-effectiveness analysis. The main impact we sought to capture was the cost per unintended birth averted: we found that postpartum family planning would cost as little as $67. We discuss why we chose to measure cost-effectiveness in unintended births in our supplementary report.
In addition to unintended births averted, we quantified cost-effectiveness in terms of DALYs, income effects, contraceptive uptake, CO2 emissions, and welfare points. We also calculated cost-effectiveness when including counterfactual considerations for donor funding, government resources, and the nonprofit’s co-founders. Based on our analysis, this intervention is cost-effective from multiple perspectives.
This overview table displays our cost-effectiveness estimates for the various factors we considered:
|Unit||$ cost per unit|
|Additional user of contraception||39|
|Unintended birth prevented||67, or 144 if counterfactuals included|
|Tonnes of CO2 averted||0.33 (3 tonnes per $ spent)|
|Welfare points||<0.003 (377 WP per $ spent)|
|Dollar generated in income benefits||<0.01 ($105 per $ spent)|
3. How you can help
We’re keen to connect with aspiring entrepreneurs, so if you know anyone who might be interested, please share this post. Further details about the Incubation Program can be found on our website (apply by April 15). Feel free to contact us for more information at firstname.lastname@example.org.