World Bank priorities for saving mothers and newborns built on false assumptions

By Rebecca Oas, Ph.D. | May 5, 2016

NEW YORK, May 6 (C-Fam) After decades of investment in birth control as a path to economic development, the World Bank still finds it easier to increase contraceptive use in a computer model than in real life. Women today reject the “modern” family planning pushed by the Bank with a high level of knowledge about its uses and side effects. Yet as a new study shows, the Bank continues to base billions of dollars of investment on flawed measurements like “unintended pregnancies” and “unmet need” for contraception that means more money will go contraception and less to lifesaving assistance like maternal and child health.

In the Reproductive, Maternal, Newborn, and Child Health volume of the World Bank’s Disease Control Priorities, the authors calculate the number of lives that could be saved by helping pregnant women, newborns, and young children.  In a separate calculation, they consider only the effects of raising the level of contraceptive use and reducing global births by almost 28 million, with all their attendant health risks to mother and child.

But their calculations rely heavily on the dubious measure of “unmet need” for family planning, and assumes that it would be possible to “meet” 90% of this “need” simply by providing access to the contraceptive products and services.  However, less than a tenth of women with “unmet need” cite lack of access as the reason they are not using family planning.  While access to contraceptives, as well as knowledge about them, have increased worldwide, the most common underlying reasons for “unmet need” include concerns about side effects and personal opposition, often for religious reasons.

A chapter discussing cost-benefit analyses says, “family planning programs generate particularly high returns, especially in countries with current high fertility rates”.  These projected benefits are calculated based on demographic estimates: fewer pregnancies means fewer deaths of women and babies, assuming the rates of maternal and newborn mortality remains the same

When the U.S. foreign aid division did a similar projection, it referred to the children whose deaths in infancy would be avoided by preventing their conception in the first place as “child lives saved from demographic impact.”  While the World Bank publication referred to them as “deaths averted,” it stopped short of calling them “lives saved.”

The World Bank also places a high priority on preventing “unintended pregnancies,” but admits that there is no consensus on how they are to be measured in the first place.  Also, the most frequently-used methods are greatly undercut by the tendency of parents to “rationalize” after the fact because of their “understandable reluctance of mothers to report children as unwanted or mistimed.”

The World Bank also found “insufficient data…to indicate whether unintended pregnancies carried to term are disadvantaged in health or schooling, compared with intended births.”  Furthermore, in presenting the health benefits of preventing “unintended” pregnancies, the publication did not claim that being “unintended” made a pregnancy or birth more risky than an intended one.

The continued use of these measurements by the World Bank will serve as a justification for funding that serves the interests of family planning groups.  Those pushed aside will include women with no intention of using contraceptives, mothers who accept their unexpected offspring, and hypothetical babies whose lives were “saved” by being prevented.