The life you save may be an exaggeration

By Rebecca Oas, Ph.D. | March 21, 2015

This past week, Melinda Gates and Graça Machel co-authored an article discussing how the new proposed Sustainable Development Goals could provide key opportunities to improve conditions for families in Africa. Among their priorities were improving maternal and child health, which were key targets of the expiring Millennium Development Goals, and which – particularly on the African continent – still lag behind their targets.

“It is impossible to separate the health of a child from the health of the mother,” write Gates and Machel, noting that maternal and child health are complementary, not competing. They note the long-lasting impact of good nutrition during the first 1,000 days of life, from conception to the child’s second birthday. Additionally, they discuss many other important and achievable interventions that can improve the lives of people even in the poorest communities, such as anti-malarial mosquito nets and solutions to prevent children with diarrheal diseases from dying of dehydration.

Given the very positive content of the article, I’m almost reluctant to criticize it, but there was one thing that does need some clarification:

“In fact, if the world extended contraceptive access to only a quarter of the women with unmet need, it could save the lives of 25,000 women and 250,000 newborns each year.”

So how exactly does contraception save the lives of newborns? The article lacks footnotes, but this statistic closely resembles one found on the website of the Office of the UN Secretary-General’s Special Envoy for Financing the Health Development Millennium Development Goals and for Malaria:

“Lack of access to family planning results in 80 million unintended pregnancies annually, or 40% of all pregnancies worldwide. Meeting 25% of the unmet need for family planning could prevent more than 11 million unintended pregnancies and, in turn, avert the deaths of 25,000 mothers and 250,000 newborns.”

See what happened there? The Special Envoy wrote about “averting deaths”, which Gates and Machel paraphrased as “saving lives.” In most cases, that might be a reasonable substitution, but there is one big exception, and that is where the means of averting the death consists of averting the person’s existence in the first place.

Following that logic, you could avert a lot of deaths by averting human reproduction – after the current generations living die out, there would be no more human death. Come to think of it, there’d be no poverty either, and men and women would be equal in every way. But, at least for most of us, that’s not the way we’d like to arrive at the world we want.

To return to the statistic, there’s one other factual problem: it implies that “unmet need” is due to lack of access to contraceptives, and that all those deaths could be averted by giving access to just a quarter of the women with this so-called “need.” Yet we know that less than ten percent of “unmet need” is attributed to lack of access, so Gates, Machel, and the Special Envoy all got that wrong.

Regarding the 80 million unintended pregnancies, as the Guttmacher Institute puts it:

“In 2012, an estimated 80 million unintended pregnancies will occur in the developing world because of contraceptive failure and nonuse among women who do not want a pregnancy soon.”

That’s right, failure and nonuse of contraceptives, which in most cases is not due to lack of access.

In summary, increasing access to contraceptives that women do not want will not save the lives of newborns. Increased access to good nutrition and basic health care would be the smarter investment.