Maternal deaths averted by contraceptive use: an analysis of 172 countries
Maternal deaths averted by contraceptive use: an analysis of 172 countries
复制标题
DOI：
10.1016/s0140-6736(12)60478-4
复制
发表时间：
2012-07-14
期刊：
影响因子：
168.9
通讯作者：
Tsui, Amy O.
中科院分区：
文献类型：
--
作者：
Ahmed, Saifuddin;Li, Qingfeng;Tsui, Amy O.
背景计划生育是旨在降低发展中国家孕产妇死亡率的安全孕产倡议的四大支柱之一。我们的目的是估计避孕药具的使用对孕产妇死亡率的影响，以及在国家、地区和世界层面上，如果未满足的避孕需求得到满足，孕产妇死亡率的预期下降。方法我们从孕产妇死亡率估计机构间小组（MMEIG）数据库、联合国2010年世界避孕药具使用数据库和联合国2010年世界人口展望数据库中提取相关数据。并采用反事实建模方法（模型一），复制MMEIG（世卫组织）孕产妇死亡率估计方法，以估计172个国家因使用避孕药具而避免的孕产妇死亡。我们使用第二个模型（模型II）对167个国家进行了同样的估计，并估计了满足未满足的避孕需求的效果。我们做了敏感性分析，并比较了模型之间的一致性。结果我们估计，使用模型I，在2008年有342203名妇女死于孕产妇原因，但避孕措施的使用避免了272040（不确定区间127 937-407 134）（减少44%），因此，如果不使用避孕药具，孕产妇死亡人数将比2008年总数高出1.8倍。满足未得到满足的避孕需求每年可以防止另外104000例孕产妇死亡（减少29%）。解释在许多发展中国家，意外怀孕和未得到满足的避孕需求的数量仍然很高。我们提供的证据表明，使用避孕药具是降低发展中国家孕产妇死亡率的一项实质性且有效的一级预防策略。
Background Family planning is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. We aimed to estimate the effect of contraceptive use on maternal mortality and the expected reduction in maternal mortality if the unmet need for contraception were met, at country, regional, and world levels.Method We extracted relevant data from the Maternal Mortality Estimation Inter-Agency Group (MMEIG) database, the UN World Contraceptive Use 2010 database, and the UN World Population Prospects 2010 database, and applied a counterfactual modelling approach (model I), replicating the MMEIG (WHO) maternal mortality estimation method, to estimate maternal deaths averted by contraceptive use in 172 countries. We used a second model (model II) to make the same estimate for 167 countries and to estimate the effect of satisfying unmet need for contraception. We did sensitivity analyses and compared agreement between the models.Findings We estimate, using model I, that 342 203 women died of maternal causes in 2008, but that contraceptive use averted 272 040 (uncertainty interval 127 937-407 134) maternal deaths (44% reduction), so without contraceptive use, the number of maternal deaths would have been 1.8 times higher than the 2008 total. Satisfying unmet need for contraception could prevent another 104 000 maternal deaths per year (29% reduction).Interpretation Numbers of unwanted pregnancies and unmet contraceptive need are still high in many developing countries. We provide evidence that use of contraception is a substantial and effective primary prevention strategy to reduce maternal mortality in developing countries.