{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T02:36:14Z","timestamp":1793932574416,"version":"4.8.0"},"reference-count":33,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T00:00:00Z","timestamp":1675728000000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006660","name":"United Nations Fund for Population Activities","doi-asserted-by":"publisher","award":["No grant number"],"award-info":[{"award-number":["No grant number"]}],"id":[{"id":"10.13039\/100006660","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2023,1,18]]},"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Reducing unmet need for modern contraception and expanding access to quality maternal health (MH) services are priorities for improving women\u2019s health and economic empowerment. To support investment decisions, we estimated the additional cost and expected health and economic benefits of achieving the United Nations targets of zero unmet need for modern contraceptive choices and 95% coverage of MH services by 2030 in select Small Island Developing States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Five Pacific (Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu) and four Caribbean (Barbados, Guyana, Jamaica and Saint Lucia) countries were considered based on population survey data availability. For each country, the Lives Saved Tool was used to model costs, health outcomes and economic benefits for two scenarios: business-as-usual (BAU) (coverage maintained) and coverage-targets-achieved, which scaled linearly from 2022 (following COVID-19 disruptions) coverage of evidence-based family planning and MH interventions to reach United Nations targets, including modern contraceptive methods and access to complete antenatal, delivery and emergency care. Unintended pregnancies, maternal deaths, stillbirths and newborn deaths averted by the coverage-targets-achieved scenario were converted to workforce, education and social economic benefits; and benefit\u2013cost ratios were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The coverage-targets-achieved scenario required an additional US$12.6M (US$10.8M\u2212US$15.9M) over 2020\u20132030 for the five Pacific countries (15% more than US$82.4M to maintain BAU). This additional investment was estimated to avert 126\u2009000 (40%) unintended pregnancies, 2200 (28%) stillbirths and 121 (29%) maternal deaths and lead to a 15-fold economic benefit of US$190.6M (US$67.0M\u2212US$304.5M) by 2050. For the four Caribbean countries, an additional US$17.8M (US$15.3M\u2212US$22.4M) was needed to reach the targets (4% more than US$405.4M to maintain BAU). This was estimated to avert 127\u2009000 (23%) unintended pregnancies, 3600 (23%) stillbirths and 221 (25%) maternal deaths and lead to a 24-fold economic benefit of US$426.2M (US$138.6M\u2212US$745.7M) by 2050.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Achieving full coverage of contraceptive and MH services in the Pacific and Caribbean is likely to have a high return on investment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2022-010018","type":"journal-article","created":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T12:03:30Z","timestamp":1675771410000},"page":"e010018","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Health and economic benefits of achieving contraceptive and maternal health targets in Small Island Developing States in the Pacific and Caribbean"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6232-5586","authenticated-orcid":false,"given":"Sherrie L","family":"Kelly","sequence":"first","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"},{"name":"Swiss Tropical and Public Health Institute, Allschwil, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Walsh","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Delport","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra","family":"ten Brink","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan","family":"Martin-Hughes","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7454-3011","authenticated-orcid":false,"given":"Caroline SE","family":"Homer","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Butler","sequence":"additional","affiliation":[{"name":"UNFPA Pacific Sub Regional Office, Suva, Fiji"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olanike","family":"Adedeji","sequence":"additional","affiliation":[{"name":"UNFPA Pacific Sub Regional Office, Suva, Fiji"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"De Beni","sequence":"additional","affiliation":[{"name":"UNFPA Asia Pacific Regional Office, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Maurizio","sequence":"additional","affiliation":[{"name":"UNFPA Asia Pacific Regional Office, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard S","family":"Friedman","sequence":"additional","affiliation":[{"name":"UNFPA, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doretta","family":"Di Marco","sequence":"additional","affiliation":[{"name":"UNFPA Latin America and the Caribbean Regional Office, Panama, Panama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Tobar","sequence":"additional","affiliation":[{"name":"UNFPA Latin America and the Caribbean Regional Office, Panama, Panama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Pilar","family":"de la Corte Molina","sequence":"additional","affiliation":[{"name":"UNFPA Sub-regional Office for the Caribbean, Kingston, Jamaica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre S","family":"Richards","sequence":"additional","affiliation":[{"name":"UNFPA Sub-regional Office for the Caribbean, Kingston, Jamaica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9213-0798","authenticated-orcid":false,"given":"Nick","family":"Scott","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Victoria, Australia"},{"name":"Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"key":"2025073012490146000_8.2.e010018.1","unstructured":"Organization WH . SDG target 3.1: fact sheets on sustainable development goals: health targets. Geneva: WHO, 2017."},{"key":"2025073012490146000_8.2.e010018.2","unstructured":"Organization WH . Maternal mortality: fact sheets. Geneva: WHO, 2021."},{"key":"2025073012490146000_8.2.e010018.3","unstructured":"United Nationas Department of Economic and Social Affairs (UNDESA) . Estimates and projections of family planning indicators 2020. New York: United Nations; 2020. Available: https:\/\/www.un.org\/en\/development\/desa\/population\/theme\/family-planning\/cp_model.asp [Accessed 18 Oct 2021]."},{"key":"2025073012490146000_8.2.e010018.4","unstructured":"The World Bank . Contraceptive prevalence, modern methods (% of women ages 15-49). Washington DC: World Bank; 2020. Available: https:\/\/data.worldbank.org\/indicator\/SP.DYN.CONM.ZS [Accessed 18 Oct 2021]."},{"key":"2025073012490146000_8.2.e010018.5","unstructured":"The World Bank . Adolescent fertility rate (births per 1,000 women ages 15-19) - pacific island small states. Washington DC: World Bank; 2020. Available: https:\/\/data.worldbank.org\/indicator\/SP.ADO.TFRT?end=2019&locations=S2&start=1960&view=chart [Accessed 18 Oct 2021]."},{"key":"2025073012490146000_8.2.e010018.6","unstructured":"The World . Adolescent fertility rate (births per 1,000 women ages 15-19) - caribbean small states. Washington DC: World Bank; 2020. Available: https:\/\/data.worldbank.org\/indicator\/SP.ADO.TFRT?end=2019&locations=S3&start=1960&view=chart [Accessed 18 Oct 2021]."},{"key":"2025073012490146000_8.2.e010018.7","article-title":"The impact of COVID-19 on public health systems in the pacific island countries and territories","volume":"25","author":"Bell","year":"2022","journal-title":"Lancet Reg Health West Pac"},{"key":"2025073012490146000_8.2.e010018.8","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1111\/joim.13499","article-title":"COVID-19 in Latin America and the Caribbean: two years of the pandemic","volume":"292","author":"Schwalb","year":"2022","journal-title":"J Intern Med"},{"key":"2025073012490146000_8.2.e010018.9","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1177\/1354816618792792","article-title":"The economic growth impact of tourism in small island developing states\u2014evidence from the Caribbean","volume":"25","author":"Cannonier","year":"2019","journal-title":"Tourism Economics"},{"key":"2025073012490146000_8.2.e010018.10","unstructured":"Westoby R , Loehr J , Fleming C . Pacific islands tourism during covid-19: time for a rethink. 2020. Available: https:\/\/www.griffith.edu.au\/__data\/assets\/pdf_file\/0036\/1197189\/Pacific-islands-tourism-during-COVID-19.pdf [Accessed 21 Dec 2022]."},{"key":"2025073012490146000_8.2.e010018.11","unstructured":"Institute of Medicine (US) Committee on Unintended Pregnancy . The best intentions: unintended pregnancy and the well-being of children and families. chapter 3, consequences of unintended pregnancy. Washington (DC): National Academies Press (US); 1995. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK232137 [Accessed 21 Dec 2022]."},{"key":"2025073012490146000_8.2.e010018.12","unstructured":"The World Bank . World development indicators. 2021. Available: https:\/\/databank.worldbank.org\/source\/world-development-indicators [Accessed 29 Nov 2021]."},{"key":"2025073012490146000_8.2.e010018.13","unstructured":"The World Bank . Current health expenditure (% of GDP). 2019. Available: https:\/\/data.worldbank.org\/indicator\/SH.XPD.CHEX.GD.ZS [Accessed 21 Dec 2022]."},{"key":"2025073012490146000_8.2.e010018.14","unstructured":"The World Bank . UHC service coverage index. 2019. Available: https:\/\/data.worldbank.org\/indicator\/SH.UHC.SRVS.CV.XD [Accessed 21 Dec 2022]."},{"key":"2025073012490146000_8.2.e010018.15","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19074108","article-title":"Universal health coverage and the Pacific islands: an overview of senior leaders\u2019 discussions, challenges, priorities and solutions, 2015-2020","volume":"19","author":"Craig","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025073012490146000_8.2.e010018.16","unstructured":"World Health Organization . SIDS summit for health policy brief. health systems challenges: workforce and medicines. 2021. Available: https:\/\/cdn.who.int\/media\/docs\/default-source\/sids-summit\/sids-health-systems-policy-brief.pdf?sfvrsn=b57828e8_5 [Accessed 21 Dec 2022]."},{"key":"2025073012490146000_8.2.e010018.17","unstructured":"World Health Organization (WHO) . WHO recommendations on postnatal care of the mother and newborn. Geneva: WHO, 2013."},{"key":"2025073012490146000_8.2.e010018.18","unstructured":"World Health Organization (WHO) . WHO recommendations on maternal health: guidelines approved by the WHO guidelines review committee. Geneva, 2017."},{"key":"2025073012490146000_8.2.e010018.19","unstructured":"World Health Organization (WHO) . WHO recommendations on child health: guidelines approved by the WHO guidelines review committee. Geneva, 2017."},{"key":"2025073012490146000_8.2.e010018.20","unstructured":"World Health Organization (WHO) . WHO recommendations intrapartum care for a positive childbirth experience. Geneva, 2018."},{"key":"2025073012490146000_8.2.e010018.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)13811-1"},{"key":"2025073012490146000_8.2.e010018.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61693-6"},{"key":"2025073012490146000_8.2.e010018.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60996-4"},{"key":"2025073012490146000_8.2.e010018.24","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)31472-6"},{"key":"2025073012490146000_8.2.e010018.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31390-3"},{"key":"2025073012490146000_8.2.e010018.26","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S0140-6736(19)32497-3","article-title":"Dynamics of the double burden of malnutrition and the changing nutrition reality","volume":"395","author":"Popkin","year":"2020","journal-title":"Lancet"},{"issue":"Suppl 3","key":"2025073012490146000_8.2.e010018.27","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-13-S3-S1","article-title":"Overview of the lives saved tool (list)","volume":"13","author":"Walker","year":"2013","journal-title":"BMC Public Health"},{"key":"2025073012490146000_8.2.e010018.28","unstructured":"Hopkins J . Lives saved tool (list). 2022. Available: https:\/\/www.livessavedtool.org"},{"key":"2025073012490146000_8.2.e010018.29","doi-asserted-by":"crossref","first-page":"e875","DOI":"10.1016\/S2214-109X(17)30263-2","article-title":"Financing transformative health systems towards achievement of the health sustainable development goals: a model for projected resource needs in 67 low-income and middle-income countries","volume":"5","author":"Stenberg","year":"2017","journal-title":"Lancet Glob Health"},{"key":"2025073012490146000_8.2.e010018.30","unstructured":"World Health Organization . Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, world bank group and the united nations population division. Geneva: WHO, 2019."},{"key":"2025073012490146000_8.2.e010018.31","article-title":"Improving the quality of maternal and newborn care in the pacific region: a scoping review","volume":"3","author":"Wilson","year":"2020","journal-title":"Lancet Reg Health West Pac"},{"key":"2025073012490146000_8.2.e010018.32","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.1016\/S2214-109X(20)30397-1","article-title":"Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a lives saved tool modelling study","volume":"9","author":"Nove","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2025073012490146000_8.2.e010018.33","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62231-X"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2022-010018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T19:49:10Z","timestamp":1753904950000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2022-010018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2,7]]},"published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1136\/bmjgh-2022-010018"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2022-010018","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2]]}}}