{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:33:40Z","timestamp":1777944820787,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2017,8,29]],"date-time":"2017-08-29T00:00:00Z","timestamp":1503964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:p>Family planning is commonly regarded as a highly cost-effective health intervention with wider social and economic benefits. Yet use of family planning services in Sierra Leone is currently low and 25.0% of married women have an unmet need for contraception. This study aims to estimate the costs and benefits of scaling up family planning in Sierra Leone. Using the OneHealth Tool, two scenarios of scaling up family planning coverage to currently married women in Sierra Leone over 2013\u20132035 were assessed and compared to a \u2018no-change\u2019 counterfactual. Our costing included direct costs of drugs, supplies and personnel time, programme costs and a share of health facility overhead costs. To monetise the benefits, we projected the cost savings of the government providing five essential social services \u2013 primary education, child immunisation, malaria prevention, maternal health services and improved drinking water \u2013 in the scale-up scenarios compared to the counterfactual. The total population, estimated at 6.1\u2009million in 2013, is projected to reach 8.3\u2009million by 2035 in the high scenario compared to a counterfactual of 9.6\u2009million. We estimate that by 2035, there will be 1400 fewer maternal deaths and 700 fewer infant deaths in the high scenario compared to the counterfactual. Our modelling suggests that total costs of the family planning programme in Sierra Leone will increase from US$4.2\u2009million in 2013 to US$10.6\u2009million a year by 2035 in the high scenario. For every dollar spent on family planning, Sierra Leone is estimated to save US$2.10 in expenditure on the five selected social sector services over the period. There is a strong investment case for scaling up family planning services in Sierra Leone. The ambitious scale-up scenarios have historical precedent in other sub-Saharan African countries, but the extent to which they will be achieved depends on a commitment from both the government and donors to strengthening Sierra Leone\u2019s health system post-Ebola.<\/jats:p>","DOI":"10.1177\/1745505717724617","type":"journal-article","created":{"date-parts":[[2017,8,29]],"date-time":"2017-08-29T07:35:18Z","timestamp":1503992118000},"page":"43-57","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Scaling up family planning in Sierra Leone: A prospective cost\u2013benefit analysis"],"prefix":"10.1177","volume":"13","author":[{"given":"Sarah","family":"Keen","sequence":"first","affiliation":[{"name":"Oxford Policy Management, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hashina","family":"Begum","sequence":"additional","affiliation":[{"name":"UNFPA Tanzania, Dar Es Salaam, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard S","family":"Friedman","sequence":"additional","affiliation":[{"name":"UNFPA HQ, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris D","family":"James","sequence":"additional","affiliation":[{"name":"OECD, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,8,29]]},"reference":[{"key":"bibr1-1745505717724617","unstructured":"Bryce J, Victora C, Berman P, et al. Fulfilling the health agenda for women and children: the 2014 report, 2014, https:\/\/data.unicef.org\/wp-content\/uploads\/2015\/12\/Countdown_to_2015-Fulfilling-the-Health_Agenda_for_Women_and_Children-The_2014_Report-Conference_Draft_159.pdf"},{"key":"bibr2-1745505717724617","unstructured":"Leone S. The status of women and children in Sierra Leone, https:\/\/books.google.co.in\/books\/about\/The_status_of_women_and_children_in_Sier.html?id=cLa3AAAAIAAJ&redir_esc=y"},{"key":"bibr3-1745505717724617","unstructured":"Leone S. Health survey, 2008, http:\/\/www.mamaye.org.sl\/sites\/default\/files\/evidence\/SL%20DHS%202008.pdf"},{"key":"bibr4-1745505717724617","volume-title":"Sierra Leone demographic health survey 2013","author":"Statistics Sierra Leone, ICF International","year":"2014"},{"key":"bibr5-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)62204-1"},{"key":"bibr6-1745505717724617","unstructured":"UNFPA. Rapid assessment of Ebola impact on reproductive health services and service seeking behaviour in Sierra Leone table of contents, 2015, http:\/\/www.mamaye.org.sl\/sites\/default\/files\/evidence\/UNFPA%20study%20_synthesis_March%2025_final_d.pdf"},{"key":"bibr7-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60906-4"},{"key":"bibr8-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62231-X"},{"key":"bibr9-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60609-6"},{"key":"bibr10-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60478-4"},{"key":"bibr11-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000232229.96134.56"},{"key":"bibr12-1745505717724617","unstructured":"Rutstein SO. Further evidence of the effects of preceding birth intervals on neonatal, infant and under-five-years mortality and nutritional status in developing countries: evidence from the demographic and health surveys, 2008, https:\/\/dhsprogram.com\/pubs\/pdf\/WP41\/WP41.pdf"},{"key":"bibr13-1745505717724617","unstructured":"Moreland S, Talbird S. Achieving the Millennium Development Goals: the contribution of fulfilling the unmet need for family planning, 2006, http:\/\/pdf.usaid.gov\/pdf_docs\/Pnadm175.pdf"},{"key":"bibr14-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60958-1"},{"issue":"2","key":"bibr15-1745505717724617","first-page":"1","volume":"67","author":"Gribble JN","year":"2012","journal-title":"Popul Bull"},{"key":"bibr16-1745505717724617","unstructured":"Joshi S, Schultz TP. Family planning as an investment in development and female human capital: evaluating the long term consequences in Matlab, Bangladesh, 2006, http:\/\/paa2006.princeton.edu\/download.aspx?submissionId=60499"},{"key":"bibr17-1745505717724617","volume-title":"Adding it up: the benefits of investing in sexual and reproductive health care","author":"Singh S","year":"2003"},{"key":"bibr18-1745505717724617","volume-title":"Adding it up: costs and benefits of contraceptive services estimates for 2012","author":"Singh S","year":"2012"},{"key":"bibr19-1745505717724617","volume-title":"Adding it up: the costs and benefits of investing in sexual and reproductive health 2014","author":"Singh S","year":"2014"},{"key":"bibr20-1745505717724617","unstructured":"Avenir Health. OneHealth Tool, 2015, http:\/\/www.avenirhealth.org\/software-onehealth.php (accessed 26 July 2015)."},{"key":"bibr21-1745505717724617","unstructured":"Government of Sierra Leone. The Agenda for Prosperity: Sierra Leone\u2019s third generation poverty reduction strategy paper (2013\u20132018), 2013, http:\/\/www.undp.org\/content\/dam\/sierraleone\/docs\/projectdocuments\/povreduction\/undp_sle_The%20Agenda%20for%20Prosperity%20.pdf"},{"key":"bibr22-1745505717724617","doi-asserted-by":"publisher","DOI":"10.2307\/2133334"},{"key":"bibr23-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60904-0"},{"key":"bibr24-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1186\/1478-7547-1-1"},{"key":"bibr25-1745505717724617","unstructured":"United Nations: Department of Social and Economic Affairs. World population prospects: the 2012 revision, DVD edition. Popul Div 2013, http:\/\/esa.un.org\/unpd\/wpp\/Excel-Data\/population.htm"},{"key":"bibr26-1745505717724617","unstructured":"Government of Sierra Leone. Education country status report: an analysis for further improving the quality, equity and efficiency of the education system in Sierra Leone, 2013, http:\/\/unesdoc.unesco.org\/images\/0022\/002260\/226039e.pdf"},{"key":"bibr27-1745505717724617","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.045096"},{"key":"bibr28-1745505717724617","unstructured":"Jamison DT, et al. Investing in a grand convergence in health: methodology. Supplementary web appendix 4, 2003, http:\/\/globalhealth2035.org\/sites\/default\/files\/2035\/appendix-4.pdf"},{"key":"bibr29-1745505717724617","volume-title":"Constraints to scaling up the health Millennium Development Goals: costing and financial analysis gap","author":"World Health Organization (WHO)","year":"2010"},{"key":"bibr30-1745505717724617","volume-title":"Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage","author":"Hutton G.","year":"2012"},{"key":"bibr31-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/5.2.107"},{"issue":"3","key":"bibr32-1745505717724617","first-page":"329","volume":"71","author":"Mills AJ","year":"1993","journal-title":"Bull World Health Organ"},{"issue":"3","key":"bibr33-1745505717724617","first-page":"83","volume":"44","author":"Aboagye AQ","year":"2010","journal-title":"Ghana Med J"},{"key":"bibr34-1745505717724617","volume-title":"Methods for estimating the costs of family planning","author":"Moreland S.","year":"2011"},{"key":"bibr35-1745505717724617","unstructured":"Ministry of Health and Sanitation. Sierra Leone National Health Accounts, 2013, http:\/\/www.mamaye.org\/sites\/default\/files\/evidence\/MoHS%20SL_2015_Sierra%20Leone%20NHA%202013.pdf"},{"key":"bibr36-1745505717724617","unstructured":"Datta S, Winfrey B. OneHealth Tool: technical notes, 2012, http:\/\/avenirhealth.org\/Download\/Spectrum\/Manuals\/OneHealth_technical_manual_annexes_2012_02_07.pdf"},{"key":"bibr37-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1111\/j.1728-4457.2013.00575.x"},{"key":"bibr38-1745505717724617","doi-asserted-by":"publisher","DOI":"10.1016\/S1574-0064(00)80160-2"},{"key":"bibr39-1745505717724617","unstructured":"UN Sustainable Development Knowledge Platform. Total fertility rate, 2015, http:\/\/www.un.org\/esa\/sustdev\/natlinfo\/indicators\/methodology_sheets\/demographics\/total_fertility_rate.pdf (accessed 15 September 2015)."},{"key":"bibr40-1745505717724617","doi-asserted-by":"publisher","DOI":"10.2307\/1972149"},{"key":"bibr41-1745505717724617","unstructured":"Friberg I, Winfrey B. Understanding how FamPlan calculates the numbers of abortions and their impact on MMR in\n                      LiST\n                      , 2012, http:\/\/www.jhsph.edu\/research\/centers-and-institutes\/institute-for-international-programs\/_documents\/manuals\/MMRabortions-family-planning.pdf"},{"key":"bibr42-1745505717724617","volume-title":"Rwanda demographic and health survey 2010","author":"National Institute of Statistics Rwanda","year":"2012"}],"container-title":["Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1745505717724617","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1745505717724617","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1745505717724617","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:24:25Z","timestamp":1777710265000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1745505717724617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,29]]},"references-count":42,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017,12]]}},"alternative-id":["10.1177\/1745505717724617"],"URL":"https:\/\/doi.org\/10.1177\/1745505717724617","relation":{},"ISSN":["1745-5057","1745-5065"],"issn-type":[{"value":"1745-5057","type":"print"},{"value":"1745-5065","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,29]]}}}