November 5, 2018 (C-Fam) – A new report claims that estimates of lives saved by UK foreign aid efforts are greatly exaggerated.
The Independent Commission for Aid Impact graded maternal health programming by the Department for International Development (DFID) as “unsatisfactory achievement in most areas, with some positive elements.”
Their chief critique was that DFID's claims about the impact of its work could not be concretely verified. Additionally, the report noted DFID did not try to strengthen basic health care to expectant mothers with the same intensity as it did to encourage women to avoid pregnancy through contraception.
Family planning was a major priority for the UK aid agency during the review period of 2011-2015, however, as the report points out, “most maternal deaths result from intentional pregnancies, rather than accidental ones…” and therefore most maternal deaths have nothing to do with a lack of contraception.
Meanwhile, newborn and emergency obstetric care targets lagged far behind, as did promised interventions targeting the poorest women and girls.
The UK development agency claimed to have saved the lives of 103,000 women's lives by 2015 but this was later downgraded to 80,100 in an unpublished report.
Estimating maternal mortality is difficult, particularly in low-resource areas, in part because maternal deaths are relatively rare occurrences even where rates are comparatively high.
In 2010, an independent group found the World Health Organization's estimates of maternal mortality were greatly exaggerated. WHO revised its figures the following year.
Given the difficulty in establishing the scale of the problem, setting reasonable goals and measuring progress is even more difficult. When UN Secretary-General Ban Ki-moon launched the Global Strategy for Women's and Children's Health in 2010, its slogan was “Saving 16 million lives by 2015.” However, by 2015, only 2.4 million deaths had been averted. This led to the creation of an independent accountability panel to determine what had gone wrong.
One potential problem is the measurements being used. The most widely-used indicator is the maternal mortality ratio, which measures the number of maternal deaths per 100,000 live births. This allows for country to country comparisons. However, “lives saved” are harder to verify since this relies strictly on projections and not hard numbers.
The UK used a statistical tool that predicts potential lives saved through a package of specific interventions. A separate module estimates the impact of family planning on the total numbers of pregnancies and births, and projects an alternate scenario in which there are fewer complications due to fewer pregnancies in the first place. Based on this questionable accounting, the UK aid agency claims 62% of estimated lives saved could be attributed to family planning.
Ultimately, what counts is what gets counted. The UK simultaneously chose to prioritize family planning and use measurements of progress that characterize it as the most effective life-saving intervention for maternal health. Arguably, the source of their failure was its choice to shift from treating the complications of pregnancy to treating pregnancy itself as a complication.
Similar metrics have been used in other contexts to argue that family planning “saves the lives” of newborns and young children by averting their births, thus preventing their deaths. A proposed law pending in the U.S. Congress proposes a target for “child lives saved” in which a third are attributed to nonexistence through contraception.
Published with permission from C-Fam.