Why Do Projections of the Cost of Family Planning Differ So Widely?

Abstract

Projections of the costs of providing family planning in the year 2000 differ from a low of $2.6 million to a high of $11.5 million. The cost estimates per user of modern methods vary from a low of $14 to a high of $20. 4 key studies are reviewed to show how per-unit costs are estimated. Speidel's Cost Study was carried out in 1983, and he estimated the cost per user at $12 in 1980 for 80 million users per year, with expenditures estimated at $2 billion annually. Per-user costs vary from $4.70 for Colombia to $445.80 for Swaziland. Speidel found that $350 million came from sole donor sources, including the United States Agency for International Development, $286 million from multilateral sources (the United Nations Fund for Population Activities, the World Bank, and the International Planned Parenthood Federation), and the rest from the less developed countries. Bulatao in 1985 calculated pubic and private voluntary organizations' (PVO) expenditures per user at an average of $19.55. Estimates for all developing countries ranged from less than $11 to $26. Gillespie estimated cost per user from Bulatao's study using a cost per user or per couple-years protection (CYP) of $18, which was derived from international averages presented by Bulatao. In Janowitz's cost study the focus was on service-delivery costs that a typical user would incur whereby service-delivery costs for different method-delivery costs for different method-delivery-system combinations can be determined. Nonservice-delivery costs in Rao's estimate in the year 2000 was based on the studies of Janowitz and Gillespie with a range from $4.6 to $6.5 billion (including China), Rao added $1.2 billion for maternal-child health expenditures. Another $3 billion was added for complementary activities, giving a total of $8.3 billion to $9.5 billion. Rao included a wider range of indirect activities than was included in estimates of sample surveys, vital registration, and censuses. ALthough some of the indirect activities listed by Ray may be included in cost estimates of Janowitz and Gillespie, comparisons are not easy to make.