Best buys for Africa: Reduced adolescence pregnancy through education
Adolescent pregnancy is major public health problem in low- and middle-income countries. The younger the age of the mother the higher the chance of developing pregnancy and childbearing complications including maternal and infant death. A cost-benefit analysis of providing structured school-based sexual and reproductive health education (SRHE) was conducted among a cohort of 1 million girls attending grade 4 to 8 in rural schools in Ethiopia. SRHE was delivered for one hour weekly for ten months in a year. Provision of SRHE cost 11 million USD with investment returns of 112 million USD, giving a Benefit-Cost ratio of 10.2. The estimated costs cover salary, educational materials and training. The benefits accumulate from reduced rates of maternal and infant mortalities, cost-savings from reduced incidence of pregnancy and birth-related complications and the value of time saved. The analysis did not include educational costs associated with increased school retention rates and benefits associated with increased future earnings due to more education and reduced rates of stillbirths and years lived with disability (YLD), which may underestimate the investment returns. Therefore, delaying pregnancy to a more appropriate age through SRHE has the potential to prevent undesirable and costly health, social and economic outcomes to the mother and the baby. However, despite the demonstrated good return to investment, there are controversies and disagreements among stakeholders including parents about the contents of the SRHE curriculum, which could negatively affect scale-up plans in different countries.