Study finds benefit-cost ratio calculation points to very high potential for gains from interventions
Amid the high prevalence of child marriages, reducing teenage pregnancies continues to be the biggest challenge in addressing issues related to the reproductive health of adolescents in Rajasthan. Since more than one-third of the girls get married before 18 years, and 6.3% of girls in the age group of 15 to 19 years are already mothers or are pregnant, investment in sexual and reproductive health is crucial for the State.
With these findings, a new study titled “Returns on Investment in Adolescents’ Sexual and Reproductive Health in Rajasthan” has calculated the benefit-cost ratio to conclude that for every ₹100 spent on meeting the unmet needs of adolescents, there will be a return of approximately ₹300 in terms of healthcare costs saved. This indicates very high potential for gains in health, and economic gains, from the interventions.
Arvind Mayaram, Economic Advisor to the Chief Minister, released the study, conducted by the Population Foundation of India (PFI), here recently, with the suggestion to develop new standards and guidelines to improve the quality of reproductive health services. Dr. Mayaram said that since adolescents comprised 23% of the State’s population, their demographic dividend could be harnessed through effective strategies.
The potential health gains from the interventions could avert 1.45 lakh unwanted pregnancies, 1.46 lakh unwanted births, over 14,000 unsafe abortions, and the deaths of more than 7,000 infants and 300 pregnant women between 2021 and 2025, said the study. It could also save 7,321 infant lives and 343 maternal lives by 2025, and lead to a gain of 80,058 disability-adjusted life years.
The findings also revealed that a per capita investment of ₹1 in weekly iron and folic acid supplement (WIFS) could save almost ₹2 to ₹20 in terms of averted productivity loss in adolescents. In order to reap this benefit, the State will need to make an annual investment of ₹6.6 crore to ₹8 crore in order to realise ₹13.2 core in returns.
For achieving the coverage of at least 50% of in-school and out-of-school adolescents, the State will need to increase its reach of WIFS from the existing level of 9.2% to 25%. Similarly, the benefits from the provision of sanitary pads to adolescent girls for a year will be about 4:1, indicating that every rupee invested in this intervention will produce a return of ₹4 by averting loss in educational achievement, according to the study.
The study highlighted challenges in the field of sexual and reproductive health because of structural poverty, social discrimination, regressive social norms, inadequate education, and early marriage and childbearing. While calculating the benefit-cost ratio, it recommended adoption of a multi-faceted and innovative approach to reach out to adolescents.
Taking note of the unmet need for contraception among married adolescents in the State, resulting in unintended pregnancies and induced abortions, the study recommended an increase in the modern contraceptive prevalence rate for spacing methods from the existing 10.1% to 32% in the 2021-25 period. In absolute numbers, the State will have to provide contraceptives to an additional 2.53 lakh users and comprehensive abortion care services to an additional 75,000 users.
PFI’s executive director Poonam Muttreja said the State government should prudently invest in ensuring that the working age population is healthy and literate, and has access to resources. While the adolescent-specific health interventions needed to be sensitive to their requirements, nutrition supplementation programmes should also be strengthened and scaled up, she said.