Health and Socio-Economic Consequences by Omission of Sexual and Reproductive Health Policy

Background: The design and implementation of Sexual and Reproductive Health (SRH) policies based on values, beliefs, and interests can have negative impacts on health outcomes, resulting in social and economic damages. This study presents the concept of "omission" of SHR policy and measures the economic costs of not performing or partially performing SRH care in Ecuador, 2015. Methods: The omission of SRH policies was defined as the social and economic losses due to unintended pregnancies (UP). The total cost (TC) of this omission was estimated by summing the direct medical cost (DMC) and the social cost (SC) due to school dropout and maternal death. We compared TC with the cost to provide universal access to contraceptives. Findings: TC was estimated at $740·2 million, representing 59·5 times the cost of preventing UP ($15·4 million) through contraception. Of the TC, 90·8% was related to school dropout. Women who are younger, less educated, and living in poverty face the greatest health, social, and economic damages related to unintended pregnancy. Interpretation: This study presents as an axis of analysis the omission of adequate public policy and its health, social, and economic consequences. The omission was defined as a result of the complex relationship between different factors, including the criteria used by decision-makers and the limitations imposed by scarce resources available to implement policy. The consequences of this omission are distributed inequitably: economically vulnerable women face the greatest burden, via school dropout and maternal death. Funding Statement: Planned Parenthood Global, United Nations Population Fund (UNFPA), Sendas Foundation. Declaration of Interests: Authors declare: "Authors have nothing to disclose." Ethics Approval Statement: The Ethics and Conflicts of Interest Committee of the National Institute of Public Health of Mexico (where the authors of the study are in residence) reviewed and approved the protocol and the collection instruments used during the fieldwork. The research commission, in turn, reviewed and approved the methodology proposed for the study.