The most cost-effective way to save a life depends how you define saving a life

The most cost-effective way to save a life depends how you define saving a life
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In the aftermath of the devastating earthquake in Mexico, an international audience waited in rapt attention for news of Frida Sofia, a girl who had survived the collapse of her school and remained trapped in the rubble. Concern quickly turned to outrage when it emerged that this child, who had been directly quoted in news reports, was in fact a total fabrication. The rescue effort was real, but the survivor was not.

If the invention of one child in need of rescue can become a front-page news story around the world, it should not pass unnoticed that a bill recently introduced in the U.S. Senate. The Reach Every Mother and Child (REACH) Act aspires to invent not just one fictional child at risk of death, but five million of them.

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The goal is “to save 15,000,000 children’s lives and 600,000 women’s lives by 2020,” which was first set out in the 2014 USAID report, Acting On the Call.” Of the 15 million child lives projected to be saved, only 10 million would be actual survivors: a third of those lives would be “saved from demographic impact.”

 

In other words, by virtue of never existing, they would be spared from early death, thanks to U.S.-funded family planning.

Measuring lives saved is not a trivial undertaking — even the best interventions sometimes fail, and even the best estimates are only as good as the inputs used to generate them. But it is reasonable to expect that saving a given number of lives should leave a corresponding number of survivors. It is tragic that children die of preventable causes every day, and the fact that this happens at a higher rate in some regions than others warrants an effort to address the inequity.

Saving a life means removing an imminent threat to a person’s well being. While the Reach Act correctly identifies many preventable diseases and injuries that claim children’s lives, it undermines its approach by adding some children’s very existence to the list of threats to be eliminated.

Given the stated purpose of the bill, it is not surprising that the Reach Act, both now and in its 2015 iteration, received a great deal of bipartisan support from lawmakers who believe that mothers and babies around the world deserve the chance to survive and thrive. But while ambitious goals and soaring rhetoric may serve to gather support, it is the definitions and metrics that ultimately determine whether legislation can succeed.

According to a fact sheet from Results, this bill would “hold USAID accountable” to “clear, measurable goals” and “save more lives by prioritizing highest-impact, evidence-based interventions.”

Given that no less than a third of this bill’s child beneficiaries are phantoms of statistical convenience, such dubious accounting should not form the basis of an accountability framework, much less be used to determine the best use of funding from the American taxpayer. 

Clearly, the measurements originating from “Acting On the Call” were chosen for the purpose of ensuring the centrality of family planning within USAID’s maternal and child health strategy. While family planning prevalence varies from region to region, only a very small percentage of women cite cost or lack of access as barriers to using it.

Unfortunately, combining family planning with other interventions in the calculation of lives saved results in an approach that vacillates between treating the complications of pregnancy and infancy and treating pregnancy and infancy as complications.

Estimates of deaths averted due to family planning rely on child mortality rates and maternal mortality ratios, which are measures of risk. USAID’s maternal and child health interventions save lives by driving down those risks. In contrast, the higher the risk of maternal or child mortality in a given region, the more deaths family planning can claim to avert.

The tension between these two measurements becomes important when we consider returns on investment: it costs less to provide contraceptives than to care for a mother and child through pregnancy, birth, and the postnatal period.

Ultimately, the determination of what is the most cost-effective way to save the most lives hinges on how you define saving a life. The definitions undergirding the goals of this legislation are, simply put, quite a reach.

Rebecca Oas is Associate Director of Research at the Center for Family and Human Rights (C-Fam), which is based in New York City and Washington, D.C.