Returns on investment in family planning across 54 low- and middle-income countries_Supplementary Materials

Background: Despite strong evidence linking family planning (FP) to reductions in maternal mortality, prevention of unsafe abortion, and broader economic development, return-on-investment (ROI) estimates vary widely due to differences in modelling approaches and time horizons. This study addresses that gap by integrating health impacts, cost savings, and macroeconomic returns within a single, transparent framework. Methods: We estimate the ROI from scaling FP across 54 LMICs over 2025–2060. A gradual scale-up in contraceptive use, based on the Family Planning Estimation Tool (FPET) country projections, is compared against a baseline with constant 2025 prevalence rates. Costs are estimated from both provider and user perspectives. Health impacts are modelled using the Lives Saved Tool (LiST), with maternal deaths monetized via a country-adjusted Value of Statistical Life (VSL) approach. Macroeconomic returns are estimated by linking LiST demographic outputs to the Canning-Karra-Wilde (CKW) macrosimulation model. Findings: Scaling FP across 54 countries over 35 years requires a $32.5 billion investment, generating 2.7 million additional contraceptive users annually. This yields three benefit streams: 1.04 million maternal deaths averted ($59 billion); $42 billion in averted healthcare costs; and $1.8 trillion in GDP gains from the demographic dividend — producing an overall return of $56 for every $1 invested. Conclusion: Scaling contraceptive access generates substantial returns, from immediate reductions in maternal mortality to long-term economic growth. As governments and donors face tightening fiscal constraints, these findings offer a transparent, evidence-based case that sustained FP investment is both a health imperative and a high-return economic investment.