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Estimated disability-adjusted life years averted by free-of-charge provision of the levonorgestrel-releasing intrauterine system over a 9-year period in Brazil
  1. Jessica M Ferreira,
  2. Ilza Monteiro,
  3. Arlete Fernandes,
  4. Maria V Bahamondes,
  5. Ana Pitoli,
  6. Luis Bahamondes
  1. Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
  1. Correspondence to Dr Luis Bahamondes, Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181 13084-971 Campinas, SP, Brazil; bahamond{at}


Background The objective was to analyse the contribution of the provision at no cost to users of the 20 µg/day levonorgestrel-releasing intrauterine system (LNG-IUS) towards disability-adjusted life years (DALY) averted over a 9-year period.

Methods We analysed data from 15 030 new users of the LNG-IUS who had the device inserted at 26 Brazilian teaching hospitals between January 2007 and December 2015. The devices came from the International Contraceptive Access Foundation (ICA), a not-for-profit foundation that donates the devices to developing countries for use by low-income women who desire long-term contraception and who freely choose to use this device. Estimation of the DALY averted included live births averted, maternal morbidity and mortality, child mortality and unsafe abortions averted.

Results A total of 15 030 women chose the LNG-IUS as a contraceptive method during the study period. Over the 9 years of evaluation, the estimated cumulative contribution of the Brazilian program in terms of DALY averted consisted of 486 live births, 14 cases of combined maternal mortality and morbidity, 143 cases of child mortality and 410 unsafe abortions.

Conclusions Provision of the LNG-IUS at no cost to low-income Brazilian women reduced unwanted pregnancies and probably averted maternal mortality and morbidity, child mortality and unsafe abortions. Family planning programs, policymakers and stakeholders based in low-resource settings could take advantage of the information that the provision of this contraceptive at no cost, or at affordable cost to a publicly-insured population, is an effective policy to help promote women’s health.

  • Levonorgestrel-releasing intrauterine system
  • unintended pregnancies
  • disability-adjusted life years.

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  • Contributors All co-authors contributed equal in the development and writing of the manuscript.

  • Funding This study received partial financial support from the Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) award # 2015/20504/9 and from the National Research Council (CNPq), grant #573747/2008/3. The LNG/IUSs were donated by the International Contraceptive Access Foundation, Turku, Finland under an unrestricted grant.

  • Competing interests LB received honorarium to be member of advisory board and has been an invited speaker at scientific meetings for Bayer Healthcare Pharmaceuticals. Also, he was a member of the ICA Foundation without remuneration. IM received honorarium as speaker at scientific meetings for Bayer Healthcare Pharmaceuticals.

  • Ethics approval Ethical Committee of the University of Campinas, Campinas, Brazil.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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