Research Projects: 7 Cost Benefit Analyses

Research Brief 7

This research brief describes two separate pieces of cost/benefit analyses that relate to the Crisis Pregancy Agency’s remit and will feed into the implementation and subsequent development of the Crisis Pregnancy Programme’s Strategy to address the issue of crisis pregnancy, this Strategy to provide, inter alia, for :

• A reduction in the number of crisis pregnancies by the provision of education, advice and contraceptive services;
• A reduction in the number of women with crisis pregnancies who opt for abortion by offering services and supports which make other options more attractive;
• the provision of counselling and medical services after crisis pregnancy.

PART A
In the first instance the CPA requires a feasibility study of whether a cost/benefit analysis of the actions and developments it proposes in its strategy to reduce the level of crisis pregnancy in Ireland is practical and viable. This analysis might also make recommendations for the feasibility of developing numeric targets in this field.

One of the main problems in calculating numeric targets in this field is that there is no reliable statistical indicator for crisis pregnancy in the first instance. This is compounded by the complexity of the area, where a multiplicity of factors give rise to crisis pregnancy and causal inferences are difficult to make and quantify . Proxy indicators such as the number of women in the UK giving Irish addresses in UK abortion clinics, the number of domestic adoptions, the number of births outside marriage have various limitations associated with their use.

Costs of taking preventative action
This piece of research aims to estimate the positive or negative benefits of Crisis Pregancy Agency interventions/expenditure to reduce crisis pregnancy in Ireland.

Preventative action will focus on these main areas:
1) Improving sexual health knowledge and skills. This will happen by supporting relationship and sex education in schools and developing communication campaigns and sexual health information for adults. This will be assessed via survey data and monitoring indices undertaken by the Crisis Pregnancy Programme
2) Development of contraceptive services by increasing services nationally. This will also involve developing information on services for the user and improving accessibility by targeting information and basing initiatives on need. Increased capacity will be assessed via auditing service provision overtime.
3) Improving access and awareness of emergency contraception. This will be done by communication campaigns increasing public knowledge and by working in partnership with service providers (GPs family planning clinics etc.)

Benefits in reducing crisis pregnancy
A basis for estimating the level of reduction that will result from actions will have to be developed. This analysis might feed into the debate as to whether targets can realistically be set outlining the extent to which crisis pregnancy can be averted
Benefits associated with reducing the costs of crisis pregnancy will involve developing an index for what these costs are in the first place. The following section summarises some of these costs that will have to be addressed in any analysis.

Costs of unsafe sex
Negative outcomes of unprotected sexual intercourse such as unwanted or crisis pregnancy and STIs incur a series of costs to both the individual and the state. The following list outlines costs specific to the state. This study is interested in assessing overall generic costs rather than costs at the level of the individual. Among these cots are:

• Medical and psychological costs to the state and individual in a minority of cases post-abortion
• Medical costs of childbirth and the costs to the state for each child
• Benefits are also incurred to the state in terms of the economic and social contribution of individuals.
• Long term counselling and administrative costs of adoption.
• Public health costs (vulnerability to infection) and medical costs of STIs. Also costs to the state in terms of provision of testing and analysis centres/clinics/laboratories.
• Welfare costs of support for the children and parents of these children.
• Unintended pregnancy for women often results in the woman terminating their schooling/education, possibly spending some time being supported by the state and not having similar opportunities (for work, education) as women who may postpone pregnancy as an adolescent or plan pregnancy as an adult (years lost analysis).

Costs are intensified where unintended or crisis pregnancy occurs with vulnerable groups e.g. adolescents. Adolescent pregnancy can be associated with increased risks of obstetrical complications (Health and Welfare, Canada 1989), and children of teenage parents are more likely to become teenage parents themselves, with all its associated risks of poverty, poorer health and lack of opportunity (Kiernan, 1995).

It is envisaged that the above information, in addition to a subsequent meeting with staff of the Crisis Pregnancy Programme, will provide an adequate basis for interested parties to develop a tender outlining the feasibility of the proposed methodology. This should lead to the development of a model that aims to estimate the positive and negative costs of the Crisis Pregnancy Programme’s strategic actions in relation to reducing crisis pregnancy.

Part B
The second and separate cost benefit exercise the Crisis Pregancy Agency requires is an analysis of the economic factors influencing decision making by women when faced with a crisis pregnancy.

The aim of this part of the research is to incorporate in one analysis the range of economic and policy factors that potentially effect women’s decision making in crisis pregnancy and to quantify such data in cost – benefit terms. This information could be used to influence national fiscal policies in these areas.

Separate analyses may need to be considered for women working in the workplace and those in receipt of social welfare
It is important that the methodology of this part of the brief, if feasible, will allow for replication and monitoring over the coming years.

Notes to inform this work
Various studies have reported the financial ramifications and considerations women make when having a baby, especially women facing an unintended or crisis pregnancy. Some costs affect all women/parents with children, yet others affect more intensely women who are also lone parents.

Research (e.g. Mahon, Conlon & Dillon 1998) has documented the kinds of issues that women raise and worry about when contemplating lone motherhood, abortion and adoption. These include issues such as:
Economic and social ramifications of lone motherhood
Life career, training and educational concerns
Financially and emotionally unready
Living arrangements and accommodation
Being reliant on welfare or dependent on support of parents and consequent loss of independence.

For women who choose adoption in Mahon et. al’s (1998) research, attitudes toward lone motherhood played a significant part in their decision. For women who had decided to keep their baby, childcare, accommodation and finance were their biggest concerns. For women opting for abortion, career and job related concerns including the stigma of lone motherhood were paramount.

One of the goals of the National Strategy to Address Crisis Pregnancy in Ireland is to reduce abortion, by making other options more attractive, i.e. keeping a baby and/or adopting a baby. To our knowledge, no Irish research pulls together in one analysis the costs and benefits of different economic factors that potentially affect women’s decision-making when faced with a crisis pregnancy. A proposed aim of this part of the brief is to fill this research gap.

Key issues
Poverty, lone parenthood and welfare policy: Research has revealed a clear link between lone motherhood and a higher risk of poverty than among two parent families (Strengthening families for life, 1998; McCashin 1996).

Level of welfare payments and income adequacy
Issues surrounding the workplace, maternity benefits and longer term workplace influencers.

Welfare payments to lone parents were merged into the one parent family payment (OPFP), formerly lone mother’s allowance, in 1997. This marked a shift in social security payments from an allowance that expected parents to stay at home to an employment led approach (Department of Social and Community Affairs, 2000). The children’s allowance, a payment made to all parents, often becomes a financial crutch to families receiving the one parent family allowance (McCashin 1996). The increase in births outside marriage in Ireland has been associated with increased demand on public expenditure, despite the reported inadequacy of payments and increased poverty for those within one parent families (Fahy, & Fitzgerald 1997).

Two main factors account for the difficulties experienced by lone parents when wanting to enter or re-enter the workforce or education. Both of these are related to welfare policies. They include: Lack of childcare provision and disincentives inherent in the current social welfare income supports to labour market entry. It is important to note that labour market participation rates for Irish women with children are low compared to our European neighbours – this is whether women are lone parents or not, although lone mothers are further marginalised economically (McCashin, 1996).

Education is an important issue, including the provision of third level grants and educational/training schemes for lone parents and the effect this has on welfare status, e.g. withdrawal of subsidiary benefits. Access and affordability of childcare affects access to education, employment, re-training and participation levels in employment programmes for lone parents in Ireland (and for all mothers). Cost of childcare and its relationship to labour market entry needs to be addressed in this analysis.

Budget:
The allocated budget for this piece of work is in the region of €40,000, inclusive of VAT

Timeframe:
Tenderers will be required to outline a project plan with clear timeframes.

References
Fahy, T., Fitzgerald, J. (1997). The welfare implications of demographic trends. Oak Tree Press. Dublin.
Harvey, P.D. (1994). The impact of condom pricing on sales in social marketing programmes. Studies in Family Planning, vol. 25, (1). Pp52-58
Health and Welfare, Canada (1989). Adolescent Pregnancy Study: a statistical set of tables for provinces. Canada, Ottawa.
Kiernan, K. (1995). Transition to parenthood: young mothers, young fathers – associated factors and later life experiences. Welfare state programme discussion paper 113. London:, London School of Economics.
Mahon, E., Conlon, C & Dillon, L. (1998). Women and Crisis Pregnancy. The Stationery Office. Government publications, Dublin.
Mc Cashin, A. (1996). Employment Aspects of Young Lone Parenthood in Ireland. Oak tree Press. Dublin.
Strengthening Families for Life (1998). Final report to the Minister for Social, Community and Family Affairs. Stationery Office. Government Publications. Dublin

1. Statutory Instruments No. 446 of 2001. Crisis Pregnancy Agency (Establishment) Order, 2001.
2. While the strategy is not published yet, broad areas for action in the areas of education and contraceptive services are available to the successful tenderer to work from.
3. A CPA report reviewing evidence in this field is available to interested bidders