Editorial note and disclaimer
This report assesses the nonprofit Family Empowerment Media (FEM). The project was commissioned and supported by a donor who wishes to remain anonymous. It was conducted in February 2023 over two weeks.
This report attempts to estimate the cost-effectiveness of FEM, mainly relying on two existing cost-effectiveness analyses (from GiveWell and Founders Pledge). We were asked to look into the cost-effectiveness of the organization in an unbiased way, and we started the research without a prior for whether this organization would be cost-effective or not. In this report, we express cost-effectiveness as a function of the cost-effectiveness of cash transfers (like the original models mentioned above). We did not analyze the cost-effectiveness of any other family planning interventions, so we cannot and do not make any claims about how FEM compares to other family planning interventions.
In addition to looking at the cost-effectiveness of FEM’s program, we describe their track record to date, and try to determine the main uncertainties about the program and its (cost-)effectiveness.
We relied on four expert interviews to attempt to answer some of the questions: We interviewed Anna Christina Thorsheim (Executive Director and cofounder of FEM), Andrew Martin (Senior Research Analyst at GiveWell), Rosie Bettle (Applied Researcher at Founders Pledge), and Dr. Mukhtar Muhammad (medically trained expert in social and behavior change communication with a historical focus on family planning programming).
We have tried to flag major sources of uncertainty in the report and are open to revising our views as more information becomes available.
We haven’t attempted to assess the value of different population ethics views, or how those would affect the (cost-)effectiveness of FEM’s work. We believe that that is a highly complex topic that would take more time than the short period we had to conduct this research. Work on this would benefit from the Worldview Investigations Team at Rethink Priorities, which could explore family planning topics in the future.
We would like to mention that Melanie Basnak previously worked at Charity Entrepreneurship (CE), the nonprofit organization that incubated FEM. Melanie did not overlap with Anna Christina Thorsheim during her time at CE and believes she oversaw this research in an unbiased manner.
Executive summary
In a randomized controlled trial in Burkina Faso from 2016-2018, a family planning mass media campaign led by the nonprofit Development Media International (DMI) led to a 5.9 percentage point (20%) increase in the modern contraceptive prevalence rate (mCPR), leading the study authors to estimate a cost effectiveness of $7.70 per couple-year protection, albeit with uncertainty. The nonprofit Family Empowerment Media (FEM) ran a pilot family planning mass media campaign in Kano, Nigeria, and they observed a 6 percentage point (75%) increase in mCPR using less rigorous pre- and post-pilot data comparisons. GiveWell conducted a cost-effectiveness analysis (CEA) of DMI’s intervention, finding it to be 1.1-5.4x the cost-effectiveness of cash transfers, depending on the context. FEM altered the model to pertain to its pilot intervention in Kano, finding that their intervention was ~27x the cost-effectiveness of cash transfers. Founders Pledge conducted a separate CEA, finding a cost-effectiveness of ~22x that of cash transfers, complete with a full (unpublished) report.
We used the original models as a starting point to conduct our own cost-effectiveness estimation, tweaking certain values. In most cases, our adjustments would tend to increase these existing cost-effectiveness estimates, so we are confident that the cost-effectiveness of FEM’s intervention beats that of cash transfers, and we believe that their cost-effectiveness might be higher than GiveWell’s and Founders Pledge’s estimates. However, we would like to see several remaining uncertainties resolved before we would feel confident putting a bound on cost-effectiveness, and we discuss these uncertainties in some depth. For instance, we are highly uncertain regarding the persistence and magnitude of the treatment effect, as well as the nature and magnitude of spillover costs (e.g., to governments) and benefits (e.g., for women’s education, child health, animal welfare, and climate outcomes) at scale. We hope that FEM’s research will take these uncertainties into account, and we believe that further data exploration and conversations with experts could additionally help to reduce them.
Click here for the full version of this report on the Rethink Priorities website.
Contributions and acknowledgments
Greer Gosnell and Melanie Basnak were the main authors of this report. Melanie Basnak reviewed and supervised this report. Thanks to James Hu for assisting with the citations. Thanks to Adam Papineau for copyediting and to Rachel Norman for assistance with publishing the report online. Further thanks to Anna Christina Thorsheim (FEM); Andrew Martin (GiveWell); Rosie Bettle (Founders Pledge); and Dr. Mukhtar Muhammad for taking the time to speak with us.
If you are interested in Rethink Priorities' work, please consider subscribing to our newsletter. You can explore our completed public work here.
I am just coming from a What We Owe the Future reading group - thanks for reminding me of the gap between my moral untuitions and total utilitarianism!
One reason why I am not convinded by your argument is that I am not sure that the additional lifes lived due to the unintended pregnancies are globally net-positive:
the number of 100 pregnancies averted does not correspond to 100 fewer children being born in the end. A significant part of the pregnancies would only be shifted in time. I would be surprised if the true number is larger than 10 and expect it to be lower than this. My reasoning here is that the total number of children each set of parents is going to have will hardly be reduced by 100x from access to contraception. If this number started at 10 children and is reduced to a single child, we have a reduction that corresponds to 10 fewer births per death averted. And stated like this, even the number 10 seems quite high(sorry, there were a few confusions in this argument)This being said, the main reason why I am emotionally unconvinced by the argument you give is probably that I am on some level unable to contemplate "failing to have children" as something that is morally bad. My intuitions have somewhat cought up with the arguments that giving happy lives the opportunity to exist is a great thing, but they do not agree to the sign-flipped case for now. Probably, a part of this is that I do not trust myself (or others) to actually reason clearly on this topic and this just feels like "do not go there" emotionally.
It also does not seem obvious that we are above that number. Especially when trying to include topics like wild animal suffering. At least I feel confident that human population isn't off from the optimum by a huge factor. ↩︎