Info from FEM (note that FEM has especially low cost per person): Freedom Radio reaches 5.6 million listeners (based on third party eval, freedom radio says they reach 10 million), 40% of which are women of reproductive age. I used estimates based off of their Kano campaign only.

Assumptions and limitations

This is based on RCT in Burkina Faso, from DMI

I discounted for generalisability: I am uncertain about this value. Survey data is from women who live in rural areas, <5km from health facility, in villages without electricty access. I think these factors likely limit generalisability to Kano.

* Does not include additional benefits inc economic benefits, health benefits beyond avoiding fistula (such as avoiding postpartum depression, hypertension, etc), benefits to future children (from larger birth spacing) and wellbeing benefits from women's empowerment.

DHS Nigeria 2018 data

* Does not include government costs of providing contraception.

From Kano state data; this includes deaths from unsafe abortion as well as pregnancy complications

* Super rough way of estimating long-term effects, the probabilites of each scenario are subjective estimates.

https://www.sciencedirect.com/science/article/pii/S2214109X14703481

* Not sure how benefits stack up year on year (aka how much of audience in a given year is the same as the last year's audience?) Didn't spend much time here since it has relatively minor effect on overall CE

https://www.sciencedirect.com/science/article/pii/S2214109X14703481

* Note this is for FEM's current operations in Kano. Benefits are likely to be less in areas with lower maternal mortality (but would obv have to be significantly less to become non cost-effective).

https://www.sciencedirect.com/science/article/pii/S2214109X14703481

This is the average disability weight from rectovaginal fistula and vesicovaginal fistula

This is quite rough. From paper, most of the women who use contraception at baseline were using implants (~51%), while some were using injectables (~37%) and others were using pills (~9%). I assumed that the average implant lasts around 3 years, and that the women on injectables or pills would use them for around 1 year, then did a weighted average.

I am discounting by 40% from burkina faso RCT

Fistula prevalence x percentage of fistulas that are due to pregnancy/ average number of children for a person with a fistula

Chance of fistula per pregnancy x number of averted pregnancies

From email with Anna Christina. This is their approximate cost from campaign in Kano.

DALY-equivalents

DALY-equivalents

WELLBY-equivalents

Using 1 DALY = 3.7 WELLBY conversion

164/$ WELLBY for GD

This includes discount for generalisability from Burkina Faso trial

This is rough, subjective estimate. For full investigation, would use different weigh to weight probabilites

I put the discount rate higher than usual, because i think contraceptive access/ knowledge will increase even without this intervention

DALY-equivalents

WELLBY-equivalents

Using 1 DALY = 3.7 WELLBY conversion

I assume that within 10 years time, even without this intervnetion there would be widespread contraceptive knowledge/ access

Note: I think it's unlikely, but not impossibly so, that new contraceptive knowledge/ behavior establishes self as new social norm

Assuming strongly diminuishing effects

DALY-equivalents

Using 1 DALY = 3.7 WELLBY conversion

Note: I think it's unlikely, but not impossibly so, that new contraceptive knowledge/ behavior establishes self as new social norm