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Around 50–55% of all births in Brazil are unplanned, and these figures include both unwanted andmistimed pregnancies.1,2 The overall rate of induced abortion is estimated at 1.5%, with all induced abortions resulting from unplanned pregnancies culminating in an adjusted abortion rate of 2.7%. In many cases, unplanned pregnancies terminate in induced abortions and, since abortion in Brazil is restricted and only allowed under certain circumstances, many of these procedures are unsafe. Indeed, unsafe abortions are estimated to account for 13% of all maternal deaths.3,4 The cost of unplanned pregnancies weighs not only on the healthcare system but also on society, and involves the cost of abortion care and of unplanned childbirth. When the pregnancy is unplanned, the likelihood of preterm births and low birthweight infants increases, and this scenario implies high costs associated with neonatal care and longterm disabilities.5,6 The total fertility rate in Brazil has fallen significantly in recent decades, and today stands at 1.8 births per woman. Over the same period, the use of contraceptives has increased.7,8 Preventing unplanned pregnancies through publicly funded programs is a strategy that has proven to be effective in significantly cutting costs for health services.9 In this editorial, we will discuss the current situation in Brazil, providing an insight into the inequalities that exist in the provision of contraceptive methods, particularly long-acting reversible contraceptive (LARC) methods, and highlighting the causes and consequences of unplanned pregnancies in Brazil, where fertility planning services are vastly different to those provided in developed countries, and where abortion legislation is restrictive. The Brazilian National Healthcare Service (SUS, in the Portuguese acronym) covers the cost of around 70–75% of all procedures performed in the country, including those related to reproduction. An estimated 1.79 million unplanned pregnancies and 1.47 million planned pregnancies occur annually, with 351 maternal deaths, of which 49 (14%) are attributed to abortions, and 302 to complications resulting from miscarriages and childbirth. The number of infant deaths in the first year of life is estimated at 32,864. The model estimates the number of preterm deliveries attributed to unplanned pregnancies at 122,523. The estimated number of neonatal admissions associated with unplanned pregnancies was 224,631 for 2010, including all preterm deliveries and 7.6% of all term deliveries.10 Consequently, the total annual costs attributed to unplanned pregnancies are estimated at R$4.1 billion or more, depending on the exchange rate. Approximately R$4.07 billion (99.2%) of that total amount is attributed to childbirth and its resulting complications. Based on national cost estimates and the number of unplanned pregnancies per year, the cost per unplanned pregnancy is calculated at R $4,439. However, this is based only on cases occurring within the public healthcare system, with abortions paid for by individuals or clandestine cases not being included in this calculation. This simple analysis highlights the considerable cost savings that can be achieved by reducing the number of unplanned pregnancies.10,11 There are many examples regarding the potential cost savings that can be made by preventing unplanned pregnancies. In the United States, for instance, it was estimated that every dollar spent on preventing unplanned pregnancies results in savings of US $2.76 at 2 years and US$5.33 at 5 years following delivery.10,11 If most unplanned pregnancies can be avoided, why is the unplanned pregnancy rate still so high in Brazil (50–55% of all pregnancies) when contraceptive prevalence is high and the total fertility rate is in decline? The answer to this question is complex and depends on many factors. Scientific evidence shows that the most effective approach to prevent unplanned

Barriers to Implementing and Consolidating a Family Planning Program that would meet Brazilian Needs