There are vast disparities in sexual and reproductive health and risks between rich and poor countries of the world. The past century witnessed dramatic improvements in what we now call “reproductive health,” especially in the more developed countries. There, near-universal access to high quality care in pregnancy and childbirth, to life-saving drugs and safe surgical procedures—including safe abortion—coupled with high levels of contraceptive use and low fertility, all contribute to good reproductive health overall.
The situation is quite different in the developing world. In the year 2000, fully 98 percent of the 3.43 million adult deaths from causes related to poor reproductive health occurred in the developing world. In developed countries, a woman has only a 1 in 2,125 risk of dying in pregnancy or childbirth over the course of her lifetime. That risk is 33 times higher, at 1 in 65, for women in developing countries.
Teen Pregnancy and Reproductive Health
Sexual activity and childbearing early in life carry significant risks for young people all around the world. Teen mothers face twice the risk of dying from childbirth than do women in their twenties, and their children are more vulnerable to health risks as well. Every year, almost half of all new HIV infections and at least one-third of all new sexually transmitted infections occur to people younger than 25.
Every year nearly 80 million unintended pregnancies occur worldwide. More than half of these pregnancies end in abortion. An estimated 150 million women in developing countries say they would prefer to plan their families but are not using contraception, and another 350 million women lack access to effective family planning methods.
Reproductive health services can help. Voluntary family planning and other reproductive health services can help couples avert high-risk pregnancies, prevent unwanted childbearing and abortion, and avoid diseases such as HIV/AIDS and other sexually transmitted infections, that can lead to death, disability, and infertility.
Worldwide, more than one-fifth of all pregnancies—nearly 46 million—are terminated each year. An estimated 36 million procedures take place in the developing world and 10 million in the developed world. Twenty million of these abortions are carried out under illegal and often unsafe conditions. Women who want to terminate a pregnancy tend to ignore the legal status of abortion. Many women are willing to risk unsafe abortions. In the poorest countries, women face a much higher risk of death from unsafe abortion. In Africa, one in every 150
abortions leads to death compared to one in every 85,000 procedures in the developed world.
Restrictive abortion policies mainly affect the poor who rely on the public sector for all their
health needs; women who have the means can usually obtain abortions from the private sector.
Nutritional Anemia in Pregnancy
Iron-deficiency anemia is the most prevalent micronutrient deficiency in the world today. It is especially common in women of reproductive age and particularly during pregnancy. The prevalence of anemia varies greatly among and within countries and is often related to poverty.
By some estimates, levels among pregnant women reach 70 percent in South Asia. In sub-Saharan Africa outside of South Africa, levels exceed 40 percent. Yet anemia can easily be treated with oral iron supplements.
Care in Pregnancy and Childbirth
Approximately one-quarter of pregnant women develop complications. More than one pregnancy in 350 is fatal. Adequate care during pregnancy and especially at labor and delivery are the most cost-effective interventions for improving maternal and newborn health, according to the World Bank. Yet in the developing world some 45 million women do not receive prenatal care and 60 million births take place in the absence of skilled attendants.
AIDS is one of the leading killers of our time. In 2000, 4.7 million adults around the world became infected with the human immuno-deficiency virus (HIV) and another 2.5 million died of AIDS. Over 95 percent of these deaths and new infections occurred in the developing world. Sub-Saharan Africa is the epicenter of the pandemic, with more than 70 percent of all new infections and 80 percent of deaths in 2000.
AIDS kills people at the height of their reproductive and productive years. Dying young often leaves women enough time to bear children, but not enough to raise them. Where the epidemic is well advanced, it adversely affects the well-being of families and precarious economies.
Where HIV infection rates are the highest in the world, condom use is lowest. With growing numbers of infections among women due to the increase in heterosexual transmission of HIV, the need for female-controlled methods has taken on greater urgency.
Risk of Death in Childbearing
Every pregnancy entails risk, especially where health care is poor. Each year, more than 500,000 women worldwide die from pregnancy or childbirth-related causes, almost all of them in the developing world.
Most maternal deaths could be prevented with inexpensive measures. The World Bank and World
Health Organization estimate it would cost just US $3.00 per capita per year to provide standard mother and baby care for women in low-income countries.
Improving Reproductive Health
The vast disparities in reproductive health worldwide and the greater vulnerability of the poor to reproductive risk point to several steps all governments can take, with the support of other sectors, to improve the health of women and their families:
- Give women more life choices. The low social and economic status of women and girls sets the stage for poor reproductive health
- Invest in reproductive health care
- Encourage delays in the onset of sexual activity and first births
- Help couples prevent and manage unwanted childbearing
- Ensure universal access to maternal health care
- Support new reproductive health technologies
- Increase efforts to address the HIV pandemic
- Involve communities in evaluating and implementing programs
- Develop partnerships with the private sector, policymakers and aid donors to broaden support for reproductive health
- Measure Progress
- Data Sources and MethodologyMaterial in this fact sheet is based on the PAI publication, A World of Difference: Sexual and Reproductive Health & Risks. This study ranks 133 countries with a population of two million or more on a Reproductive Risk Index.The ten indicators of reproductive health comprising the Reproductive Risk Index are: adolescent fertility, contraceptive prevalence, antenatal care, skilled attendance at delivery, anemia among pregnant women, HIV/AIDS prevalence among adult females, HIV/AIDS prevalence among adult males, abortion policy, total fertility rate (TFR), and maternal mortality ratio (MMR). The Reproductive Risk Index combines TFR and MMR into the indicator Lifetime Risk of Death from Pregnancy and Childbirth (LTR).
For MMR, new but not yet published estimates are used in calculating the Reproductive Risk Index; the wall chart lists previous estimates because of the embargo on the new numbers. PAI thanks WHO for sharing an advance copy of its new estimates.