A Measure of Survival – Calculating Women’s Sexual and Reproductive Risk

Pregnancy and childbirth are deadly to more than half a million women worldwide every year—a fact that is unacceptable, but not unavoidable. These women are typically poor, uneducated and living in rural areas or urban slums. Despite 20 years of campaigning to improve the reproductive health of women throughout the world, the risk of dying in pregnancy or childbirth shows the largest gap between the rich and poor of all development statistics. The uneven distribution of health services, the concentration of poverty among certain population groups and geographic areas, gender inequity and harmful social norms all contribute to the discrepancy in sexual and reproductive risk globally and locally within countries.

Continuing a Population Action International (PAI) effort begun in 1995, this study is the fourth, in a series that assesses the sexual and reproductive health status of nations. The results have been disturbingly static, with low-income countries at highest reproductive risk and high-income ones at lowest risk. Women’s sexual and reproductive health are riskiest in sub-Saharan Africa and South Asia, and the need for reproductive health services is greatest among the poorest women and men residing in the world’s lowest-income countries. Yet, effective interventions have worked in certain countries and settings, reducing or nearly erasing reproductive risk.

This study provides a benchmark of where women in 130 countries stand on a range of indicators that were incorporated into the Programme of Action International Conference on Population and Development (ICPD) in 1994, or into the Millennium Development Goals (MDGs) in 2000. Indeed, the World Summit in 2005 affirmed the importance of reproductive health (RH) to achieving the MDGs and human development.

The study utilizes a framework that takes a woman’s life-cycle approach to sexual and reproductive health and emphasizes that every step of reproduction should be healthy (See Methodology). Of course, reproductive risks emerge well before pregnancy and childbirth, and survival certainly cannot be considered an endpoint to reproductive risk. The framework for measuring reproductive risk is constructed according to the basic elements of reproduction—sex, pregnancy, childbirth and survival—as these are among the more direct causes of heightened vulnerability to death and injury for women around the world. Recognizing that reproductive health is influenced by broader issues of inequity in income distribution, in access to social services and in gender relations, this study discusses the linkages between reproductive risk and poverty and gender inequity.

For each country, the study renders a range of RH indicators into a manageable set by combining them into one single measure—the Reproductive Risk Index (RRI). As a single measure of reproductive risk overall, the RRI is a guide for advocates engaged in the continued effort toward achieving safe, healthy and informed decisions about reproductive health, especially for the world’s poorest women, and for decision-makers and planners in setting their national policy and budgetary priorities.


Table of Contents

CHAPTER 1: Introduction
CHAPTER 2: Unsafe Sex Destroys Lives and Decimates Societies
CHAPTER 3: We must smooth Young Women’s Transition through Adolescence
CHAPTER 4: Having a Safe Pregnancy must be a Right, not a Privilege
CHAPTER 5: Planned Pregnancies lead to Healthy Mothers and Families
CHAPTER 6: Skilled attendance at Child Birth can make the Difference between Life and Death
CHAPTER 7: The consequences of unsafe abortion echo for generations.
CHAPTER 8: The Leading Cause of Death for Women in Developing Countries is Preventable


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