Study ranks women's reproductive health worldwide

United States ranks 15th among 25 low-risk countries; Africa's women still most at risk

provided by Population Action International


Women in the United States face greater risks to their sexual and reproductive health than women in Singapore and many European nations. However, those risks are far less than those faced by women in Africa, according to a new study ranking 133 countries released today by Population Action International (PAI). Italy and Ethiopia are ranked lowest and highest risk, respectively, by the PAI study.

Selected country rankings
Reproductive Risk Index
10 Highest Risk Countries
10 Lowest Risk Countries
1. Ethiopia 1. Italy
2. Angola 2. Sweden
3. Chad 3. Finland
4. Afghanistan 4. Singapore
5. Central African Republic 5. Netherlands
6. Mali 6. Germany
7. Niger 7. Belgium
8. Dem. Rep. of the Congo 8. Norway
9. Sierra Leone 9. Denmark
10. Lesotho 10. Australia
    As the nations of the world marked International Women's Day last month, PAI, a leading population policy group, and CARE, one of the world's largest international relief and development organizations, are highlighting the importance of reproductive health care in women's lives and in the battle against global poverty.

    “There is a gaping chasm between rich and poor countries when it comes to the sexual and reproductive health of women,” says Amy Coen, president of PAI. “Right now, in developing countries, nearly half of all women deliver their babies with no help from skilled health personnel, and there are 150 million women who say they want to prevent or delay their next pregnancy, yet do not have access to contraceptives.”

    PAI and CARE identify access to contraceptives, essential obstetric care, and HIV/AIDS prevention programs as three interventions key to saving the lives of women and men of reproductive age.

    “The need for reproductive health care and information is shared by women everywhere, but where they live can make their experiences vastly different,” explains Maurice Middleberg, director of CARE's Health and Population Unit. “In the United States, typically, a pregnant woman visits her doctor monthly, reads books about caring for herself and her baby and, if necessary, can call 911 for emergency care. After her pregnancy, she may choose a method of contraception so that her body has time to recover before another pregnancy. In stark contrast, millions of women around the world live in countries where such “basic” services are rare; their health, and that of their children, suffer.”

    The PAI study, A World of Difference: Sexual and Reproductive Health & Risks, ranks 91 developing and 42 developed countries representing 95 percent of the world's population on a Reproductive Risk Index and places them in one of five risk categories: Very High, High, Moderate, Low and Very Low.

    The 10 indicators used in the Index are births to teens and women, contraceptive use, male and female HIV/AIDS prevalence, access to skilled care in pregnancy and childbirth, deaths during pregnancy and childbirth, abortion policies, and anemia in pregnant women. The Index chart is accompanied by a booklet that addresses such critical issues as the role of men in reproductive health, violence against women and causes of infertility.

Key findings

Lifetime Risk

Chance of a woman dying from complications of pregnancy, childbirth, or unsafe abortion during her lifetime:

Selected Countries
Ethiopia 1 in 7
Africa 1 in 15
India 1 in 57
Asia 1 in 105
Brazil 1 in 128
Latin America and the Caribbean 1 in 150
USA 1 in 3,418
Europe 1 in 1,895
Spain 1 in 9,058
Northern America 1 in 3,750
World 1 in 70
Developing Countries 1 in 65
Developed Countries 1 in 2,125

    Despite progress made over the past quarter century, one in every 65 women in developing countries will die from reproductive health-related causes during her lifetime, a rate 33 times higher than the risk to women in developed countries who face a one-in-2,125 chance of dying.

    New estimates suggest that about 515,000 women die each year in pregnancy and childbirth, or almost one death every minute, and millions more women become ill or disabled. This new figure updates previous estimates and uses a different methodology and, in some cases, more reliable data. The new estimate confirms that maternal mortality remains a serious problem, particularly in sub-Saharan Africa, where half of all deaths from pregnancy-related causes occur.

    The Index shows that nearly three-quarters of the countries in the Very High and High Risk categories are in sub-Saharan Africa. However, Afghanistan, Haiti and Laos, among others, also fall into these high-risk categories.

    Births to teenage girls associated with higher rates of death and disability than births to older women are highest in Angola, Niger, the Democratic Republic of Congo, Liberia and Sierra Leone, where one in five girls aged 15 to 19 give birth each year. Teen birthrates are lowest in Japan, the Koreas, Netherlands, and Switzerland, at fewer than one in 100. In the United States, one-in-20 teenage girls give birth each year.

    While the United States falls into the Very Low risk category, it is ranked 15th among this category's 25 countries. The United States ranks below Singapore and just above the Czech Republic and Lithuania, two countries with far fewer resources, that rank 16th and 20th, respectively.

    The key reason for the low US ranking is that, while most women in the United States have excellent prenatal care and very few women die from pregnancy-related causes, the United States has more teenage mothers than any other industrialized country. The high incidence of adolescent births reflects a lack of reproductive health information for teens and too often leads girls to drop out of school.

    Italy and Ethiopia, the countries at the extremes of the Reproductive Health Index, offer a stark picture of the reproductive health gap. In Ethiopia, less than 10 percent of births are attended by skilled personnel, and one out of seven women will die from complications of pregnancy. In Italy, skilled personnel attend nearly all births, and the likelihood of a woman dying from a pregnancy-related cause is one in 6,000.

    In countries where reproductive risk is high, CARE and its colleague organizations are working with families, health care providers, and governments to improve access to health care, medicine and information. “Reproductive health care,” explains Middleberg, “is as essential as antibiotics and immunizations to protecting the health of women and children.”

    The report calls on governments and other institutions to honor commitments made by 179 nations at the 1994 International Conference on Population and Development (ICPD) in Cairo. The Programme of Action adopted at the ICPD called for international spending of $17 billion annually by the year 2000 (rising to $21.7 billion annually by 2015) to achieve universal access to basic reproductive health services. Six years later, the United States is allocating less than half of its “fair share” of these costs, in contrast to such donors as the Netherlands, Sweden, Denmark and Norway.

    Basic reproductive health care includes high-quality contraceptive services, adequate care in pregnancy and during and after childbirth, and services for sexually transmitted infections, including HIV/AIDS. Together with newborn health care and the prevention of gender-based violence, the availability of such services will ultimately improve the health status of all women regardless of their risk category.

    PAI and CARE identify two crucial building blocks for achieving universal access to basic reproductive health care: increased support and funding for reproductive health services especially for family planning, essential obstetric care, and HIV/AIDS prevention; and increased support and funding for programs that create economic and educational opportunities for women.

    Because reproductive health is linked to a woman's social and economic well-being, programs that contribute to her status within her family, and to her knowledge of and access to institutions and ideas, will improve her health and the health of her children.

    “It's time to get serious about saving women's lives. Essential health services like family planning and HIV/AIDS prevention make a big difference for those struggling with poverty and ill health,” concludes Coen. “With three billion young people nearly half the world's population entering or soon to enter their reproductive years, we must act now.”

    PAI seeks to increase political and financial support for effective population policies and programs grounded in individual rights. PAI advocates the expansion of voluntary family planning and related health services, and of educational and economic opportunities for women. PAI is a private, nonprofit organization and accepts no government funds.

    CARE is one of the world's largest private international relief and development organizations. Founded in the aftermath of World War II, CARE enabled Americans to send more than 100 million CARE Packages® to survivors of the conflict in Europe and Asia. CARE has become a leader in sustainable development and emergency aid, reaching tens of millions of people each year in more than 60 countries in Africa, Asia, Europe and Latin America. For more than 50 years now, CARE has been a vehicle of American generosity abroad. Population Action International is a partner in the campaign.