Data Sources and Methodology

Geographic coverage

This study ranks 133 countries with a population of two million or more on a Reproductive Risk Index, which is composed of 10 indicators of reproductive health. All countries in the Index have data for at least nine indicators. Nine countries were not included in the study for lack of data for two or more of the indicators included. These countries are Somalia, Hong Kong, Greece, Ireland, Taiwan, Bosnia and Herzegovina, Slovenia, Croatia, and Macedonia.

Data Sources

Specific references for this study are available upon request. The primary sources for the study are the World Health Organization (WHO) and other United Nations (UN) agencies. Key sources are:

• WHO’s The World Health Report, 1998
• UN Population Division’s World Population Prospects: The 1998 Revision
• UN Population Division’s World Abortion Policies, 1999
• UN Population Division’s World Contraceptive Use, 1998
• UNAIDS, Report on the Global HIV/AIDS Epidemic: June 2000
• UNAIDS, AIDS Epidemic Update: December 2000
• World Bank’s World Development Indicators, 1998
• Demographic and Health Surveys (DHS) conducted by Macro, International for the U.S. Agency for International Development
• A series of data bases compiled by the division of Maternal and Newborn Health/Safe Motherhood (MSM) at WHO

Methodology

The ten indicators of reproductive health composing 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 choice of indicators was partly determined by the availability of global comparative data sets.

A World of Difference uses the most recent, reliable and consistent data available at the time of publication. 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. For this reason, there is no figure listed for either Slovakia or Yugoslavia. PAI thanks WHO for sharing an advance copy of its new estimates.

The Reproductive Risk Index combines TFR and MMR into the indicator Lifetime Risk of Death from Pregnancy and Childbirth (LTR) to which a logarithmic function is applied. LTR indicates the risk associated with each pregnancy and the number of times a woman becomes pregnant. The observed range for seven of the resulting nine indicators are then transformed into a range of 0 to 100. For each of these seven indicators, each country is located in the new range, giving the country at the top of the range for each indicator a score of 100 and the country at the bottom of the range a score of zero.

Abortion policies are graded on a standard scholastic scale, with A being excellent, and E representing a failing grade. Each grade is assigned a score as follows:

For prevalence of anemia among pregnant women, scores are assigned. Actual data are not used due to the possible lack of uniformity and consistency in reporting. The midpoints of the ranges of anemia prevalence are scored as follows:

For the construction of the Reproductive Risk Index, LTR is given a weight of two to reflect the importance of the two indicators from which it is derived. The final composite index score is derived by dividing the sum of the eight scaled values and the two assigned scores by 10. The wall chart displays the country ranking based on each country’s Reproductive Risk Index score. The maximum value of the index a country can have is 95 because the maximum scores assigned to prevalence of anemia and abortion policies are 70 and 80 respectively.

A 1995 PAI report ranked the reproductive health status of women in 118 countries on a somewhat similar 100-point reproductive risk index. This study uses nine of the 10 indicators used in the 1995 report. The indicator on infertility in women was replaced by HIV prevalence among men, both to include an indicator for men and because estimates of infertility have not been updated since the earlier wall chart was published.