Trends in Reproductive Health Worldwide

The situation is quite different in the developing world where, in 2000, fully 98 percent of the 3.43 million adult deaths from causes related to poor reproductive health took place. The situation is most dire in sub-Saharan Africa. A decade ago, even before the recent rapid rise in cases of HIV/AIDS, reproductive illnesses caused almost 40 percent of all disability and premature death among reproductive-age women (ages 15-44) in the region, and about 8 percent among similarly aged men.

The Reproductive Risk Index ranks 133 countries on 10 indicators of sexual and reproductive health for which comparable national data are available. The indicators reflect both access to services and outcomes relating to fertility, fertility regulation, health and survival in pregnancy and childbirth, and the prevalence of HIV/AIDS in women and men.

A useful measure of the vast disparity in reproductive health status between rich and poor countries is that of "lifetime risk." 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.

Yet progress has been made. Contraceptive use has increased more than ten-fold in developing countries and women have, on average, half as many children as they did 35 years ago. Deaths in pregnancy and childbirth have dropped significantly in some countries and access to care in pregnancy and childbirth has improved in every region except sub-Saharan Africa. However, more than a quarter of pregnant women in these countries still receive no prenatal care and nearly half deliver with no help from skilled health personnel.

Reducing reproductive risk requires multiple strategies and the coordination of health and development policies. Key to success is a strong commitment among all sectors of society, and at the local, national and international level, to the provision of good quality healthcare services that include contraception, safe abortion, obstetric care, and the diagnosis and treatment of sexually transmitted infections.

Equally important, however, are efforts to improve the socioeconomic status of women, which greatly affects and is affected by poor reproductive health. Education beyond the primary school level is strongly associated with improved decision making in health-related matters and greater use of available health services, as well as with later childbearing and fewer births overall. A woman's educational level and earning potential can also improve her status within the household, thereby increasing not only her role in decisionmaking, but access to food and other resources that contribute to good health.