A Measure of Survival - Calculating Women's Sexual and Reproductive Risk

Highest risk category (26 countries)

All countries in this category have low incomes; all are in sub-Saharan Africa except Haiti, Yemen, and Laos—the poorest countries in their respective regions—and Bangladesh. Skilled care during pregnancy and childbirth is limited, especially in Ethiopia. Infant and maternal mortality are high or very high. Contraceptive use is generally low and there is very high unmet need for contraception. At about 40 percent, Yemen, Rwanda, Laos and Haiti have the highest unmet need for contraception in the world. Very early marriage is common, adolescent fertility is high and abortion policies are mostly restrictive. Levels of HIV infection are moderate to high.

High risk category (24 countries)

Half of the countries in this category are in sub-Saharan Africa. Skilled care during pregnancy and childbirth is generally available, except in Nepal and Cambodia. Maternal and infant mortality is high and very high in three quarters of the countries. Unmet need for contraception is relatively significant and is highest in Western Africa. Proportion of family planning demand met is highest in Central America and lowest in West Africa and India and Zimbabwe. Very early marriage is common and adolescent fertility is generally high. Abortion is generally restricted to save a woman's life or health. All countries with low levels of HIV/AIDS are outside sub-Saharan Africa.

Moderate risk category (26 countries)

Nine developing regions (including most of South America and the three wealthiest nations in sub-Saharan Africa) are represented in this category. Antenatal care and skilled attendance at delivery are generally high. The countries are split between low and moderate levels of maternal mortality. Infant mortality is low. A significant proportion of family planning demand is met. Levels of contraceptive use, unmet need for family planning, very early marriage, and adolescent fertility vary across countries. Abortion is generally restricted to cases where they are necessary to save a woman's life or health. HIV prevalence and infant mortality are low except in South Africa and Botswana.

Low risk category (26 countries)

Six developing and four developed regions in the world are represented in this category. Antenatal care and skilled attendance at delivery are generally high. Three quarters of the countries in this category have low levels of deaths during pregnancy and childbirth. Infant mortality is low to moderate except in five Central Asian countries. A significant proportion of family planning demand is met. More than half the countries in this category allow abortion unrestricted. With a few exceptions, HIV prevalence is low.

Lowest risk category (28 countries)

Countries in this category have high incomes; Cuba, China and Singapore are the only countries in the developing world. Motherhood is safe; skilled care at childbirth is universal and the risk of death from pregnancy or delivery is extremely low. Infant mortality is rare. Contraceptive use is high. Early marriage is rare. Abortion is unrestricted. Adolescent fertility and HIV prevalence are low.

Figure 2.2 - Reproductive Risk by Region

Reproductive risk is highest in low-income countries, and lowest in the industrialized nations. Weak and uneven distribution of health services, the concentration of poverty among certain population groups and geographic areas, gender inequities and harmful social practices all contribute to discrepancies in sexual and reproductive risk globally and locally within countries.

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