Methodology and Data Sources

GEOGRAPHIC COVERAGE

The study ranks 130 developing and developed countries, representing 96 percent of the world population, with a population size of 1 million or more into five categories from highest to lowest reproductive risk based on a Reproductive Risk Index (RRI). The RRI is constructed of nine indicators of access to reproductive health services and health outcomes for which comparable national data are available. Twenty-three countries with a population size of 1 million or more are not included in the study due to lack of data for three or more indicators. These countries are: Afghanistan, Algeria, Angola, Austria, Bosnia and Herzegovina, Democratic Republic of Congo, Denmark, East Timor, Gambia, Greece, Hong Kong, Israel, Liberia, North Korea, Norway, Occupied Palestinian Territory, Puerto Rico, Portugal, Serbia, Sweden, Syria, Tajikistan and United Arab Emirates.

DATA SOURCES

The primary sources for the report are a series of databases compiled by the United Nations (UN) agencies. Key sources are:

• United Nations Population Division Database on marriage data, unmet need and contraceptive prevalence; and World Population Prospects: The 2006 Revision.

• UNFPA, Database on unmet need and contraceptive prevalence.
• UNICEF, State of the World's Children 2007.
• UNAIDS, 2006 Report on the Global AIDS Epidemic.
• WHO, World Health Statistics 2007.
• Center for Reproductive Rights.
• Demographic and Health Surveys (DHS) conducted by Macro International.

DATA QUALITY

The study encountered a number of data problems. National statistics on women's health are often of poor quality, lacking or outdated, especially where statistical systems are not well developed. Definitions can vary from one country to another.

The national level statistics used in this analysis, while they elucidate the differentials between poor and rich countries, mask differentials in reproductive health within countries. Also, statistics on coverage of health services do not reflect the quality of available care.

CONCEPTUAL FRAMEWORK

The study follows a conceptual framework developed in consultation with experts in the field of population and reproductive health.1 It takes a life cycle approach to reproductive health and emphasizes that every step of reproduction should be both healthy and voluntary. The reproductive process is thus divided into four stages: Sex, Pregnancy, Birth and Survival. Each stage is then assessed on how Safe/Healthy and Voluntary it is.

METHODOLOGY

The indicators are selected based on their applicability to the model and on the availability of comparable national data from international data sets. The choice of indicators was partly determined by the availability of comparative data for most countries in the world on ICPD+5 goals and Millennium Development Goals (MDGs).

The nine indicators composing the RRI are: HIV/AIDS prevalence among adults, adolescent fertility, percent girls married before age 18, antenatal care coverage, percent of family planning demand met (based on contraceptive prevalence and unmet need for family planning), births attended by skilled health personnel, grounds on which abortion is permitted, maternal mortality ratio (MMR) and infant mortality rate (IMR).

The indicator family planning demand met was computed as follows: 100*Contraceptive prevalence / (Contraceptive prevalence + Unmet need for FP).

The study 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; we therefore listed MMR as categorical data because of the embargo on the new numbers. PAI thanks the Interagency Group (UNFPA, UNICEF, WHO, The World Bank) for sharing an advance copy of the new estimates.

Percent girls married before age 18 had data missing for many countries, so we developed an adjustment ratio based on two indicators from known countries: Percent of women aged 20-24 married before age 18 (A) and Percent women aged 15-19 ever married (B). We calculated the ratio of A to B for those countries with data for both indicators, averaged these ratios (1.7) and applied that ratio to the unknown countries, adjusting upward their data on Percent women aged 15-19 ever married by a factor of 1.7.

Eight quantitative indicators are scored on a 100-point scale of 0 to 100. The observed range for six of these eight indicators is transformed into a range that goes from 0 to 100. For each of these six indicators, each country is located in the new range. The remaining two quantitative indicators kept their actual ranges because they went approximately from 0 to 100. The country at the top of the range (non-desirable outcome) has a score of 100, while the country at the bottom of the range (desirable outcome) has a score of zero.

For the ninth indicator, Grounds on which abortion is permitted, is an ordinal indicator, and scores are assigned as follows: To save the woman's life or prohibited altogether—95; To preserve physical health (also to save the woman's life)—70; To preserve mental health (also to save the woman's life and physical health)—40; Socioeconomic grounds (also to save the woman's life, physical health and mental health)—15; Without restriction as to reason—5.

Finally, we merged the nine indicators for each country into a single composite index we called the Reproductive Risk Index (RRI) by computing a simple average for all nine scores. Equal weight is given to all nine indicators. RRI, which is the overall country score, is derived by dividing the sum of the six scaled scores, two actual scores and the assigned score by number of indicators for which data are available. The RRI has a minimum value of 1 and a maximum of 78. The maximum value of the RRI that a country can have is 97, because data ranges and assigned scores of three indicators are more than 0 or less than 100.

Countries are then ranked from highest to lowest reproductive risk based on each country's RRI, and then grouped into five quintiles as follows: Highest Risk, Elevated Risk, Moderate Risk, Reduced Risk and Lowest Risk.