Population Action International

What's your number and how do you improve it?

A Measure of Survival is an invaluable tool for advocates, decision-makers, donors and the media to assess the state of women's lives and health in low- and middle-income countries. That so little progress has been made in helping the world's poorest women survive pregnancy and childbirth should serve as a wake-up call to all of us. Thirteen years after the International Conference on Population and Development, women are still dying from largely preventable causes.

The Reproductive Risk Index is designed to assist advocates in changing hearts and minds and reviving political leadership. Use it to make the case for increased funding and strong policies for sexual and reproductive health and rights. Use it to gird and strengthen health care systems. Most importantly, use it to advance women's equality, for, without steady progress in securing the rights of girls and women, none of the recommendations below are achievable.

Reach youth.

Comprehensive, age-appropriate sexual and reproductive health education for both in- and out-of-school youth is imperative, in every society. So, too, are youth-friendly services that are confidential, easy to get to, and accessible in places and times that are convenient to youth. Policymakers should redouble efforts to invest in quality education for girls and all young people. The transition from adolescence to adulthood should be supported and enriched through public policy that values girls' and boys' rights, cherishes their potential and espouses gender equity.

Scale-up sexually transmitted infection (STI) interventions.

Preventing, screening and treating STIs must re-emerge as a public health priority. Integration of STI screening and treatment within a broader range of sexual and reproductive health services has the potential to increase coverage, and must be made more available in resource-poor settings. Action requires improved research on the effectiveness of different STI interventions. Male and female condoms must be accessible to those who need them—as methods of contraception and HIV/STI prevention. The female condom expands the limited range of available barrier methods.

End harmful practices.

Very early marriage and childbearing, intimate partner violence, female genital mutilation/cutting and other harmful traditional practices violate women's rights and are detrimental to their health and lives. To effect lasting change, laws and policies to ban harmful practices must accompany locally-driven educational efforts to end such practices and honor the rights of girls and women. But it will take time, steadfast leadership, and consistent activism and education at the local and national levels.

Recommit to voluntary family planning.

Family planning efforts have languished due to decreased funding, diminished political support, restrictive policies such as the U.S. Global Gag Rule, and—in recent years—the migration of seasoned family planning staff to other well-funded health initiatives. Efforts to satisfy the unmet need for family planning are an urgent global priority and should always be rights-based and non-coercive. They should be fully funded to ensure a broad mix of contraceptives—including emergency contraception (EC), as well as male and female condoms—and provide high-quality care that empowers women, men and young people to make informed decisions.

Make childbirth safer.

Increasing women's access to life-saving reproductive health care is a smart investment; maternal health interventions are among the most cost-effective interventions for women of reproductive age. Scaling up emergency obstetric care, combined with recruiting and training health professionals, is paramount. These efforts will fundamentally save the lives of women and their babies.

Make abortion safe, legal and accessible.

Health professionals need a supportive policy and regulatory environment that provides training, furnishes necessary resources and ensures that abortion is accessible in a range of health care settings—not just hospitals. Post-abortion care (PAC) is a core component of reproductive health care and should be fully funded and accessible.

Focus on the distribution of services.

Poor reproductive health and inadequate access to services are concentrated among poor people. In the short-term, the focus should be on reducing inequities in service delivery. In the long-term, the goal should be to improve infrastructure, including roads, transportation and communication systems and health care systems altogether.

Involve communities.

The mix of factors that contribute to poor reproductive health varies from one community to another. Therefore, efforts to reach women, men and youth with comprehensive sexual and reproductive health information and services must be locally led and implemented. Community-based reproductive health workers were once the backbone of primary health care in many rural areas, but declining funding for family planning, combined with onerous policy restrictions, have taken their toll. It's imperative to rebuild and sustain networks of community heath workers to provide health information and supplies.

Coordinate sexual and reproductive health with HIV/AIDS efforts.

Voluntary family planning is a key HIV-prevention strategy and must be closely coordinated with HIV/AIDS efforts. Funding, policies and programs must work together to achieve maximum impact. For instance, family planning services must be offered within PMTCT programs, and HIV-positive women, men and youth must have access to sexual and reproductive health information and care.

Finance reproductive health supplies.

Government and donor support for reproductive health supplies must increase significantly. Inconsistent financing and weak distribution systems hinder supplies from getting to where they are needed, resulting in frequent shortages and stock-outs of key health supplies. Improving the health of women and young people depends upon a sufficient and reliable supply of contraceptives (including female and male condoms), safe delivery kits, immunizations, drugs to treat STIs and malaria, and other basic supplies, reaching their communities on a regular basis.

Make country ownership a reality.

Decision-making on health priorities, policies and strategies at the country level must include government officials, parliamentarians, civil society (NGOs and community-based organizations) the private sector and donors. This will strengthen voluntary family planning services, comprehensive maternal and child health care, and prevention of HIV/AIDS and STIs. A country-led approach to development assistance can and must be a reality.

Improve research of sexual and reproductive health.

Better information and measurement of sexual and reproductive health is crucial for evidenced-based programming at the local level, as well as better monitoring of progress, evaluation of programs and policy-setting at the national level. Improved research and data-collection will highlight where changes in programming and strategy are needed.

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