Gender 
Africa's women face highest reproductive health risks

As the nations of the world today mark International Women's Day, PAI, a leading population policy group, is releasing A World of Difference: Sexual and Reproductive Health & Risks to highlight the importance of reproductive health care in women's lives and in the battle against poverty around the world.

- There is a gaping chasm between rich and poor countries when it comes to the sexual and reproductive health of women, says Amy Coen, president of PAI. "Right now, in developing countries, nearly half of all women deliver their babies with no help from skilled health personnel, and there are 150 million women who say they want to prevent or delay their next pregnancy, yet do not have access to contraceptives."

PAI identifies access to contraceptives, essential obstetric care, and HIV/AIDS prevention programs as three interventions key to saving the lives of women and men of reproductive age.

The PAI study ranks 91 developing and 42 developed countries representing 95 percent of the world's population on a Reproductive Risk Index and places them in one of five risk categories: Very High, High, Moderate, Low and Very Low. The 10 indicators used in the Index are births to teens and women, contraceptive use, male and female HIV/AIDS prevalence, access to skilled care in pregnancy and childbirth, deaths during pregnancy and childbirth, abortion policies, and anemia in pregnant women. 

Key Findings
· Despite progress made over the past quarter century, one in every 65 women in developing countries will die from reproductive health-related causes during her lifetime, a rate 33 times higher than the risk to women in developed countries who face a one in 2,125 chance of dying. 

· New estimates suggest that about 515,000 women die each year in pregnancy and childbirth, or almost one death every minute, and millions more women become ill or disabled. This new figure updates previous estimates and uses a different methodology and, in some cases, more reliable data. The new estimate confirms that maternal mortality remains a serious problem, particularly in sub-Saharan Africa where half of all deaths from pregnancy-related causes occur.

· The Index shows that nearly three-quarters of the countries in the Very High and High Risk categories are in sub-Saharan Africa. However, Afghanistan, Haiti and Laos, among others, also fall into these high-risk categories.

· Births to teenage girls-associated with higher rates of death and disability than births to older women-are highest in Angola, Niger, the Democratic Republic of Congo, Liberia and Sierra Leone, where one in five girls aged 15 to 19 give birth each year. Teen birthrates are lowest in Japan, the Koreas, Netherlands, and Switzerland, at fewer than one in 100. In the United States, one in 20 teenage girls give birth each year.

· While the United States falls into the Very Low risk category, it is ranked 15th among this category's 25 countries. The United States ranks below Singapore and just above the Czech Republic and Lithuania, two countries with far fewer resources that rank 16th and 20th respectively.

The key reason for the low U.S. ranking is that while most women in the United States have excellent prenatal care, and very few women die from pregnancy-related causes, the United States has more teenage mothers than any other industrialized country. The high incidence of adolescent births reflects a lack of reproductive health information for teens and too often leads girls to drop out of school.

Selected Country Rankings
Reproductive Risk Index

Italy and Ethiopia, the countries at the extremes of the Reproductive Health Index, offer a stark picture of the reproductive health gap. In Ethiopia, less than 10 percent of births are attended by skilled personnel, and one out of seven women will die from complications of pregnancy. In Italy, skilled personnel attend nearly all births, and the likelihood of a woman dying from a pregnancy-related cause is one in 6,000.

The report calls on governments and other institutions to honor commitments made by 179 nations at the 1994 International Conference on Population and Development (ICPD) in Cairo. The Programme of Action adopted at the ICPD called for international spending of US$ 17 billion annually by the year 2000 (rising to US$ 21.7 billion annually by 2015) to achieve universal access to basic reproductive health services. Six years later, the United States is allocating less than half of its "fair share" of these costs, in contrast to such donors as the Netherlands, Sweden, Denmark and Norway.

Basic reproductive health care includes high-quality contraceptive services, adequate care in pregnancy and during and after childbirth, and services for sexually transmitted infections, including HIV/AIDS. Together with newborn health care and the prevention of gender-based violence, the availability of such services will ultimately improve the health status of all women regardless of their risk category.

PAI identifies two crucial building blocks for achieving universal access to basic reproductive health care:
· Increased support and funding for reproductive health services-especially for family planning, essential obstetric care, and HIV/AIDS prevention; and,
· Increased support and funding for programs that create economic and educational opportunities for women. Because reproductive health is linked to a woman's social and economic wellbeing, programs that contribute to her status within her family, and to her knowledge of and access to institutions and ideas, will improve her health and the health of her children.

- It's time to get serious about saving women's lives. Essential health services like family planning and HIV/AIDS prevention make a big difference for those struggling with poverty and ill health, concludes Coen. "With three billion young people - nearly half the world's population - entering or soon to enter their reproductive years, we must act now.". 

Sources: PAI

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