Global Reproductive Health Indicators

 

WHO's short list of reproductive health indicators for global monitoring

Definition:

These 17 largely population-based indicators provide an overview of the reproductive health (RH) situation at the global and national level, endorsed by the WHO and the United Nations Interagency Working Group.

Data Requirements:

Information on each of the 17 indicators (Note: Most of the indicators are described in full elsewhere in this database.)

Data Sources:

The DHS or other representative surveys of the intended population can provide certain indicators (1, 2, 4, 5, 8, 11, 13, 14, 15, and 17). Other indicators (6, 7, 10, 12 and 16) require program-level data: service statistics, facility-based services, or laboratory results on clients. Whereas data are generally available for indicators based on the DHS or RHS, data may be difficult to obtain for certain measures (e.g., percentage of OB-GYN admissions owing to abortion).

Purpose:

During the 1990s, the official representatives of countries worldwide attended international conferences (ICPD in Cairo, the Fourth Women's Conference in WHO's Short List of Reproductive Health Indicators for Global Monitoring in Beijing) and endorsed a number of global goals and targets in the broad area of sexual and RH. This endorsement led to a proliferation of RH indicators on which countries were asked to report. Subsequently, the UN asked WHO to take the lead in organizing an interagency technical process to examine the issue of RH indicators and to reach consensus on a short list of indicators for global monitoring.

WHO's resulting set of 17 indicators covers the main RH areas and represents the consensus among international agencies of the key indicators for international comparison, global monitoring, and follow-up to the international conferences.

The purpose of this set of indicators is to provide an overview of the RH situation at global and national levels. The objective is not to present a comprehensive set of indicators for program monitoring and evaluation. However, the data collected for reporting the indicators should be useful at the program management level.

dEFINITIONS
  1. Total Fertility Rate (TFR)

    Total number of children a woman would have by the end of her reproductive period if she experienced the currently prevailing age-specific fertility rates throughout her childbearing life

  2. Contraceptive Prevalence Rate (CPR)1

    Percent of women of reproductive age (15-49) who are using (or whose partner is using) a contraceptive method at a particular point in time

  3. Maternal Mortality Ratio (MMR)

    Annual number of maternal deaths per 100,000 live births

  4. Antenatal Care Coverage

    Percent of women attended at least once during pregnancy, by skilled health personnel (excluding trained or untrained traditional birth attendants), for reasons relating to pregnancy

  5. Percent of Births Attended by Skilled Health Personnel

    Percent of births attended by skilled health personnel (excluding trained or untrained traditional birth attendants)

  6. Availability of Basic Essential Obstetric Care

    Number of facilities with functioning basic essential obstetric care per 500,000 population

  7. Availability of Comprehensive Essential Obstetric Care

    Number of facilities with functioning comprehensive essential obstetric care per 500,000 population

  8. Perinatal Mortality Rate (PMR)

    Number of perinatal deaths per 1,000 total births

  9. Low Birth Weight Prevalence

    Percent of live births that weigh less than 2,500g

  10. Positive Syphilis Serology Prevalence in Pregnant Women

    Percent of pregnant women (15-24) attending antenatal clinics, whose blood has been screened for syphilis, with positive serology for syphilis

  11. Prevalence of Anemia in Women

    Percent of women of reproductive age (15-49) screened for hemoglobin levels with levels 110g/l for pregnant women, and 120g/l for non-pregnant women

  12. Percent of Obstetric and Gynecological Admissions Owing to Abortion

    Percent of all cases admitted to service delivery points providing in-patient obstetric and gynecological services, which are due to abortion (spontaneous and induced, but excluding planned termination of pregnancy)

  13. Reported Prevalence of Women with FGC

    Percent of women interviewed in a community survey reporting having undergone FGC

  14. Prevalence of Infertility in Women

    Percent of women of reproductive age (15-49) at risk of pregnancy (not pregnant, sexually active, non-contracepting, and non-lactating) who report trying for a pregnancy for two years or more

  15. Reported Incidence of Urethritis in Men

    Percent of men aged (15-49) interviewed in a community survey reporting episodes of urethritis in the last 12 months

  16. HIV Prevalence among Pregnant Women

    Percent of pregnant women (15-24) attending antenatal clinics, whose blood has been screened for HIV and who are sero-positive for HIV

  17. Knowledge of HIV-related Prevention Practices

    Percent of all respondents who correctly identify all three major ways of preventing the sexual transmission of HIV and who reject three major misconceptions about HIV transmission or prevention

1 The expert group working with WHO on this set of indicators recommends basing the calculation of contraceptive prevalence on all women of reproductive age, in contrast to the convention used by the DHS and RHS to report it for married women only (or married and unmarried women separately).

Issue(s):

This set of indicators is not meant to serve as an index; rather, it draws attention to the key measurable areas of RH.

PAI's Reproductive Risk Index

Definition:

Population Action International's (PAI) "report card" of nations is composed of 10 key indicators of reproductive health (RH). Indicators used for the Reproductive Risk Index are each scored on a 100-point scale, and the scores are averaged to yield a total country score on the index. Based on their overall scores, countries are classified by their risk level: very high, high, moderate, low, and very low.

Data Requirements:

Information on the 10 key indicators

Data Sources:

The data for each of the indicators come from diverse sources (DHS, WHO-estimates of MMR, and others)

Purpose:

PAI's Reproductive Risk Index measures the progress of nations toward achieving the goals set at the ICPD. This tool is useful for advocacy purposes to document the poor state of sexual and RH in much of the developing world. A total of 130 countries were ranked, representing 95 percent of the world's population.

PAI's Reproductive Risk Index were based on the ICPD, Millennium Development Goals, and WHO/UNFPA core indicators of RH.  In fact, the Reproductive Risk Index includes many of the same indicators as the WHO's Short List of Reproductive Health Indicators for Global Monitoring. In fact, the two have seven indicators in common. In contrast to the WHO set which are not "combined" into an index, PAI has used scores on individual indicators to produce a summary score. This approach is open to methodological criticism that it implicitly gives equal weight to all ten indicators and "combines apples and oranges." However, the summary score allows for a classification of countries by level of risk, which is useful for advocacy purposes. The five risk categories are as follows:

Highest risk (60 points or more): The 26 countries in this category are characterized by early and high fertility, together with limited care during pregnancy and childbirth, all of which contribute to extremely high levels of maternal mortality. Safe and legal abortion is all but unavailable and, with few exceptions, levels of HIV infection are significant. All countries in this category have low incomes; all but four are in sub-Saharan Africa.

High risk (45 - 59 points): The 24 countries in this category generally have low levels of contraceptive use, restrictive abortion policies, high birth rates, and high maternal mortality. HIV prevalence varies widely. Half of the high risk countries are in sub-Saharan Africa, while the remaining nine are among the poorest nations in their respective regions.

Moderate risk (30 - 44 points): Women from these 26 countries have, on average, fewer than five children. Obtaining a safe and legal abortion is difficult or impossible in most countries in this category. Nine developing regions (including most of South America and the three wealthiest nations in sub-Saharan Africa) are moderate risk.

Low risk (15 - 29 points): In most of these 26 countries, fewer than one in twenty teenage girls gives birth annually and women have, on average, fewer than three children. Abortion is available on request in many of these countries. HIV prevalence is below one percent of adults in all but one of the countries in this category.

Very low risk (less than 15 points): Women in these 28 countries bear, on average, two or fewer children. Contraceptive use is high while anemia among pregnant women, HIV prevalence, and deaths from pregnancy and childbirth are low. Abortion is available on request in nearly all countries in this category. Countries in this category have high incomes.

Ten Indicators Used in PAI's Reproductive Risk Index: measurement
1. HIV Prevalence Among Adults 15-49 Quantitative
2. Adolescent Fertility Quantitative
3. Female Secondary School Enrolment (Gross) Quantitative
4. Female Illiteracy Rate Quantitative
5. Antenatal Care (ANC) Coverage: At Least 4 Visits Quantitative
6. Contraceptive Prevalence Rate (CPR) Quantitative
7. Births Attended by Skilled Health Personnel Quantitative
8. Grounds on Which Abortion is permitted* Qualitative
9. Maternal Mortality Rate (MMR) Quantitative
10. Infant Mortality Rate (IMR) Quantitative

* The 8th indicator is an ordinal indicator and scored as follows: to save a woman’s life or prohibited
altogether 95, to preserve a woman’s life 70, to preserve woman’s mental health – 40, socioeconomic grounds 15, no restriction 5.