PAI's Reproductive Risk Index

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.

Information on the 10 key indicators

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

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.

index, empowerment, safe motherhood (SM), women's status, family planning, HIV/AIDS, newborn (NB)