Women at Risk: A Measure of Survival

Amy Coen

PAI's report released today at the inaugural Women Deliver conference ranks reproductive health risks for women country by country and provides clear solutions for improving women's lives.

One of the happiest times of my life was my pregnancy, and my most joyous day was the birth of my twin sons. Knowing the joy that pregnancy and birth can bring heightens my sense of tragedy when I think about the half a million women who die each year from pregnancy related causes, though their deaths are largely preventable. Instead of celebration, pregnancy and childbirth are immersed in grief and suffering.

I am incredibly proud of Population Action International (PAI) and our new report A Measure of Survival: Calculating Women's Sexual and Reproductive Risk, which we are releasing today at the Women Deliver conference in London. This report is unique because it recognizes that there are many factors that contribute to a woman's sexual and reproductive health. A Measure of Survival puts all the pieces of the puzzle together to form a complete picture. The report ranks 130 developing and developed countries according to sexual and reproductive risks, and provides steps to improve the lives of women, particularly in regards to their reproductive health, in all countries.

I am also very proud of the organizers of Women Deliver – they are champions of change! Women Deliver is going to be a watershed event for women, which is why PAI has done all we can to support this momentous event. After working on this issue for 30 years, it's time for women's survival and well-being around pregnancy and childbirth to take center stage.

We are presenting A Measure of Survival at Women Deliver so that advocates around the world can use the numbers to pressure their governments, ministers of health and their communities to invest in women's sexual and reproductive health.

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What's YOUR number? It's a measure of your country's dedication to women's well-being. But make no mistake, behind each number is a woman, a family, a community and a possibility for a better future.

Women are at highest sexual and reproductive health risk in Niger, Chad, Mali, Yemen and Ethiopia, while the Netherlands, Switzerland, Singapore, Germany and Belgium are the safest countries for women's health. In general, women's sexual and reproductive health are riskiest in sub-Saharan Africa and South Asia, and the need for reproductive health services is greatest among the poorest women and men residing in the world's lowest-income countries.

Some countries – including low-income countries – have successfully reduced maternal mortality. Romania, Thailand, Malaysia, Sri Lanka, Egypt and Honduras have used a variety of strategies including increasing access to hospitals and midwives, improving quality of care and controlling infectious diseases.

Youth are our future – they must have the opportunity to blossom into adulthood. Yet the United States still has the highest teen pregnancy rate of all developed countries, which leads to higher death and injury rates for young mothers and their infants. This keeps the U.S. from leading the world in women's sexual and reproductive health; we barely make it into the top 25 in the "lowest risk" category of A Measure of Survival, behind a few surprising leaders like Croatia and Cuba.

This report is especially critical for U.S. policymakers as they consider repealing the harmful Global Gag Rule. Also known as the Mexico City policy, these restrictions undermine sexual and reproductive health services around the world – leading to more unplanned pregnancies and more unsafe abortions.

Investing in women also improves the health and well-being of families, communities and even nations. It contributes towards reducing poverty and stimulating economic development. It is critical that policymakers, advocates and the media begin to understand these connections. As long as family planning and reproductive health are perceived as only having to do with a woman's body, achieving progress on critical global issues will remain out of our reach.

Main findings from the report:

It is astonishing that in 2007 we must release a report called "A Measure of Survival." We are long past the time when our report should be called "A Measure of Women's Well-Being." In order for societies to flourish, women's survival must be taken for granted and opportunities for education, good health and self-determination must be within the realm of possibility.


  • Reach youth with comprehensive sexual and reproductive health education
  • Scale-up sexually transmitted infection (STI) interventions
  • End harmful practices like very early marriage, intimate partner violence and female genital mutilation
  • Recommit to voluntary family planning
  • Make childbirth safer by increasing access to reproductive health care
  • Make abortion safe, legal and accessible
  • Focus on the distribution of services
  • Involve communities in building networks of health workers
  • Coordinate sexual and reproductive health with HIV/AIDS efforts
  • Finance reproductive health supplies
  • Make country ownership a reality by including local officials and civil society in decision-making
  • Improve research of sexual and reproductive health

Even though this is 2007, too many communities are still living in the dark ages regarding women! Discussing women's survival as an end point is no longer acceptable. Let's commit ourselves to doing everything in our grasp during this next decade so that success is the well-being of a woman measured by her rights, choices, health, prosperity and full participation in her community – regardless of where she lives. Our urgent call to action is NOW and each person reading this has a role to play. Please join us!

More information about the report is available online at http://www.populationaction.org/mos.

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