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East: Former Socialist Nations Fare Well On Health Index

A new survey by an international family planning organization says women in Eastern and Central Europe and the former Soviet republics face surprisingly few risks to their health during pregnancy and childbirth. Our correspondent K.P. Foley reports.

Washington, 7 March 2001 (RFE/RL) -- An international family planning organization says women in the former communist states of Eastern and Central Europe and the former Soviet Union face fewer risks to their reproductive health than women in Asia, Africa, and Latin America.

Population Action International (PAI), a non-profit advocate for family planning and related health services based its findings on a survey of 133 countries. The Washington-based organization issued its report a day in advance of the 26th observance of International Women's Day, a United Nations event.

In an RFE/RL interview, PAI demographer Meg Green said the term "reproductive health," encompasses a broad range of issues associated with a woman's child-bearing years.

"Reproductive health is health that has to do with people's sexual and reproductive lives, so good health would include the possibility of protecting oneself from sexually transmitted infection, contraceptive use, healthy pregnancy, antenatal care, deliveries attended by trained personnel."

Green said the Population Action International study ranked 91 developing nations and 42 developed countries. That's about 95 percent of the world's population.

The Reproductive Risk Index is divided into five categories of risk: very high; high; moderate; low, and very low.

Population Action researchers used ten indicators to determine a nation's place in the risk rankings. These indicators included the annual number of births for every 100 women aged 15-19; the prevalence of contraceptive use; the number of cases of HIV/AIDS among men and women; the access a woman has to skilled medical and related care during pregnancy and childbirth; the number of maternal deaths for every 100,000 births; a nation's policies on abortion, and the number of cases of anemia among pregnant women.

Green said the PAI survey's indicators are based on World Health Organization standards. She said the index assigns a point value to each of the indicators. The more points for a nation, the higher its reproductive health risks.

Italy was at the very top of the rankings. It had the lowest total risk index score -- 5.3. The wealthiest nations -- Germany, Britain, France, the United States, and Japan -- were also in the top tier of nations with the lowest risk index scores. Joining this group in the "very low," risk index category were: the Czech Republic, Lithuania, Slovakia, Bulgaria, and Belarus.

The next segment of the rankings, the "low" risk group, included: Latvia, Romania, Kazakhstan, Russia, Moldova, Yugoslavia, Azerbaijan, Armenia, Ukraine, Georgia, Uzbekistan, Turkmenistan, Kyrgyzstan, Albania, and Tajikistan.

The Reproductive Risk Index ranked Iran in the "moderate" risk category, while Iraq was listed in the "high risk" rankings. The index ranked Afghanistan in the "very high risk," category, just ahead of Chad, Angola, and Ethiopia.

The survey did not include rankings of Bosnia, Croatia, Macedonia, and Slovenia because not enough data was available.

Green said the findings for the former communist countries were surprising, given the well-documented burdens on the public health systems in Central and Eastern Europe and the former Soviet Union.

She said one of the main reasons for the comparatively good rankings is a very low birth rate among teenagers. The number of births per 100 women in this age group ranged from a low of 3.2 in Slovakia to 5.4 in Kazakhstan. Italy and Sweden had the lowest scores, 0.7, for this indicator. Angola recorded the highest number of births among teenagers, 21.9.

Another primary cause for the low scores, said Green, is access to legal abortions.

"Since women will seek out abortion regardless of its legal status, when it's legal it means that they have the opportunity to go to legitimate health care services and they have a better chance of getting good care."

She noted that worldwide, 75,000 women die each year from improperly performed abortions.

Green also noted that what she called a very important underlying factor is that fertility is generally lower in the European region. She said that fewer births mean fewer risks to a woman's health.

The purpose of the survey, said Green, is to advance the cause of women's health throughout the world. She said reducing the risk of death during maternity is a principal goal of PAI. In many countries, she said even the simplest steps work wonders. She cited the use of clean surgical instruments and supplies as things that can make a real difference to the health of a mother and child.

While the survey covers the globe, Green said her organization focuses its advocacy efforts on the U.S. government.

"We focus our advocacy particularly on the U.S. because the U.S. as a donor country plays an important role supporting reproductive health programs in other countries."

Some of PAI's positions are at odds with the family planning policies of President George W. Bush. Green said PAI was distressed by the new president's decision in January to reinstate a ban on U.S. economic aid to international organizations that include abortion as a family planning option. One of the president's election campaign themes was his opposition to abortion.

Nevertheless, Green said PAI will continue to press the U.S. government to devote more of its foreign economic assistance resources to reproductive health. She said PAI "can make a difference," because "we know what works."

(The full report is available at )