Reproductive rights approach to reproductive health in developing countries

Figures & data

Fig. 1.  A rights-based model of reproductive health in developing countries.

Table 1. Variables and their definitions

Variables related to reproductive health
Prenacar	Percent pregnant women who received prenatal care.
Daskill	Percent deliveries attended by skilled attendant.
Matmort1	Maternal mortality ratio (per 100,000 live births).
Tfr	Total fertility rate (births per woman)
Stunted	Percentage of children stunted is the percentage of children under 5 years who have a height-for-age below minus two standard deviations of the National Center for Health Statistics (NCHS)/WHO reference median.
Birthw	Births per 1,000 women aged 15–19.
Infantm	Infant deaths per 1,000 births
Variables related to reproductive rights
Materind	This is an index composed of two variables. Leave: length of maternal leave (days). Second is the percentage of wages paid in covered period I, both variables were standardized and added to get the index ‘Materind.’
Wosoc1	It is extent of social rights. It is coded 0 if there are no social rights for women under law. Coded 1 if there are a few social rights for women under law. Coded 2 if there are some social rights for women under law Finally, it is coded 3, if almost all of women's social rights are guaranteed by law.
Adoptidx	This is an additive index composed of whether they signed or not (signatory or not); the type of agreement and number of authorities score. The type of agreement is scored as 6 for Ratification, 5 for accession, 4 for accession giving rise to an acceptance procedure, 3 for continuation, 2 for succession, 1 for denunciation, and 0 for no agreement.
Contra1	Contraceptive prevalence rate (%)
Variables related to gender equality
Wenrol	Women's share of third level enrolment in percentage
Agedif	Singulate mean age at marriage, women – singulate mean age at marriage, men
Litdif
Seat	Seats in parliament held by women (% of total)
Variables related to democracy
Demindex	This is the economists’ intelligence Unit's index of democracy. The index is based on electoral process and pluralism, civil liberties, the functioning of the government, political participation, and political culture
Compete	This is one of the indicators of the well-known Vanhanen scale. It is calculated by subtracting the percentage of votes won by the largest party from 100. If data on the distribution of votes are not available, the value of this variable is calculated on the basis of distribution seats in the parliament 71.
Partici	This is another indicator from the Vanhanen scale. The value of this variable is calculated from the total population, not from the total or enfranchised population.
So4	The Political Terror Scale. Level 1: These countries enjoy secure rule of Law. Level 2: In these countries, there is a limited amount of imprisonment for non-violent political activity. Political murder is rare. Level 3: There is extensive political imprisonment, or a recent history of such imprisonment. Level 4: The practices of level 3 are expanded to larger numbers. Murders, disappearances and torture are a common part of life. Level 5: The terrors of level 4 have been expanded to the whole population.
Variables related to social development
Gini1	Gini index
Pubexp1	It is the proportion of allocation for public health expenditure percent of GDP
Ecoind1	Average of indicators of land (land diversity and quality indicators), water (use and quality indicators), air (global and national indicators), species and genes (biodiversity indicators), and resource use (energy and materials consumption indicators). A higher score indicates greater ecosystem health.
Tele.	It is the average score of two indicators: telephone and Internet users per 10,000 population. A higher value indicates a greater level of communication.
Adultlit:	Adult literacy rate (% ages 15 or above)
Variable related abortion availability
Abindex	This is an index of three indicators: level of legal support for abortion; level availability of emergency contraception; level of access to EC (Prescri). Level of availability of emergency contraception (EC) is coded as follows. 0: no EC available; 1: [Progestin only] available 2: [Progestin+Estrogen Combined] available. 3: Both available and the variety of services. The level of access to EC is coded as follows: 1=if no EC available 2=if doctors’ prescription is needed to get EC; 3=available from the pharmacist; and 4=available at the counter. Availability of abortion is coded as follows. Available on request, 5; Permitted on broad social and health grounds, 4; Permitted on limited health grounds, 3; Permitted only for special cases (Rape, incest, to save a woman's life), 2; and illegal or permitted only to save a woman's life is coded 1. All three variables are standardized and added.
Variable related to economic development
Gdpind	GDP per capita (PPP US$)

Table 2. Descriptive statistics for all variables in the reproductive rights–reproductive health model^a

Variable	Mean	SD	N of cases
Prenacar	77.5588	21.31176	106
Daskill	66.4952	29.63568	113
Birthwo	−77.4634	51.23799	134
Tfr	3.5410	1.71329	134
Matmort1	277.7637	262.44864	117
Infantm	49.2702	36.88324	134
Stunted	25.1874	12.74087	140
Materind	60.5652	16.44313	136
Wosoc1	1.1901	0.89072	125
Adoptidx	1.6456	3.38268	140
Contra1	45.7880	21.72629	104
Wenrol	43.5608	12.33713	82
Litdif	10.24456	−6.5735	130
Agedif	−3.7548	1.71475	130
Seat	14.1449	8.83272	133
Demindex	5.0264	1.89037	131
Compete	35.4573	19.12024	121
Partici	34.3521	12.09552	121
So4	−2.7324	1.02394	136
Gini1	42.4956	8.97022	98
Ecoind1	−46.7255	12.38403	140
Pubexp1	54.5964	19.41691	123
Adultlit	77.1853	20.84435	137
Tele	19.0451	20.61147	140
Abindex	01.7613	0.45790	142
Gdpind	0.5930	0.1476	0.142
Valid N (142)

^aThese statistics are for all variables in the model before imputation for missing values.

Table 3. Factor loadings, reliability, and goodness of fit of variables from measurement models for the latent constructs in the reproductive rights–reproductive health model

Latent variable	Observed	Slope	Scale reliability	Goodness of fit
Social	Tele	0.786	0.791	CFI=1.00
Development	Adultlit	0.986		Rmsea=0.00
	Pubexp1	0.332		Hoelter=21,512
	Ecoind1	0.458
	Gini1	−0.217
Democracy	So4	0.702	0.482	CFI=1.00
	Partici	0.411		Rmsea=0.102
	Compete	0.462		Hoeter=236
	Demindex	0.922
Gender	Seat	0.190	0.762	CFI=1.00
Equality	Agedif	0.880		Rmsea=0.06
	Litdif	0.868		Hoelter=256
	Wenrol	0.809
Reproductive rights	Materind	0.449	0.559	CFI=1.00
	Wosoc1	0.553		Rmsea=0.00
	Adoptidx	0.546		Hoelter=473
	Contra1	0.508
Reproductive health	Prenacar	0.665	0.892	CFI=1.00
	Tfr	−0.917		Rmsea=0.00
	Marmort1	−0.891		Hoelter=375
	Infantm	−0.889
	Stunted	−0.766
	Birthwo	−0.789
	Daskill	0.860

Table 4. Validating hypothesis that reproductive health–social developmentis a two factor model versus it is one factor model

One-factor model	Two-factor model
Indicators	Reproductive health factor loading	Reproductive health factor loading	Social development factor loading
Prenacar	0.701	0.701
Tfr	−0.911	−0.903
Matmort1	−0.917	−0.926
Infantm	−0.879	−0.877
Stunted	−0.750	−0.752
Birthwo	0.767	0.758
Daskill	0.904	0.907
Gini1	−0.333		−0.345
Ecoind1	0.594		0.581
Pubexp1	0.325		0.407
Adultlit	0.811		0.806
Tele	0.681		0.642
CFI=0.919			CFI=0.962
RMSEA=0.116			RMSEA=0.098

Fig. 2.  Structural equation model of reproductive rights and reproductive health.3 See Table 3 for variable names of latent constructs.

Table 5. Structural equation analysis of reproductive rights–reproductive health model: structural parameter estimates (standardized)

Economic development	→	Gender equality=0.397*
Democracy	→	Gender equality=0.986*
Gender equality	→	Reproductive rights=0.174*
Social development	→	Reproductive rights=0.984*
Gender equality	→	Reproductive rights=0.174*
Economic development	→	Reproductive health=−.180
Reproductive rights	→	Reproductive health=0.934*
Abortion rights	→	Reproductive health=0.082*
Goodness of fit		CFI=0.944; RMSEA=0.060; Hoelter=105

*=p<0.05.

Fig. 3.  Reproductive rights as a mediating variable.

Vanhanen T. Democratization: a comparative analysis of 170 Countries. Routledge. New York, 2003

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