Comparative analysis of 2 approaches to monitor countries' progress towards full and equal access to sexual and reproductive health care, information, and education in 75 countries: An observational validation study.

Differences in total indicator values comparing the alternative versus current formulation ranged from -7.18 percentage points in Mali to 26.21 percentage points in South Sudan.

• The study used secondary data from the 2022 UNFPA Sexual and Reproductive Health and Rights Country Profiles from 75 countries.
• The majority of countries (n = 47) had an increase in total indicator score under the alternative formula.
• 27 countries had a decrease in score under the alternative formula.
• Only 1 country, Sweden, saw no change in score, as it scored 100% of the possible indicator value under both rubrics.

The mean difference between scores produced by the two measures was 2.28 percentage points, suggesting the two methods may produce systematically different results.

• Convergent validity was assessed using the Bland-Altman approach.
• The mean difference of 2.28 indicates a systematic rather than random difference between the two scoring approaches.
• The current formula uses a mean of 13 individual component scores, while the proposed formula uses a weighted additive approach assigning equal weight to substantive domains.

The current indicator calculation assigns a score of zero for Component 3 (Abortion) to 16 countries, masking important differences in the number of legal barriers present and whether women can be criminally charged for illegal abortion.

• Under the alternative formulation, which re-expresses barriers on a positive scale, only 4 countries have a score of zero for Component 3.
• The most substantial changes under the alternative formulation were observed in scores for 'Component 3: Abortion.'
• The current formula's treatment of abortion-related barriers results in loss of discriminatory information across countries.

The proposed revision involved two specific changes to the indicator's calculation: re-expressing all barriers and enablers as positive values, and using a weighted additive approach rather than a mean of 13 individual component scores.

• The weighted additive approach assigns equal weight to substantive domains rather than to individual components.
• The study used data from 75 countries drawn from the 2022 UNFPA Sexual and Reproductive Health and Rights Country Profiles.
• These proposed changes were designed to address global recommendations and concerns noted about the current SDG Indicator 5.6.2 calculation.

The authors acknowledged that the absence of a gold standard for measuring the phenomenon under study means it is not possible to specify with total certainty which indicator formulation performs better.

• This was identified as the main limitation of the methodology.
• Despite this limitation, the authors concluded that the current indicator formulation has underlying challenges that impact its interpretability.
• The proposed changes could alter understanding of the current legal landscape governing sexual and reproductive health, thereby pointing to different programmatic and policy priorities.