Statistique, Développement et Droits de l‘Homme Session C-Pa 5c Indicators of Population Aspects of Human Rights: Some Operational Issues Ranjan K. SOM Montreux, 4. – 8. 9. 2000 Statistique, Développement et Droits de l‘Homme Indicators of Population Aspects of Human Rights: Some Operational Issues Ranjan K. SOM Consultant in Population and Statistics 30 Waterside Plaza, Ste. 24A New York, NY 10010-2625, USA T. / F. + 1 212 685 6917 r.som@worldnet.att.net ABSTRACT Indicators of Population Aspects of Human Rights: Some Operational Issues The paper attempts to review a number of operational issues relating to „core“ indicators of some population aspects of human rights. The fields covered concern people ─ access to safe water, access to adequate sanitation, family planning information and services; children ─ infant and early childhood mortality, extent of immunization, and child labour (all these separately for male and female children); and women ─ differential life expectancy at birth, differential enrolment ratios, pregnant women immunized against tetanus, births attended trained health personnel, and female genital mutilation. Desirable and available data and their source are discussed. These are reviewed in the background of the recently celebrated 50th anniversary of the Universal Declaration of Human Rights of the United Nations, and its re-affirmation and adoption of targets by the United Nations and its various specialized and operating agencies. The general operational issues raised concerning indicators are: What should be the criteria for indicators? What are the basic data sources for the indicators, and what are their advantages and limitations? At what intervals should the data be obtained? And, finally, what should be the protocols for data collection, analysis, and publication? RESUME Indicateurs des aspects des droits de l'homme liés à la population : quelques questions opérationnelles Ce document tente de passer en revue les problèmes opérationnels liés aux indicateurs de point de vue de la population sur les droits de l'homme. Les domaines couverts concernent d’une part les enfants, la mortalité chez les nourrissons et chez les jeunes enfants de sexe masculin et féminin, l'étendue de la vaccination et l'accès à l'eau potable, et les femmes d’autre part, l’espérance de vie à la naissance et les mutilations génitales qu'elles subissent. Ces domaines traitent aussi des données statistiques souhaitées et disponibles et de quelques problèmes de fonctionnement liés. Ces derniers ont été réexaminés dans leur fond lors du cinquantième anniversaire de la Déclaration universelle des droits de l'homme récemment célébré avec ses nombreuses réaffirmations et la fixation d'objectifs que se sont fixés les Nations Unies et ses nombreux 2 Montreux, 4. – 8. 9. 2000 Statistique, Développement et Droits de l‘Homme organismes spécialisés tels que le Bureau du Haut Commissaire aux droits de l'homme, le PNUD, l'UNICEF, l'OMS et le FNUAP. Enfin, un certain nombre de questions de fonctionnement d’ordre général lié aux indicateurs ont été soulevées et des éléments de réponses ont été apportés : Pourquoi des indicateurs ? Quels devraient être les critères de ces indicateurs ? Comment obtenir ces indicateurs ? Quelles sont les sources de données : rapports administratifs, statistiques sur les services, documents hospitaliers et cliniques, recensement de la population, statistiques vitales, extraits de sondages incluant des sondages par téléphone et des procédés d'évaluation rapide et ses risques. A quelle fréquence obtenir les données pour les indicateurs ? Et quels devraient être les protocoles pour la collecte des données et leurs analyses ? 1. Introduction: Human Rights and Population Issues Very soon after its establishment, the United Nations adopted in 1948 the Universal Declaration of Human Rights: its 50th anniversary, commemorated only two years ago, was also the occasion for the United Nations and its specialized and executing agencies to review the extent to which human rights in all its aspects were being observed throughout the world: to that end, efforts have been made to define adequately Common Country Assessment (CCA) and to develop indicators to measure the progress in implementing these rights. Some of the agencies and offices of the United Nations relevant to this endeavour are: Office of the Commissioner for Human Rights (UN/HR), United Nations Development Programme (UNDP), United Nations Children’s Fund (UNICEF), World Health Organization (WHO), International Labour Organisation (ILO), and United Nations Population Fund (UNFPA). UNDP has adopted human rights as the theme for its Annual Development Report for the year 2000. A millennium Survey of 57,000 adults in 60 countries conducted by Gallup International in 1999 found that respondents showed widespread dissatisfaction with the level of respect for human rights (United Nations, 2000, Box 1). Furthermore, „(a)t the start of the new millennium a quarter of the world’s children, most of them in poor countries, remain unprotected against the six core diseases: polio, diphtheria, whooping cough, measles, tetanus and tuberculosis.“ (United Nations, 2000, Box 2). Reproductive Choice has also been recognized as a basic human right by international organizations by various international conference on human rights, population, and development: the UN Committee on the Elimination of Discrimination Against Women (CEDAW) monitors access to fam family planning as an important indication of women’s situations. Guidelines for indicators reviewing and an lysing national development situations have been provided by several United Nations offices, vide United Nations (1993) on indicators to measure achievements on economic, social, and cultural rights; UN (1999a) on the implementation of major United Nations conferences and summits; UN (1999b) and (1999c) on the guidelines and indicators for CCA; UN (1999e) on the definition and indicators for civil and political rights and international legal commitment for human rights. In the fields of children, mothers, and women, including infant, early childhood and maternal mortality, the situations have been discussed in, among others, UNICEF (1999a and 1999b), UNDP (1999), UNFPA (1997a, 1997b, and 1998), WHO (1996, 1997a, 1997b, and 1998) and WHO & UNICEF (1995). This paper attempts to review a number of operational issues relating to „core“ indicators of population aspects of human rights. We shall consider the following population and related variables: (a) Population: (a1) with access to safe water, (a2) with access to adequate sanitation, and (a3) life expectancy at birth, by sex; (b) Children’s Concerns: (b1) malnourished children under 5, by sex, (b2) immunized children under 5, by sex, and (b3) child labour ─ (b3i) in household enterprises and (b3ii) in the organized sector, by sex; (b4) primary enrolment ratio, by sex; and (b5) secondary enrolment ratio, by sex; (b6) infant mortality rate, by sex, and (b7) early childhood 3 Montreux, 4. – 8. 9. 2000 Statistique, Développement et Droits de l‘Homme (under age 5 years) mortality, by sex; (c) Family and maternity – (c1) pregnant women immunized against tetanus; (c2) births attended by trained health personnel; (c3) maternal mortality, (c4) Family planning information to couples, (c5) family planning services to couples, (c6) Treatment of infertility, and (c7) Abolition of harmful practices, such as female genital mutilation (FMG). We shall consider feasible indicators and the availability of statistics at the international level. 2. Indicators for (a) - (c) The mid 1990-decade assessment by the UN, UNICEF, UNFPA, UNDP, WHO, UNESCO, and ILO, among others led to 100 countries collecting data using the Multiple Indicator Cluster Surveys (MICS), household surveys developed specifically to obtain mid-decade data, or via MICS questionnaire modules carried by other surveys; by 1996, sixty developing countries had carried out stand-alone MICS, and another 40 had incorporated some of the MICS modules in other surveys, Since then the end-decade MICS questionnaires and manuals have been developed to obtain the data for 63 of the 75 end-decade indicators (UNICEF, 2000). Most of the indicators are conveniently available in UNDP’s Human Development Report 1999 (UNDP, 1999) and in UNICEF’s The State of the World’s Children 1999 (UNICEF, 1999). A large number of countries are preparing country Human Development Reports under the umbrella of UNDP. Governmental organizations such as the U.S. Bureau of the Census, and non-governmental organizations such as Johns Hopkins University/Population Information Program, International Planned Parenthood Federation, Population Council, and Population Reference Bureau, also collect information relevant to some of the indicators. 3. Criteria of Acceptable Indicators A number of criteria, i.e., principles or standards by which the indicators should be judged, have been mentioned in the WHO Guidelines (WHO, 1997): we adapt them to the following set of criteria: • Purposeful or useful; • Scientific; • Statistically robust; and • Reductionist. The first criterion holds that the indicators should be purposeful and useful, i.e., they should be action-oriented and meet the objectives at hand. The second criterion holds that the indicators should be scientific, i.e., they should be built up by using methods based upon well-established facts and obeying well-established laws; and they should be replicable under the same conditions within acceptable instrumental or statistical margins of error. Any estimates obtained by sampling should be based upon the laws of probability and should be presented with margins of error. The third criterion holds that indicators should be statistically robust, i.e., that they should not be affected by small variations in the input. The fourth criterion holds that the indicators should preferably be obtained by a procedure or theory that reduces complex data or phenomena to simple terms (vide Marder, 1997), applying, as necessary, Occam’s razor – by taking, among several hypotheses, the simplest hypothesis with the fewest possible assumptions. 4. Direct and Indirect Estimates As direct estimates are not often available, several „indirect“, including „model-based“, estimates have been suggested for some of the indicators. These have been considered by the 4 Montreux, 4. – 8. 9. 2000 Statistique, Développement et Droits de l‘Homme UNFPA CST/TSS Thematic Workshop on Indicators, New York, 10-14 February 1997 (UNFPA, 1997a), and, for maternal mortality the WHO Inter-Agency Consultative Group Meeting (WHO, 1999; also see UNFPA/Leete, 1998). For a review of indirect and model-based estimates, see Blacker (1966), Som (1998), United Nations (1983, Introduction, Section A, and Chapter 1, Section B), and U. S./OMB (1993). In regard to indirect estimates, the following is stated in the U.N. Demographic Manual X: „The classic example is the use of the proportion of children dead among those ever borne by women aged 20-24 years to estimate the probability of dying before age 2. The observed proportion of children dead is clearly related to mortality conditions, but it is a pure mortality measure because it is affected by other, non-mortality parameters. In order to transform the proportions into the desired life-table functions, the other parameters must be allowed for, generally by using procedures founded on demographic models. Therefore, not only is the information used „indirect“, but the but the procedure followed although considerably simplified in practice, is by no means straightforward theoretically (italics ours). The extent of indirectness varies greatly, however, among procedures, in terms both of the reliance on model and of the number of unwanted factors that have to be allowed for.“ (U.N., 1983, chapter 1, section B). „Perhaps the most serious limitation of Manual X is that it does not provide sufficient guidance for the assessment of results. [ (T)he task of assessment is extremely complex, varying widely from application to application. Hence, it is almost impossible to lay down general rules to perform it“ (U.N., 1983, Introduction, section A). In regard specifically to model-based estimated, the U.S. Office of Management and Budget (OMB) says: „The need for indirect estimators is the greatest in precisely those situations where data are not available for the adequate empirical evaluation. For this reason, it is rare that a single empirical evaluation of an indirect estimator is completely convincing (italics ours). […] Two approaches can be used for empirical evaluations of indirect estimators. In the first, estimators under consideration are used to produce estimates; these estimates are then compared to a better estimate. […] The second approach is to evaluate how well the models associate with the competing estimators fit the data. A principled approach is needed; models should not only fit the data but also have a conceptual basis (italics ours). [] Rarely is enough known about the error structure of indirect estimators to produced adequate measures of their quality. For this reason, it is misleading [ and dangerous [ to publish indirect estimates that are not clearly distinguished from direct estimates and that are not offered with appropriate caution“ (italics ours) (U.S., OMB, 1993). Another caveat to the use of indirect estimates is the subjective judgement involved, resulting in widely varying estimates. 5. Data Sources The sources of relevant data could be: (a) Administrative and Health Records; (b) Administrative Education Records; (c) Population and Housing Censuses; (d) Survey Sampling: Household; Demographic; DHS (Demographic & Health Surveys); EPI (Expanded Programme on Immunization); MICS; Rapid Assessment Procedures; half n-ple sampling (Lahiri’s Method, see Som, 1998); Network Sampling; Adaptive Sampling; Telephone Surveys; and Internet Sampling. We consider briefly the characteristics of these procedures. The advantages and limitations of household, Demographic, DHS, and EPI-types of surveys are fairly well known. The other techniques mentioned in the previous paragraph are of relatively recent origin. With near-universal telephone facilities in households in most developed countries, telephone Surveys with Random Digital Dialing (RDD) was considered a cheap and efficient source of collecting data, particularly using computer-assisted telephone interview (CATI). However, many 5 Montreux, 4. – 8. 9. 2000 Statistique, Développement et Droits de l‘Homme telephones are unlisted or have unsolicited message blocking and message screening features (in the U.S.A., the percentage of telephone with answering device has increased from 68 per cent in 1988 to 74 percent in 1995, over half of which using these answering devices to screen calls (Council for Marketing and Opinion Research, 2000): now some polling organizations in the U.S. have gone back to paper and pencil interview (PAPI). In most developing countries, telephones facilities are infrequent, so that this techniques cannot be used. Internet was also hailed as the precursor of data collection techniques in the electronic age. However, the universe of internet users is highly skewed, with a „digital divide“, and cannot now form a basis for collection of relevant data on population and human rights. In the latest World Population Prospects, the United Nations (1999c) reports that while data on child mortality are available in 8 out 10 European countries with economies in transition, and in 9 out of 10 industrialized countries with market-economy, such data are available in only 1 out of 4 countries in sub-Saharan Africa, and in half of countries in other developing regions. We give in Table 1, possible data sources for the relevant indicators and also indicate their international availability. Table 1. Some Indicators of Human Rights in the Fields of Population, Reproductive Concerns, and Children’s Concerns: By Items and Data Source and International Availability Item Data Source and International Availability Administrative Records Population & Housing Census Survey Sampling Estimates (from various sources) DHS; MICS UNICEF; WHO DHS; MICS UNICEF; WHO (a) Population (a1) % with access to safe water (a2) % with access to adequate sanitation (a3) Life expectancy at birth, by sex Country (limited) Country (limited) UNPopDiv; UNICEF; UNDP (b) Children’s Concerns (b1) % of malnourished children under 5, by sex (b2) % of immunized children under 5: by sex (b3i) % of school-age child labour in household enterprise, by sex (b3ii) % of schoolage child labour in the organized sector, by sex (b4) primary enrolment ratio by sex (b5) Secondary enrolment ratio by sex (b6) Infant mortality by sex WFS;DHS; EPI (WHO/UNICEF); MICS UNICEF; UNDP UNICEF UNStat; ILO WFS;DHS; EPI (WHO/UNICEF); MICS WFS;DHS;MICS UNStat, ILO WFS;DHS;MICS ILO ILO UNESCO UNStat UNICEF UNESCO UN Stat UNICEF Country (limited) WFS; DHS, MICS 6 Montreux, 4. – 8. 9. 2000 UNPopDiv; UNStat; UNICEF Statistique, Développement et Droits de l‘Homme Item Data Source and International Availability Administrative Records (b7) Under 5 mortality rate by sex Population & Housing Census Country (limited) Survey Sampling Estimates (from various sources) WFS; DHS; MICS UNPopDiv; UNStat; UNICEF (c) Family and Maternity (c1) % of pregnant women immunized against tetanus (c2) % of births attended by trained health personnel (c3) Maternal Mortality Rate (c4)Family planning Information to couples (c5) family planning services to couples Country (limited) DHS; MICS UNICEF Country (limited) WFS; DHS; MICS UNICEF Country (limited) WFS, DHS, MICS Country (limited) WFS, DHS, MICS Country (limited) WFS;DHS;MICS (c6) Treatment of Infertility (c7) Harmful Practices - FGM Country (limited) WFS, DHS, MICS UN PopDiv, UNStat; UNICEF UN PopDiv; UNStat; UNICEF UNFPA UNPopDiv; UNStat; UNICEF; UNDP; UNFPA UNFPA Country (limited) UNFPA 6. Frequency of Data Collection for Indicators In the flux of constant change, a system of recording observations at fairly small but feasible intervals, such as every six months, should be established for data in which the changes which are sought to be measured over time have to be obtained from small samples. For other items, on the relative values of which interest is focussed, data could be collected at longer intervals, perhaps even as long as five years: the latter could be made to coincide with inter-censal household or demographic surveys that are part of the statistical system of many a country. 7. Protocols for Data Collection, Analysis, and Publication In the present context, a protocol could be defined as a detailed plan of a scientific experiment, treatment or procedure. In the field of human, social and state intentions and practices, relating to their public and personal lives, protocols for data collection and analysis should obviously be established to secure the data and safeguard the interests of the interviewed public. Within the United Nations system, the lead agencies – UN/HR, UNICEF, WHO, UNDP, and UNFPA – should obviously be entrusted with the task. The United States Bureau of the Census has already established protocols for pretesting demographic surveys (1993). Among the items of protocols, could be mentioned the following: a) Data collection: · Clear terms and definitions: For example, the statement „For statistical purposes only“ implied to many teenagers and foreign language background respondents that the government was keeping a record (U.S. OMB, 1986). · Open-ended v. Close-ended questions. When best to ask open-ended questions: – When all the appropriate response category choices are not known or are too long. – When information on sensitive attitudes and behavior is ought, · No prompting for information on sensitive items. 7 Montreux, 4. – 8. 9. 2000 Statistique, Développement et Droits de l‘Homme b) Confidentiality of the data: What is to be done on HIV/AIDS prevalence – report to the public health authorities? Inform a pregnant mother and arrange for proper medical care ? c) Ethical considerations: When abortion or female genital mutilation, that have been declared illegal in a number of countries, occurs, what to do about recording the data? 8. Concluding Remarks There are many gaps in the available indicators on population issues relevant to human rights. The sub-national indicators, relevant for countries such as China and India, are also not generally available. The gaps have to be filled in the basic data (e.g., on infant and child mortality, by sex: see section 5 above) by the concerted action of the international community. The quest for perfect indicators has to be tempered by the realization that the best is often the enemy of the good and that the permissible margin of error, i.e., the range of scientifically obtained estimates, within which the policy decision would remain the same, might be satisfied with a relatively small sample. To take an example, during the depression of the 1930's in the U. S. A., when it was not known whether the unemployed numbered five or fifteen million, the first sample did not necessarily have to be large to be useful; but now refined techniques are used to measure if the unemployment rate has changed by ¼ per cent (Kish, 1971). Acknowledgment I wish to acknowledge the cooperation, including provision of documents and discussions, received from U.N. officials at HR/New York, UNDP, UNICEF, UNFPA, UN Statistics Division , and UN Population Division. The views expressed are my own and not those of the offices or their officials. REFERENCES Blacker, J. G. C. B (1966), in Kenya Statistics Division (1966), Kenya Population Census, 1962, Vol. III, African Population, Ministry of Economic Planning and Development, Nairobi. Council for Marketing and Opinion Research (2000. Results: Telephone Survey Practices Study, Presentation at American Association of Public Opinion Research, New York Chapter, 30 March 2000: Fact sheet. Port Jefferson, New York. Kish, Leslie J. (1965). Survey Sampling, Wiley, New York. Reprint, 1995 Marder, Eric (1997). The Laws of Choice. Free Press, Glencoe, Illinois. Som, R. K. (1998). 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ABBREVIATIONS USED CCA: CEDAW : DHS : EPI : ILO : MICS: UN : UNICEF : UNDP : UNFPA : UN/HR : UN/HR/NY : UNESCO: UNPopDiv : Common Country Assessment UN Committee on the Elimination of Discrimination Against Women Demographic and Health Surveys Expanded Programme on Immunization International Labour Organisation Multiple Indicator Cluster Surveys United Nations United Nations Children’s Fund United Nations Development Programme United Nations Population Fund United Nations Office of the High Commissioner for Human Rights Office of the High Commissioner for Human Rights, New York United Nations Educational, Scientific and Cultural Organization United Nations Population Division 10 Montreux, 4. – 8. 9. 2000 Statistique, Développement et Droits de l‘Homme UNStat : U.S. OMB : WFS : WHO : United Nations Statistics Division United States Office of Management and Budget World Fertility Surveys World Health Organization 11 Montreux, 4. – 8. 9. 2000