Inside the Rankings
These pages explain the methods we used to build the Sexual Health Rankings™ composite index and ranking system, including the underlying conceptual framework, our indicator selection criteria, how we calculated state scores, and how component indicators are weighted.
why build a composite index
No matter how well informed and technically sophisticated a person may be, it is difficult to keep track of many different statistics measuring various aspects of sexual health, and understand how they are all interrelated. A composite index folds these data into one simple, functional measure.
why rank the states
In our federal system of government, individual states have powers to control conditions that affect sexual health. Differences in state laws, health systems, and social and economic conditions can produce variation in the overall sexual health of state populations. National policies and programs aimed at improving sexual health should account for variation across states. Comparing states by ranking them highlights each state's strengths and challenges, and suggests opportunities for action.
Sexual Health Rankings™ is based on a holistic, positive concept of sexual health, first advanced by the World Health Organization (WHO), that is widely accepted by authorities in the health and social sciences.
WHO defines sexual health as:
"... a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled."
WHO, 2006 Defining Sexual Health: Report of a Technical Consultation on Sexual Health, 28–31 January 2002, Geneva
WHO further defines the terms "sexuality" and "sexual rights" as follows:
SEXUALITY is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors.
SEXUAL RIGHTS embrace human rights that are already recognized in national laws, international human rights documents and other consensus statements. They include the right of all persons, free of coercion, discrimination and violence, to:
- the highest attainable standard of sexual health, including access to sexual and reproductive health care services; seek, receive and impart information related to sexuality;
- sexuality education;
- respect for bodily integrity;
- choose their partner;
- decide to be sexually active or not;
- consensual sexual relations;
- consensual marriage;
- decide whether or not, and when, to have children; and
- pursue a satisfying, safe and pleasurable sexual life.
The responsible exercise of human rights requires that all persons respect the rights of others.
For the purpose of constructing this composite index, we have condensed the WHO definition into five fundamental elements.
ELEMENTS OF SEXUAL HEALTH
- Ability of individuals to have control over, and freely decide on, their own sexual behavior and experiences
- Ability of individuals to decide freely on whether, and when, to procreate
- Freedom from discrimination and violence related to sexuality and gender
- Experience of sexual pleasure and satisfaction
- Freedom from sexual morbidity, including HIV/AIDS and other sexually transmitted infections.