All women should have access to skilled care during pregnancy and childbirth to ensure prevention, detection and management of complications. Assistance by properly trained health personnel with adequate equipment is key to lowering maternal deaths. As it is difficult to accurately measure maternal mortality, and model-based estimates of the maternal mortality ratio cannot be used for monitoring short-term trends, the proportion of births attended by skilled health personnel is used as a proxy indicator for this purpose. This is an MDG indicator.
Definition:
The proportion of births attended by skilled health personnel.
Numerator:
The number of births attended by skilled health personnel (doctors, nurses or midwives) trained in providing life saving obstetric care, including giving the necessary supervision, care and advice to women during pregnancy, childbirth and the post-partum period; to conduct deliveries on their own; and to care for newborns.
Denominator:
The total number of live births in the same period.
Method of measurement
The percentage of births attended by skilled health personnel is calculated as the number of births attended by skilled health personnel (doctors, nurses or midwives) expressed as total number of births in the same period.
Births attended by skilled health personnel = (Number of births attended by skilled health personnel / Total number of live births) x 100
In household surveys, such as the Demographic and Health Surveys, the Multiple Indicator Cluster Surveys, and the Reproductive Health Surveys, the respondent is asked about each live birth and who had helped them during delivery for a period up to five years before the interview.
Service/facility records could be used where a high proportion of births occur in health facilities and therefore they are recorded.
M&E Framework:
Outcome
Method of estimation:
The data compiled here are from the nationally representative Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS).
In terms of survey data, some survey reports may present a total percentage of births attended by a type of provider that does not conform to the MDG definition (e.g., total includes provider that is not considered skilled, such as a community health worker). In that case, the percentage delivered by a physician, nurse, or a midwife are totaled and entered into the global database as the MDG estimate.
Predominant type of statistics: adjusted
Method of estimation of global and regional aggregates:
Regional and global aggregates are weighted averages of the country data, using the number of total live births as a proxy for live births among adolescents (aged 15-19). No figures are reported if less than 50 percent of the live births in the region are covered.
Other possible data sources:
Facility reporting system
Preferred data sources:
Household surveys
Expected frequency of data dissemination:
Annual
Comments:
The indicator is a measure of a health system’s ability to provide adequate care for pregnant women. Concerns have been expressed that the term skilled attendant may not adequately capture women’s access to good quality care, particularly when complications arise.
In addition, standardization of the definition of skilled health personnel is sometimes difficult because of differences in training of health personnel in different countries. Although efforts have been made to standardize the definitions of doctors, nurses, midwives and auxiliary midwives used in most household surveys, it is probable that many skilled attendants’ ability to provide appropriate care in an emergency depends on the environment in which they work.
If you have any feedback, you are welcome to write it here.
If you need to access the old Global Health Observatory data, you can do it here. But before you leave, please provide us your feedback about our new data portal.
