Indicators

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 working within an enabling environment is key to lowering maternal and newborn 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 indicator in the Sustainable Development Goals framework (indicator 3.1.2).

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 lifesaving 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.

Age, Location (urban/rural)

The percentage of births attended by skilled health personnel is calculated as the number of births attended by skilled health personnel (doctor, nurse and/or midwife) expressed as total number of life 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.

Outcome

Data for global monitoring are reported by UNICEF and WHO. These agencies obtain the data from national sources, both survey and registry data. Before data can be included in the global databases, UNICEF and WHO undertake a process of data verification that includes correspondence with field offices to clarify any questions. 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 SDG 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. Predominant type of statistics: adjusted

 Regional and global aggregates are weighted averages of country data (latest available year), using the number of live births for the reference year in each country as the weight. No figures are reported if less than 50 per cent of the live births in the region are covered.

N/A

Annual

Annual

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. Efforts are on-going to clarify definitions related to skilled health personnel, see http://www.who.int/reproductivehealth/skilled-birth-attendant/en/.  

choud@who.int

Doris Chou