SKILLED ATTENDANT AT BIRTH

MDG 5, TARGET 5A, INDICATOR 5.2

Workshop on MDG monitoring to 2015 and beyond

Bangkok 9-13 July 2012Liliana CarvajalUNICEF

MDG 5 – Improve maternal health

Target 5.a – Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Indicator 5.2– Proportion of births attended by skilled health personnel

Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

Skilled attendant at birth

Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

Skilled attendant at birth

Background

Every year…. 287,000 maternal deaths For each maternal death 20 women suffer

injuries or disabilities related to pregnancy/childbirth

Approximately 3 million neonatal deaths

Greatest mortality risk for both mothers and children is during

delivery and immediately after birth

Who is a skilled attendant?

A skilled attendant is an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth, and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.

Traditional birth attendants, who are not formally trained, do not meet the definition of skilled birth attendants.

Source: 2004 Joint statement by WHO, ICM and FIGO, endorsed by UNFPA and the Word Bank

Why does it matter?

The presence of a trained health-care worker during delivery is crucial in reducing maternal deaths.

The single most critical intervention for safe motherhood is to ensure a skilled birth attendant is present at every birth, and transport is available to a referral facility for obstetric care in case of emergency.

A skilled health professional can administer interventions to prevent and manage life-threatening complications, such as heavy bleeding, or refer the patient to a higher level of care when needed.

Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

Skilled attendant at birth

Asian countries – coverage of skilled attendance at delivery

* Latest data value is for 2005, 2006

around

Skilled attendant at birthProportion of births attended by skilled health personnel,around 1990 and around 2009 (Percentage)

Developing regions – moderate progress from 55 per cent in 1990 to 65 per cent in 2009.

Sub-Saharan Africa and Southern Asia: substantial progress but more needs to be done as the majority of maternal deaths occur in these regions.

Source: MDG report 2011

Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

Skilled attendant at birth

Standard Indicator

Skilled attendant at deliveryProportion of women age 15-49 years with a live birth in the 2 years preceding the survey who were attended during childbirth by skilled health personnel

Note:Skilled provider means: DoctorNurse Midwife (and auxiliary midwife when appropriate)

Sources

The proportion of births attended by skilled health personnel is typically calculated from data collected through national household surveys including: Multiple Indicator Cluster Surveys (MICS) Demographic Health Surveys (DHS), Reproductive Health Surveys and sometimes from data collected from

administrative registrations.

Eligibility

Women of reproductive age (15-49 years)

Live birth in the two or five years preceding interview

Household survey – women’s questionnaire

Who assisted with the delivery of your last baby?

Skilled birth attendants

Household survey – women’s questionnaire

Multiple categories of skilled personnel

Questionnaires need to be adapted carefully at the country level

Do these additional categories meet the standard to be considered skilled?

Reporting of skilled attendants Bangladesh example: Medically trained providers include -

Qualified doctor, Nurse/midwife/paramedic, Family welfare assistant FWV, Community skilled birth attendant CSBA

Are all these categories skilled? For global reporting, confirmation from countries is needed for extra categories

Reporting of skilled attendants Bhutan example: Skilled providers include - doctor,

nurse/midwife, health assistant/basic health worker HA/BW or assistant clinical officer ACO.

Are all these categories skilled? For global reporting, confirmation from countries is needed for extra categories

Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

Skilled attendant at birth

Summary of methodological challenges Type of health provider - birth attendant is

skilled or not? Questionnaires - coding categories need to be

adapted in country MDG indicators – maintain broad coding categories

for comparability Direct communication with country office to

ensure correct interpretation for global reporting

www.childinfo.org

Prepared by: Liliana Carvajal / Statistics and Monitoring Section, UNICEF/New Yorklcarvajal@unicef.org

Thank you!