Multiple Indicator Cluster Surveys Data dissemination and further analysis workshop

1. Multiple Indicator Cluster SurveysData dissemination and further analysis workshop Maternal and Reproductive Health MICS4 Data Dissemination and Further Analysis Workshop

2. Overview of MICS4 contents • Core modules • Childbearing among adolescents (3 tables) • Contraception (2 tables) • Antenatal care (3 tables) • Delivery care (2 tables) • Other modules • Post-natal health care (6 tables) • Maternal mortality (1 table)

3. NEW! Childbearing among adolescents Calculations based data from the child mortality module (Brass questions) or birth history Pay attention to sample sizes, especially for breakdowns by background variables

4. NEW! Childbearing among adolescents Number of births to women age 15-19 years, divided by the average number of women age 15-19 (during the one year period preceding the survey) Average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates calculated for each of the 5-year age groups of women, from age 15 through to age 49. Calculations based data from the child mortality module (Brass questions) or birth history Pay attention to sample sizes, especially for breakdowns by background variables

5. NEW! Childbearing among adolescents Sum of first two columns

6. NEW! Childbearing among adolescents • Two indicators -- Note that each indicator has a different denominator • Figures in the total row are based on women age 15-49 and 20-49 for live births before age 15 and age 18, respectively. • Data from different cohorts provides trends

7. Adolescent childbearing – a comparison of indictors Unpublished example from a MICS4 survey

8. Adolescent childbearing – a comparison of indictors Unpublished example from a MICS4 survey

9. Adolescent childbearing – a comparison of indictors Unpublished example from a MICS4 survey

10. Contraception Traditional Modern Any method is an MDG indicator

11. How to define unmet need? • Women with an unmet need for family planning are women who • are married or in union • are fecund • not using any method of contraception • report not wanting any more children or wanting to delay the birth of their next child for at least two years

12. How to define unmet need? We also consider the following to have unmet need: • Women* who are pregnant, but whose current pregnancy unwanted or mistimed • Postpartum amenorrheic women* (not using contraception) whose last birth was unwanted or mistimed *Married/in union

13. Key indicator elements • Marital status • Current use of contraception (any method) • Fecundity • Pregnant or amenorrheic • Desire for last birth • Desire for future births

14. Unmet need New MICS4 methodology – may make comparisons challenging Note that met need for contraception includes both traditional and modern methods

15. MICS4 country example of unmet need RH4: Use of contraception Note that met need for contraception includes both traditional and modern methods

16. Antenatal care • Key indicator: At least one ANC visit (MDG) • Personnel categories • Should have been modified in country • MICS4 standard -- Skilled health personnel includes doctors, nurses, midwives, and auxiliary midwives. But double-check and document in final report text

17. NEW! Antenatal care • MDG indicator; for reporting ensure that 4+ can be derived from table • Watch out for… • Indicator definition (any provider) • “don’t knows”

18. Antenatal care

19. NEW! Delivery Care MDG indicator: Skilled attendant at delivery MICS 4 standard -- Skilled health personnel includes doctors, nurses, midwives, and auxiliary midwives. But double-check and document in final report text New indicator! C-section should be within 5%-15%

20. Delivery Care Place of delivery categories should have been modified in country Possible to present additional categories

21. Continuum of reproductive and maternal health interventions

22. Continuum of reproductive and maternal health interventions Gap! Gap!

23. NEW! Post-natal Health Checks • New MICS4 module • 6 tables covering post-natal health checks for both mother and child • Post-partum stay in health facility • Post-natal health checks for newborns • Post-natal care (PNC) visits for newborns • Post-natal health checks for mothers • Post-natal care (PNC) visits for mothers • Post-natal health checks for mothers and newborns

24. Maternal mortality • MICS4 – now recommends direct sisterhood method (survivorship of all siblings) • Limitations include: • Reference period usually 7 years or 10 years before the survey • Confidence intervals are very wide • Studies indicate that both male and female mortality underestimated

25. Maternal mortality

26. Trend Estimation from Sibling Histories with 95% Confidence Intervals (Namibia) Estimates are averages over long periods (here 7 or 9 years) and 95% confidence intervals are large Source: Ken Hill – UN maternal mort workshop, Nairobi December 2010

27. Further use of the data

29. Tracking Progress on Child and Maternal Nutrition

30. Brainstorming • Focus on adolescents • Maternal health… • fertility desires • Empowerment (Attitude towards domestic violence) • HIV and maternal care (knowledge, testing during ANC)

31. Thank you!