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. ABR: Number of births per 1,000 adolescent girls aged 15–19. 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 the 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 15-19 and 20-24 for live births before age 15 and age 18, respectively. • Data from different cohorts provides trends

7. Adolescent childbearing – a comparison of indicators *Adolescent birth rate: Age-specific fertility rate for women aged 15–19 2010-2011 MICS4

8. Adolescent childbearing – a comparison of indictors Example from MICS4

9. Adolescent childbearing – a comparison of indictors Example from MICS4

10. 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)

11. Contraception Traditional Modern Any method is an MDG indicator

12. 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

13. 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

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

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

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

17. 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)

18. 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

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

20. Antenatal care

21. 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)

22. 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%

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

24. Continuum of reproductive and maternal health interventions

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

26. 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)

27. 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

28. The MICS4 Module

29. PNC Data from West African country MICS 2011 • West African country MICS 2011; unpublished data • Place of delivery (Last births in last 2 years) • Facility births: 67 percent • 74 percent stay in facility for more than 12 hours • 10 percent are discharged within 6 hours of delivery • Survey data provide important programmatic insights – especially with detailed data on PNC visits

30. Majority receive a health check while in facility or at home (much less for home deliveries) – similar figures for newborns and mothers Only 41 percent receive a PNC visit 15 percent receive a PNC visit on the same day, or one or two days following delivery Similar patterns for mothers, but mothers are less likely to receive a PNC visit 21 percent receive a first PNC visit more than one week after delivery PNC Data from West African country MICS 2011

31. PNC Data from West African country MICS 2011 • Health checks performed universally in facilities, but PNC visits may not be performed at all, or may be performed quite late • In the case of home deliveries, less than half of birth attendants perform health checks on mothers and newborns • More PNC visits for newborns than mothers – both for home and facility deliveries

32. PNC Data from West African country MICS 2011 Very similar patterns for newborns and mothers Majority of home deliveries receive PNC visits at home; more than half have PNC visits with a TBA Facility deliveries return to a facility for a PNC visit (88 %) Almost all are seen by a doctor/midwife/nurse

33. PNC Data from West African country MICS 2011 Possible to use MICS data to uncover differentials – for example: • 80 percent of both mothers and newborns receive PNHC • Newborns in rural areas and poorest households lag behind, at 73 and 63 percent Per cent of both mothers and newborns receiving a health check in the facility or at home, or a PNC visit within two days of birth

34. To conclude • Substantial increase in PNC data availability due to inclusion in MICS • 18 surveys in 2009-2012 • Many more expected in MICS5 (2012-2014) • More data will also mean better understanding of how the module is working

35. Further use of the data

36. Coverage of interventions varies across the continuum of care Source: Countdown to 2015: The 2012 report

37. Tracking Progress on Child and Maternal Nutrition

38. Brainstorming • Focus on adolescents – coverage of maternal health services • Maternal health… • fertility desires by background characteristics • HIV and maternal care (knowledge, testing during ANC) • Malaria in pregnancy (provision of IPTp during ANC visits)

39. Thank you!