Skilled attendant at birth mDG 5, target 5A, Indicator 5.2

1. Skilled attendant at birthmDG 5, target 5A, Indicator 5.2 Workshop on MDG monitoring to 2015 and beyond Bangkok 9-13 July 2012 Liliana Carvajal UNICEF

2. 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

3. Skilled attendant at birth Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

4. Skilled attendant at birth Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

5. Background Every year…. • 287,000 maternal deaths • For each maternal death 20 women suffer injuries or disabilities related to pregnancy/childbirth • Approximately 3million neonatal deaths Greatest mortality risk for both mothers and children is during delivery and immediately after birth

6. 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

7. 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.

8. Skilled attendant at birth Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

9. Asian countries – coverage of skilled attendance at delivery around * Latest data value is for 2005, 2006

10. 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

11. Skilled attendant at birth Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

12. Standard Indicator Skilled attendant at delivery Proportion 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: • Doctor • Nurse • Midwife (and auxiliary midwife when appropriate)

13. 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.

14. Eligibility • Women of reproductive age (15-49 years) • Live birth in the two or five years preceding interview

15. Household survey – women’s questionnaire • Who assisted with the delivery of your last baby? Skilled birth attendants

16. 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?

17. 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

18. 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

19. Skilled attendant at birth Background, definitions and relevance National and regional perspective Measuring the standard indicator Summary of methodological challenges

20. 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

21. Thank you! Prepared by: Liliana Carvajal /Statistics and Monitoring Section, UNICEF/New Yorklcarvajal@unicef.org www.childinfo.org