Number of births attended by skilled health personnel (doctor, nurse or midwife) trained in providing quality obstetric care, including giving the necessary support and care to the mother and the newborn during childbirth and immediate postpartum period

Denominator: The total number of live births in the same period.

Number of total births

The unit of analysis differs by survey type. DHS utilizes live births in the last two, three or five years while MICS utilizes women who had a live birth in the last two years.

Dee Wang

[email protected]

Having a skilled attendant at the time of childbirth is an important lifesaving intervention for both women and babies. Not having access to this key assistance is detrimental to women’s health because it could cause the death of the women or long lasting morbidity, especially in vulnerable settings.

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Births attended by skilled health personnel is an indicator of health care utilization. It is a measure of the health system’s functioning and potential to provide adequate coverage for childbirth. On its own, however, this indicator does not provide insight into the availability or accessibility of services, for example in cases where emergency care is needed. Neither does this indicator capture the quality of care received.

Data collection and data interpretation in many countries is challenged by lack of guidelines, standardization of professional titles and functions of the health care provider, and in some countries by task-shifting. In addition, many countries have found that there are large gaps between international standards and the competencies of existing health care professionals providing childbirth care. Lack of training and an enabling environment often hinder evidence-based management of common obstetric and neonatal complications

Numerator:

Number of births attended by skilled health personnel (doctor, nurse or midwife) trained in providing quality childbirth care, including giving the necessary support and care in the immediate postpartum period.

Denominator:

The total number of live 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.

For this indicator, when data are reported from household surveys, disaggregation is available for residence (urban/rural), household wealth (quintiles) and maternal age, geographic regions. When data are reported from administrative sources, disaggregation is more limited and tend to include only residence.

There is no treatment of missing values at country level. If value is missing for a given year, then there is no reporting of that value.

For the calculation of the regional and global aggregations, an annualized estimation process of underlying country values is conducted. Missing aggregate values are estimated based on observed trajectories.

Regional and global estimates are calculated using weighted averages. Annual number of live births from United Nations Population Division, World Population Prospects (3) are used as the weighting indicator. Regional values are calculated for a reference year using the annualized country-level estimates based on observed trajectories.

Discrepancies are possible if there are national figures compiled at the health facility level. These would differ from the global figures, which are typically based on survey data collected at the household level. In terms of survey data, some survey reports may present a total percentage of births attended by a skilled health professional that does not conform to the MDG 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 totalled and entered into the global database as the MDG estimate. In some countries where skilled attendant at birth is not available, birth in a health facility (institutional births) is used instead. This is frequent among Latin American countries, where the proportion of institutional births is very high. Nonetheless, it should be noted that institutional births may underestimate the percentage of births with skilled attendant.

Definition of skilled health personnel varies between countries. The proportion of births attended by skilled health personnel is calculated as the number of births attended by skilled health personnel (doctors, nurses or midwives) expressed as a proportion of the number of live births in the same period.

In household surveys, such as DHS, MICS and RHS, the respondent is asked about the most recent birth and who helped during childbirth for a period up to five years before the interview. For consistency of reporting, survey customization teams in country are encouraged to review categories or occupational title of health care providers reported on the previous surveys and ensure comparability. Service/facility records could be used where a high proportion of births occur in health facilities and are recorded.

Data are reported to UNICEF on an annual basis during the country consultation. Values are reviewed and assessed to make sure that reported indicator complies with standard definition and methodology.

As part of the data harmonization process, an annual country consultation is conducted by UNICEF. Country inputs are reviewed and assessed jointly with WHO. During the process, SDG country focal points are contacted for updating and verifying values included in the database and obtaining new sources of data. The national categories of skilled health personnel are verified, and the estimates for some countries may include additional categories of trained personnel beyond doctor, nurse, and midwife. This process serves as validation of the reported values.

Furthermore, with regard to data obtained from surveys, the validity of such data depends on the correct identification by the women of the credentials of the person attending the childbirth, which may not be obvious in certain countries.

Data are available for 191 countries.
The lag between the reference year and actual production of data series depends on the availability of the household survey for each country.

2000-2022

National-level household surveys are the main data sources used to collect data for the antenatal care indicators. These surveys include Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), Reproductive Health Surveys (RHS) and national surveys based on similar methodologies. The surveys are undertaken every 3 to 5 years. For mainly industrialized countries (where the coverage is high), data sources include routine service statistics.

National-level household surveys are the main data sources used to collect data for skilled health personnel providing childbirth care. These surveys include Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), Reproductive Health Surveys (RHS) and other national surveys based on similar methodologies. In these surveys the respondent is asked about the last live birth and who helped during delivery for a period up to five years before the interview.
Surveys are undertaken every three to five years.
Population-based surveys are the preferred data source in countries with a low utilization of childbirth services, where private sector data are excluded from routine data collection, and/or with weak health information systems.
Routine service/facility records are a more common data source in countries where a high proportion of births occur in health facilities and are therefore recorded. These data can be used to track the indicator on an annual basis.

As the main source of data is household surveys which are conducted every 3-5 years, the collection of data are under this schedule. When data comes from administrative source, data can be available on an annual basis.

Estimates are published annually, in February by UNICEF in the data website www.data.unicef.org (2) and by the World Health Organization in May in the World Health Statistics Report (http://www.who.int/whosis/whostat/en/) and the WHO Global Health Observatory (www.who.int/data/gho). UNICEF also reports this indicator in the State of the World’s Children report which is on a bi-annual reporting schedule (https://www.unicef.org/reports/state-of-worlds-children)

Ministries of Health and National Statistical Offices, either through household surveys or routine sources.

URL: https://data.unicef.org/topic/maternal-health/delivery-care/#

References:  
(1) Definition of skilled health personnel providing care during childbirth 2018 joint statement by WHO, UNFPA, UNICEF, ICM, ICN, FIGO and IPA. https://www.who.int/reproductivehealth/publications/statement-competent-mnh-professionals/en/
(2) Joint UNICEF/WHO database of skilled health personnel, based on population-based national household survey data and routine health systems. https://data.unicef.org/topic/maternal-health/delivery-care/#.
(3) United Nations Population Division, World Population Prospects. https://population.un.org/wpp/Download/Standard/Population/.

Having a skilled health care provider at the time of childbirth is an important lifesaving intervention for both women and newborns. Not having access to this key assistance is detrimental to women’s and newborns’ health because it could cause adverse health outcomes such as the death of the women and/or the newborns or long lasting morbidity. Achieving universal coverage is therefore essential for reducing maternal and newborn mortality and morbidity.

Projections are based on data from 2000–2019. The threshold for meeting the ‘universal coverage’ target is 95 per cent. Data are deemed insufficient to establish a trend if there are fewer than two data points, or no data in the period 2014-2019; the country is categorized as having no data if there is none since 2000.