Definition
The proportion of births attended by skilled health personnel is the percentage of deliveries attended by personnel trained to give the necessary supervision, care and advice to women during pregnancy, labour and the post-partum period; to conduct deliveries on their own; and to care for newborns.
Skilled health personnel include only those who are properly trained and who have appropriate equipment and drugs. Traditional birth attendants, even if they have received a short training course, are not to be included.
Goal/target addressed
Goal 5. Improve maternal health.
Target 6. Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.
Rationale
Measuring maternal mortality accurately is notoriously difficult, except where there is comprehensive registration of deaths and causes of death. Several process indicators have been proposed for tracking progress by focusing on professional care during pregnancy and childbirth, particularly for the management of complications. The most widely available indicator is the proportion of women who deliver with the assistance of a medically trained health care provider.
Method of computation
The number of births attended by skilled health personnel (doctors, nurses or midwives) is expressed as a percentage of deliveries (or births if those are the only data available) in the same period.
Data collection and source
Data are collected through household surveys, in particular Demographic and Health Surveys and Multiple Indicator Cluster Surveys, as well as other national household surveys.
References
“Issues in Measuring and Monitoring Maternal Mortality: Implications for Programmes”, Technical and Policy Paper 1, 1998, United Nation’s Population Fund.
The State of the World’s Children, annual, United Nation’s Children’s Fund (www.unicef.org/publications).
World Health Organization, www3.who.int/whosis.
World Development Indicators, annual, World Bank (www.worldbank.org/data).
Human Development Report, annual, United Nations Development Programme (www.undp.org).
Gender issues
The low social status of women in developing countries limits their access to economic resources and basic education and thus their ability to make decisions related to health and nutrition. Some women are denied access to care when it is needed either because of cultural practices of seclusion or because decision-making is the responsibility of other family members. Lack of access to or use of essential obstetric services is a crucial factor contributing to high maternal mortality.
Periodicity of measurement
Household survey data on these indicators are generally available every three to five years.
International data comparisons
The State of the World’s Children, annual, United Nation’s Children’s Fund (www.unicef.org/publications).
World Health Organization, www3.who.int/whosis.
World Development Indicators, annual, World Bank (www.worldbank.org/data).
Human Development Report, annual, United Nations Development Programme (www.undp.org).
Comments and limitations
The indicator is a measure of a health system’s ability to provide adequate care for pregnant women. Concerns have been expressed that the term skilled attendant may not adequately capture women’s access to good quality care, particularly when complications arise. Standardization of the definition of skilled health personnel is sometimes difficult because of differences in training of health personnel in different countries. Although efforts have been made to standardize the definitions of doctors, nurses and midwives and auxiliary midwives used in most household surveys, it is probable that many “skilled attendants” would not meet the criteria for a “skilled attendant” as defined by the World Health Organization. Moreover, it is clear that skilled attendants’ ability to provide appropriate care in an emergency depends on the environment in which they work.
Agencies
Ministries of health.
United Nations Children’s Fund.
World Health Organization.
Unite