Health services coverage statistics
Births attended by skilled health personnel (percentage)
Rationale for use
Since the indicator Maternal Mortality Ratio cannot measure short-term trends, it would not capture changes over the time period covered by the MDGs i.e. 1990 to 2015, there is a need to use a proxy indicator. The proportion of births attended by skilled health personnel has been selected to monitor progress towards the MDGs.
A skilled birth 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, trained or not, are excluded from the category of skilled attendant at delivery. In developed countries and in many urban areas in developing countries, skilled care at delivery is usually provided in a health facility. However, birth can take place in a range of appropriate places, from home to tertiary referral centre, depending on availability and need, and WHO does not recommend any particular setting. Home delivery may be appropriate for a normal delivery, provided that the person attending the delivery is suitably trained and equipped and that referral to a higher level of care is an option.
Live birth refers to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life - e.g. beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles - whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.
Health services statistics: As the point of contact with women, this is the main and most obvious routine source of information for the numerator. Nevertheless, health service information used on its own constitutes a poor source of statistics on coverage of care as it is often incomplete because of inadequate reporting or exclusion of private sector information. Census projections or in some cases vital registration data are used to provide the denominator (numbers of live births).
Household surveys: An important source of information on maternity care on ad hoc basis and for many countries, are the main source of information on skilled birth attendants. When using survey data, absolute numbers and confidence intervals should be reported to indicate the reliability of the data and facilitate interpretation of trends and differentials.
Methods of estimation
Empirical data from health facilities and/or household surveys are used.
By place of delivery, type of skilled health personnel, location (urban/rural, major regions/provinces) and socio-economic characteristics (e.g. education level, wealth quintile).
Reduction of Maternal Mortality
Making pregnancy safer: the critical role of the skilled attendant
World health report 2005 statistical annex
While efforts are made to standardize definitions of skilled birth attendants, there is doubt about the comparability of some of the results across countries and within countries at different time periods.