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 vital health care service is detrimental to women's and newborns’ health because it could cause the death of the women and/or the newborns or long lasting morbidity. Achieving universal coverage for this indicator is therefore essential for reducing maternal and newborn mortality and morbidity.

Percentage of births attended by skilled health personnel (generally doctors, nurses or midwives but can refer to other health professionals providing childbirth care) is the percentage of childbirths attended by professional health personnel. According to the current definition (1) these are competent maternal and newborn health professionals educated, trained and regulated to national and international standards. They are competent to: (i) provide and promote evidence-based, human-rights based, quality, socio-culturally sensitive and dignified care to women and newborns; (ii) facilitate physiological processes during labour and delivery to ensure a clean and positive childbirth experience; and (iii) identify and manage or refer women and/or newborns with complications.

The percentage of births attended by skilled health personnel is calculated as the number of births attended by skilled health personnel (doctor, nurse and/or midwife) expressed as total number of life 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. In household surveys, such as the Demographic and Health Surveys, the Multiple Indicator Cluster Surveys, and the Reproductive Health Surveys, the respondent is asked about each live birth and who had helped them during childbirth for a period up to five years (two or three years) before the interview. Service/facility records could be used where a high proportion of births occur in health facilities.

Outcome

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 to the mother and the newborn during childbirth and 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.

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, Sustainable Development Goals 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 skilled health 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.

Regional and global estimates are calculated using weighed averages. Annual number of births from United Nations Population Division, World Population Prospects* are used as weighing indicator. Regional values are calculated for a reference year using modelled annualized country level time series estimates. The time series are calculated using a Bayesian hierarchical time series AR(1) model with region- and country-specific intercepts and slopes, including a range of four to five years for each reference year or year range.

Data sources: 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.

*United Nations Population Division, World Population Prospects 2024.

This indicator is reported in percentage (%)

Annual

Annual

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 childbirth and neonatal complications.

cresswellj@who.int

Jenny Cresswell

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