Births attended by skilled health personnel

What does this indicator tell us?

The births attended by skilled health personnel indicator measures the health system's ability to provide sufficient care during birth - a period of high risk of morbid ity and mortality. In NLiS , it is used as a proxy for access to health services and maternal care. This indicator is also included in the WHO Global reference list of 100 core health indicators.

How is it defined?

This indicator gives the percentage of live births attended by skilled health personnel in a given period. 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 (i.e. uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of women and neonates for complications. Traditional birth attendants, whether 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 health facilities. Births do, however, take place in various other appropriate places, from homes to tertiary referral centres, depending on availability and need. WHO does not recommend a particular setting for giving birth. Home delivery may be appropriate for normal births, provided that the person attending the delivery is suitably trained and equipped, and that referral to a higher level of care is an option; however, this may lead to an overestimation of births attended by skilled personal, because infants delivered outside of a health facility may not have their birth method recorded.

What are the consequences and implications?

All women should have access to skilled care during pregnancy and at delivery, to ensure the detection and management of complications. One woman dies needlessly of pregnancy-related causes every minute, representing more than half a million mothers lost each year, a figure that has improved little over recent decades. Another 8 million or more women experience lifelong health consequences from the complications of pregnancy. Every woman, rich or poor, has a 15% risk for complications around the time of delivery, but almost no maternal deaths occur in developed regions. The lack of progress in reducing maternal mortality in many countries often reflects the low value placed on the lives of women and their limited role in setting public priorities. The lives of many women in developing countries could be saved by reproductive health interventions that people in rich countries take for granted, such as the presence of skilled health personnel at delivery.

Source of data

WHO. Global Health Observatory (GHO) data repository. Births attended by skilled health personnel. Data by country (http://apps.who.int/gho/data/view.main.GSWCAH02v).

Further reading

WHO, International Confederation of Midwives (ICM), International Federation of Gynaecology and Obstetrics (FIGO). Making pregnancy safer: the critical role of the skilled attendant. Geneva: World Health Organization; 2004 (http://www.who.int/maternal_child_adolescent/documents/9241591692/en/).

WHO. Global reference list of 100 core health indicators (plus health-related SDGs). Geneva: World Health Organization; 2018 (https://www.who.int/healthinfo/indicators/2018/en/).