Proxy measure for the utilization rate of obstetrics services in health facilities and in communities where Village-Trained Midwives are operating. It is a measure of a health system?s ability to provide adequate care for pregnant women during labour and delivery.
Number of births in a defined administrative or health area in a given period of time
Estimated total number of births in the same administrative or health area in the same period of time
Administrative area; health area
Indicator used for response monitoring ?
Threshold / Standard
>90% Follow-up of trends
Calculation: Numerator: 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. Denominator should be calculated by using the fertility rate by age class and region (e.g. obtained via demographic and health surveys). In Sub-Saharan Africa, for instance, the expected proportion of births is between 4 and 5 % of the total population. Alternatively, percentage of births assisted by a skilled attendant can be assessed through household surveys where the numerator is the number of reported deliveries over a certain period of time assisted by a skilled attendant and the denominator is the reported number of births over the same period of time. Interpretation: This indicator can serve as a proxy for monitoring progress in the health response. Limitations: the indicator may not sufficiently capture women?s access to high quality care, particularly when complications arise. It also does not provide information on availability of any supplies and equipment a skilled attendant may need. Both administrative and household survey methods have limitations. The calculation of the number of births from administrative population number and fertility rates can be very imprecise. Reporting bias in houshold surveys can lead to imprecision in the estimate.
Guidance on phases
There is a differing level of quality of data which can be collected at different phases of the emergency depending on the context, eg the data available and the systems for data collection in place before the crisis, the accessibility of the affected areas, the resources on the ground, etc... Periodical household surveys should be considered. Households surveys will be more doable in later phases of the emergency.
Numerator: routine health facility reporting system Denominator: administrative boundaries; health areas boundaries; population per administrative area; population per health areas; fertility rate (from DHS, for example) Alternatively numerator and denominator can be recorded through household surveys
Further guidance: monitoring maternal and newborn child health (http://www.who.int/healthmetrics/news/monitoring_maternal_newborn_child_health.pdf)