Percentage of births assisted by a skilled attendant

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.