Births attended by skilled health personnel

Number of births attended by skilled health personnel (doctors, nurses or midwives) trained in providing life-saving obstetric care, including giving the necessary supervision, care and advice to women during pregnancy, childbirth and the postpartum period, to conduct deliveries on their own, and to care for newborns.

The total number of live births in the same period.

Age, parity, place of residence, socioeconomic status, type of provider.

Definition of skilled birth attendant varies between countries. The percentage of births attended by skilled health personnel is calculated as the number of births attended by skilled health personnel (doctors, nurses or midwives) expressed as a percentage of the total number of 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 DHS, MICS and RHS, the respondent is asked about each live birth and who helped during delivery for a period up to five years before the interview.

Service/facility records could be used where a high proportion of births occur in health facilities and are therefore recorded.

Data for global monitoring are reported by UNICEF and WHO. These agencies obtain the data − both survey and registry data – from national sources. Before data can be included in the global databases, UNICEF and WHO undertake a process of data verification that includes correspondence with field offices to clarify any questions.

In terms of survey data, some survey reports may present a total percentage of births attended by a type of provider that does not conform to the MDG definition (e.g. total includes providers who are not considered skilled, such as community health workers). In this case, the percentage delivered by a physician, nurse or midwife are totalled and entered into the global database as the MDG estimate.

Predominant type of statistics: adjusted.

See also: Percent of deliveries attended by skilled health personnel; Percent of births in health facilities; and Percent of all births in EmOC facilities

Household surveys

Routine facility information systems

This indicator serves as a proxy for access to health services and maternal care.

The 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 (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of women and newborns for complications. 

Traditional birth attendants, whether trained or not, are excluded from the category of ‘skilled attendant at delivery’.

Differences in what definitions are used and in how skilled attendants are reported may lead to discrepancies. Most surveys such as the DHS rely on women’s self-report, but how women interpret the question on “who
assisted with delivery?” and whether they accurately identify the health staff attending the delivery is unknown. Major differences are also likely to exist in how providers are trained, in what providers are allowed to practice and do practice, and in what resources, equipment and supplies are at their disposal.

As this indicator uses a birth-based analysis, the sample will over-represent women with multiple births in the survey period. Women with more than one birth are also more likely to have risk factors, such as high parity and lower rates of health services use. Delivery coverage may therefore be underestimated, although this underestimate is likely to be small. Furthermore, the strong correlation between skilled attendant and institutional delivery makes assessing the impact of skilled attendant alone difficult to determine.

Evaluators can disaggregate skilled attendant at delivery by place of delivery to further document the degree of care received at the time of delivery. This measure of care or “skilled attendance” will vary by setting and attendant. A skilled attendant conducting a delivery in hospital, for example provides a higher level of “skilled attendance” than does a skilled attendant conducting a delivery at home.

World Health Organization (WHO). 2015 Global Reference List of 100 Core Health Indicators.; 2015. http://apps.who.int/iris/bitstream/10665/173589/1/WHO_HIS_HSI_2015.3_eng.pdf

World Health Organization. Monitoring, Evaluation, and Review of National Health Strategies: A Country-Led Platform for Information and Accountability.; 2011. http://www.who.int/healthinfo/country_monitoring_evaluation/1085_IER_131011_web.pdf

World Health Organization. Nutrition Landscape Information System (NLIS). Country Profile Indicators: Interpretation Guide. Geneva, Switzerland; 2010. http://apps.who.int/iris/bitstream/10665/44397/1/9789241599955_eng.pdf

Gage AJ, Ali D, Suzuki C. A Guide for Monitoring and Evaluating Child Health Programs. MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel Hill.; 2005. http://www.coregroup.org/storage/documents/Workingpapers/ms-05-15.pdf

Further information and related links

Countdown to 2015 decade report (2000−2010): taking stock of maternal, newborn and child survival. Geneva and New York (NY): World Health Organization/United Nations Children’s Fund; 2010 (Retrieved from http://www.countdown2015mnch.org/reports-and-articles/previous-reports/2010-decadereport).

Countdown to 2015. Monitoring maternal, newborn and child health: understanding key progress indicators. Geneva: World Health Organization; 2011 (Retrieved from http://apps.who.int/iris/bitstream/10665/44770/1/9789241502818_eng.pdf).

Every newborn: an action plan to end preventable deaths. Geneva: World Health Organization; 2014 (Retrieved from http://www.everynewborn.org/Documents/Full-action-plan-EN.pdf).

Framework of actions for the follow-up to the Programme of Action of the International Conference on Population and Development beyond 2014. Report of the Secretary-General. New York (NY): United Nations; 2014 (Retrieved from https://www.unfpa.org/webdav/site/global/shared/documents/ICPD/Framework%20of%20action%20for%20the%20follow-up%20to%20the%20PoA%20of%20the%20ICPD.pdf).

Indicators for monitoring the Millennium Development Goals: definitions, rationale, concepts and sources. New York (NY): United Nations; 2012 (Retrieved from http://mdgs.un.org/unsd/mi/wiki/MainPage.ashx).

Keeping promises, measuring results. Commission on information and accountability for Women’s and Children’s Health. Geneva: World Health Organization; 2011 (Retrieved from http://www.who.int/topics/millennium_development_goals/accountability_commission/Commission_Report_advance_copy.pdf).