Maternal and Reproductive Health indicators
CRING data compilation process
Examples from MICS reports
Statistics and Monitoring Section
UNICEF HQ
March 2013
Maternal health indicators in CRING
– Contraceptive prevalence rate
– Antenatal care
• At least one visit (skilled
provider)
• At least 4 visits (any provider)
– Delivery care
• Skilled attendant at birth
• C-Section
• Institutional deliveries
– Early child bearing
• Births by age 18
MDG 5 – Improve maternal health
Goal 5: Improve maternal health
Indicators – all in MICS
Target 5.A: Reduce by three quarters,
between 1990 and 2015, the maternal
mortality ratio
5.1 Maternal mortality ratio (CRING)
Target 5.B: Achieve, by 2015, universal
access to reproductive health
5.3 Contraceptive prevalence rate (CRING)
5.2 Proportion of births attended by
skilled health personnel (CRING)
5.4 Adolescent birth rate
5.5 Antenatal care coverage (at least one
visit and at least four visits) (CRING)
5.6 Unmet need for family planning
MICS4 Survey Design Workshop
Maternal health indicators in CRING
– Contraceptive prevalence rate
– Antenatal care
• At least one visit (skilled provider)
• At least 4 visits (any provider)
– Delivery care
• Skilled attendant at birth
• C-Section
• Institutional deliveries
– Early child bearing
• Births by age 18
Contraceptive prevalence rate
• Contraceptive use has contributed to
improvements in maternal and infant health
by serving to prevent unintended or closely
spaced pregnancies.
MDG report 2012
Contraceptive prevalence rate
Numerator
Denominator
Number of women age 15-49 years
Total number of women age 15-49
currently married or in union who are years who are currently married or in
using (or whose partner is using) any union
(modern or traditional) contraceptive
method
Contraceptive prevalence rate
Table RH.4: Use of contraception
Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Country, Year
Percent of women (currently married or in union) who are using:
Not
using Fe-male Male
any
sterili- sterilimethod zation zation
IUD
Injectabl Imes
plants
Pill
Diaphragm/
Male Fe-male Foam/Je
con-dom con-dom lly
Modern
Any method is an MDG indicator
LAM
Periodic
abstin- Withence drawal
Number
of
women
Any
currently
Any
tradimarried
modern tional
Any
or in
Other method method method1 union
Traditional
Modern and
traditional
Maternal health indicators in CRING
– Contraceptive prevalence rate
– Antenatal care
• At least one visit (skilled provider)
• At least 4 visits (any provider)
– Delivery care
• Skilled attendant at birth
• C-Section
• Institutional deliveries
– Early child bearing
• Births by age 18
Antenatal care
• Antenatal care is also among the
interventions that can reduce maternal
mortality and morbidity.
• The antenatal period is critically
important for reaching women with
interventions and information that
promote health, wellbeing and survival of
mothers as well as their babies.
MDG report 2012
Antenatal care:
At least one visit with skilled provider (ANC1)
Numerator
Denominator
Number of women age 15-49 years
who were attended during
pregnancy:
• at least once by skilled personnel
(doctor, nurse or midwife)
Total number of women age 15-49 years
with a live birth in the 2 years preceding
the survey
Antenatal care:
At least one visit with skilled provider (ANC1)
Table RH.6: Antenatal care coverage
Percent distribution of women age 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, Country,
Year
Person providing antenatal care
No
Number of women
Traditional Community
antenatal
who gave birth in
Medical Nurse/ Auxiliary
birth
health
care
Any skilled the preceding two
doctor Midwife midwife attendant worker
Other
received Total personnel
years
MDG 5 indicator: Antenatal care, at least one visit
Personnel categories
• Should have been modified in country
• MICS4 standard -- Skilled health personnel includes doctors, nurses,
midwives (auxiliary midwives in some countries).
Maternal health indicators in CRING
– Contraceptive prevalence rate
– Antenatal care
• At least one visit (skilled provider)
• At least 4 visits (any provider)
– Delivery care
• Skilled attendant at birth
• C-Section
• Institutional deliveries
– Early child bearing
• Births by age 18
Antenatal care:
Four or more visits with any provider (ANC4)
• The World Health Organization (WHO) recommends a
minimum of four visits for antenatal care, including, at a
minimum, screening and treatment for infections and
identification of warning signs during pregnancy. (MDG report
2012)
• Given measurement challenges, it is not possible to measure
that all 4 visits were done with skilled providers, although it
might be ideal.
• The ANC4 indicator does not look at the content of the visits
but rather at the number of visits.
Antenatal care:
Four or more visits with any provider (ANC4)
Numerator
Denominator
Number of women age 15-49 years
who were attended during
pregnancy:
Total number of women age 15-49 years
with a live birth in the 2 years preceding
the survey
• at least four times by any provider
Antenatal care:
Four or more visits with any provider (ANC4)
Table RH.7: Number of antenatal care visits
Percent distribution of women who had a live birth during the two years preceding the survey by
number of antenatal care visits by any provider, Country, Year
Percent distribution of women who had:
Number of women
No antewho had a live birth
natal care
Three 4 or more
in the preceding two
1
visits
One visit Two visits visits
visits
Total
years
Region
Urban-rural
Mother's age at birth
Education
Wealth index quintile
Religion/Language/Ethnicity of household head
Total
100.0
1
MICS indicator 5.5b; MDG indicator 5.5
MDG 5 indicator: Antenatal care, 4 or more visits
Watch out for…
• Indicator definition (any provider)
Maternal health indicators in CRING
– Contraceptive prevalence rate
– Antenatal care
• At least one visit (skilled provider)
• At least 4 visits (any provider)
– Delivery Care
• Skilled attendant at birth
• C-Section
• Institutional deliveries
– Early child bearing
• Births by age 18
Delivery Care
Skilled attendant at birth
• Having a skilled health professional (doctor, nurse or
midwife) is a life saving intervention, both for
mothers and babies.
• Skilled birth attendants can administer interventions
to prevent and manage life-threatening
complications such as heavy bleeding, or refer the
patient to a higher level of care when needed.
MDG report 2012
Delivery Care
Skilled attendant at birth
Numerator
Denominator
Number of women age 15-49 years with
a live birth in the 2 years preceding the
survey who were:
• attended during childbirth by skilled
health personnel (doctor, nurse or
midwife)
Total number of women age 15-49 years
with a live birth in the 2 years preceding
the survey
• Beyond doctor, nurse and midwife, skilled categories may vary by country.
• The reporting needs to be customized according to the health cadre in the
country.
• This can be confirmed with MoHs at the country level and customized accordingly
for data collection and reporting.
Delivery Care: Skilled attendant at birth
Table RH.9: Assistance during delivery
Percent distribution of women age 15-49 who had a live birth in the two years preceding the survey by person assisting at delivery and percentage of births
delivered by C-section, Country, Year
Person assisting at delivery
Tradition Comal birth munity
No
Medical Nurse/ Auxiliary attend- health Relative/
attenddoctor Midwife midwife
ant
worker Friend Other ant
Total
Delivery
assisted by
any skilled
attendant
Percent
delivered by
C-section
MDG 5 indicator: Skilled attendant at delivery
MICS 4 standard -- Skilled health personnel includes doctors, nurses, midwives
(auxiliary midwives in some countries)
Maternal health indicators in CRING
– Contraceptive prevalence rate
– Antenatal care
• At least one visit (skilled provider)
• At least 4 visits (any provider)
– Delivery Care
• Skilled attendant at birth
• C-Section
• Institutional deliveries
– Early child bearing
• Births by age 18
Delivery Care
Caesarean section (C-section)
• Caesarean sections are one component of
comprehensive emergency obstetric care, which also
includes blood transfusions and other interventions
to manage life-threatening complications of
pregnancy and childbirth.
• Rates below 5% signal a lack of access to emergency
obstetric care, and rates above 15% suggest overuse,
which may increase poor maternal and neonatal
health outcomes (WHO)
Countdown to 2015 – The 2012 report
Delivery Care
C-Section
Numerator
Denominator
Number of last live births in the 2 years
preceding the survey who were delivered
by caesarean section
Total number of last live births in the 2
years preceding the survey
Delivery Care: Skilled attendant at birth and
C-Section
Table RH.9: Assistance during delivery
Percent distribution of women age 15-49 who had a live birth in the two years preceding the survey by person assisting at delivery and percentage of births
delivered by C-section, Country, Year
Person assisting at delivery
Tradition Comal birth munity
No
Medical Nurse/ Auxiliary attend- health Relative/
attenddoctor Midwife midwife
ant
worker Friend Other ant
Total
Delivery
assisted by
any skilled
attendant
Percent
delivered by
C-section
Maternal health indicators in CRING
– Contraceptive prevalence rate
– Antenatal care
• At least one visit (skilled provider)
• At least 4 visits (any provider)
– Delivery care
• Skilled attendant at birth
• C-Section
• Institutional deliveries
– Early child bearing
• Births by age 18
Delivery Care
Institutional deliveries
• In addition to professional attention during
birth by a skilled birth attendant, it is
important that mothers deliver their babies in
an appropriate setting, where life saving
equipment and hygienic conditions can also
help reduce the risk of complications that may
cause death or illness to mother and child.
Delivery Care
Institutional deliveries
Numerator
Denominator
Number of women age 15-49 years with
a live birth in the 2 years preceding the
survey who delivered in a health facility
Total number of women age 15-49 years
with a live birth in the 2 years preceding
the survey
Delivery Care: Institutional deliveries
Table RH.10: Place of delivery
Percent distribution of women age 15-49 who had a live birth in two years preceding the survey by place of delivery, Country, Year
Place of delivery
Public sector Private sector
health facility health facility
Home
Other
Total
Number of women
Delivered in who had a live birth
in preceding two
health
years
facility1
Region
Urban-rural
Mother's age at birth
Number of antenatal care visits
Education
Wealth index quintiles
Religion/Language/Ethnicity of household head
Total
100.0
1 MICS
indicator 5.8
• Place of delivery categories varies per country
• Public and private, as long as it refers to health facilities
• Common - administrative reports on this indicator
Maternal health indicators in CRING
– Contraceptive prevalence rate
– Antenatal care
• At least one visit (skilled provider)
• At least 4 visits (any provider)
– Delivery care
• Skilled attendant at birth
• C-Section
• Institutional deliveries
– Early child bearing
• Births by age 18
Early childbearing
Births by age 18
• One measure of early childbearing is the percentage of
young women aged 20–24
• Early childbearing often results from child marriage.
• Negative consequences of child marriage abound,
particularly for girls. They may be cut off from their
families, their formal education left behind. Their
development – and the fulfillment of their human
rights – may be compromised. There are also health
concerns associated with child marriage, which often
leads to adolescent childbearing.
Early childbearing
Births by age 18
Numerator
Denominator
Number of women age 20-24 years who
had at least one live birth before age 18
Total number of women age 20-24 years
Early childbearing
Births by age 18
Table RH.2: Early childbearing
Percentage of women age 15-19 who have had a live birth or who are pregnant with the first child; percentage of women
age 15-19 who have begun childbearing before age 15, and the percentage of women age 20-24 who have had a live birth
before age 18, Country, 2010
Number of women age 15-19
Area
Urban
Rural
Education
None
Primary
Secondary +
Wealth index quintiles Poorest
Second
Middle
Fourth
Richest
Total
[1] MICS indicator 5.2
Have had a Number of
Have had a Are pregnant Have begun
live birth
women age
live birth with first child childbearing before age 15
15-19
2.9
.8
3.7
.2
753
11.8
3.5
15.3
.7
1299
20.3
4.8
25.1
1.4
548
11.6
4.1
15.7
.9
304
2.4
1.0
3.4
.0
1201
15.8
2.5
18.3
1.6
316
17.0
4.2
21.2
.1
323
13.2
5.4
18.6
1.5
339
4.6
1.4
6.0
.0
441
.8
.8
1.5
.0
633
8.5
2.5
11.0
.5
2052
Sum of the first two columns
Percentage
of women
age 20-24
who have
had a live
Number of
birth before women age
age 18 [1]
20-24
10.3
882
18.0
1620
24.0
1158
22.7
340
2.7
1004
21.1
402
17.7
413
16.8
499
17.1
614
6.3
574
15.3
2502
Childinfo – Delivery care
• http://www.childinfo.org/delivery_care.html
Childinfo – Antenatal care
• http://www.childinfo.org/antenatal_care.html