CRING data compilation process Examples from MICS reports

CRING data compilation processExamples from MICS reports

Maternal and Reproductive Health indicators

Statistics and Monitoring Section UNICEF HQMarch 2013

– 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

Maternal health indicators in CRING

MDG 5 – Improve maternal healthGoal 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)

5.2 Proportion of births attended by skilled health personnel (CRING)

Target 5.B: Achieve, by 2015, universal access to reproductive health

5.3 Contraceptive prevalence rate (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


• At least one visit (skilled provider)• At least 4 visits (any provider)

– Delivery care• Skilled attendant at birth• C-Section • Institutional deliveries



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


Numerator Denominator

Number of women age 15-49 years currently married or in union who are using (or whose partner is using) any (modern or traditional) contraceptive method

Total number of women age 15-49 years who are currently married or in union


Table RH.4: Use of contraceptionPercentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Country, Year

Not using any

method

Percent of women (currently married or in union) who are using: Number of

women currently married

or in union

Fe-male sterili-zation

Male sterili-zation IUD

Injectables

Im-plants Pill

Male con-dom

Fe-male con-dom

Dia-phragm/

Foam/Jelly LAM

Periodic abstin-ence

With-drawal Other

Any modern method

Any tradi-tional

methodAny

method1

Any method is an MDG indicator

Modern Traditional Modern and traditional






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)


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 coveragePercent 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 antenatal

care received Total

Any skilled personnel

Number of women who gave birth in the preceding two

yearsMedical doctor

Nurse/ Midwife

Auxiliary midwife

Traditional birth

attendant

Community health worker Other

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).






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)


Number of women age 15-49 years who were attended during pregnancy:• at least four times by any provider


Antenatal care: Four or more visits with any provider (ANC4)Table RH.7: Number of antenatal care visitsPercent 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

who had a live birth in the preceding two

years

No ante-natal care

visits One visit Two visitsThree visits

4 or more visits1 Total

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 visitsWatch out for…

• Indicator definition (any provider)



– Delivery Care• Skilled attendant at birth• C-Section • Institutional deliveries



Delivery CareSkilled 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 CareSkilled attendant at birth


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)


• 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 birthTable RH.9: Assistance during deliveryPercent 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

No attend-

ant Total

Delivery assisted by any skilled attendant

Percent delivered by

C-sectionMedical doctor

Nurse/ Midwife

Auxiliary midwife

Traditional birth attend-

ant

Com-munity health worker

Relative/Friend Other

MDG 5 indicator: Skilled attendant at delivery

MICS 4 standard -- Skilled health personnel includes doctors, nurses, midwives (auxiliary midwives in some countries)



– Delivery Care• Skilled attendant at birth• C-Section • Institutional deliveries



Delivery CareCaesarean 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 CareC-Section


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 deliveryPercent 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

No attend-

ant Total

Delivery assisted by any skilled attendant

Percent delivered by

C-sectionMedical doctor

Nurse/ Midwife

Auxiliary midwife

Traditional birth attend-

ant

Com-munity health worker

Relative/Friend Other






Delivery CareInstitutional 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 CareInstitutional deliveries


Number of women age 15-49 years with a live birth in the 2 years preceding the survey who delivered in a health facility


Delivery Care: Institutional deliveries

Table RH.10: Place of deliveryPercent 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

Total

Delivered in health facility1

Number of women who had a live birth

in preceding two years

Public sector health facility

Private sector health facility Home Other

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






Early childbearingBirths 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.



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

Table RH.2: Early childbearingPercentage 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

Number of women age

15-19

Percentage of women age 20-24 who have had a live

birth before age 18 [1]

Number of women age

20-24Have had a

live birthAre pregnant with first child

Have begun childbearing

Have had a live birth

before age 15Area Urban 2.9 .8 3.7 .2 753 10.3 882

Rural 11.8 3.5 15.3 .7 1299 18.0 1620Education None 20.3 4.8 25.1 1.4 548 24.0 1158

Primary 11.6 4.1 15.7 .9 304 22.7 340Secondary + 2.4 1.0 3.4 .0 1201 2.7 1004

Wealth index quintiles Poorest 15.8 2.5 18.3 1.6 316 21.1 402Second 17.0 4.2 21.2 .1 323 17.7 413Middle 13.2 5.4 18.6 1.5 339 16.8 499Fourth 4.6 1.4 6.0 .0 441 17.1 614Richest .8 .8 1.5 .0 633 6.3 574

Total 8.5 2.5 11.0 .5 2052 15.3 2502[1] MICS indicator 5.2


Sum of the first two columns

Childinfo – Delivery care

• http://www.childinfo.org/delivery_care.html

http://www.childinfo.org/delivery_care.html

Childinfo – Antenatal care

• http://www.childinfo.org/antenatal_care.html

http://www.childinfo.org/antenatal_care.html

Documents

CRING data compilation process Examples from MICS reports