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Last update: Jan 2013

World Fit For Children Goal Millenium Development Goal
Ensure that women have ready and affordable access to skilled attendance at delivery

Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio


Delivery care

 

The challenge

 

Insufficient maternal care during pregnancy and delivery is largely responsible for the staggering annual toll of 287,000 maternal deaths and the almost 3 million deaths estimated to occur within the first month of life. Indeed, roughly three quarters of all maternal deaths take place during delivery and in the immediate post-partum period.


The two most critical interventions for safe motherhood are to ensure care during delivery by skilled health personnel and to refer the mother for emergency care as needed. A skilled health personnel – doctor, nurse or midwife – should be capable of handling normal deliveries safely and be able to recognize the onset of complications beyond their capacity and refer the mother for emergency care when necessary. Traditional birth attendants, whether trained or untrained, can neither predict nor cope with serious complications.


All women should have access to basic maternity care through a continuum of services offering high-quality antenatal care, clean and safe delivery, and post-natal care for mother and newborn, with a functioning referral system linking the whole process. The quality of care provided by health personnel is crucial. Particularly when there are complications, skilled personnel need access to essential drugs, supplies, equipment and emergency obstetric care. They should receive training on required competencies and they need supervision that helps ensure high standards of care. This is vitally important.

 

Coverage in skilled attendance at delivery varies by region

Globally, 66 per cent of births are attended by skilled health personnel. Sub-Saharan Africa and South Asia, which bear the greatest burden of maternal mortality, also have the lowest levels of skilled birth attendance. Regional averages range from below 50 per cent in South Asia and sub-Saharan Africa to a high of 97 per cent in Central and Eastern Europe/Commonwealth of Independent States (CEE/CIS).


Coverage in skilled attendance at delivery must be accelerated in South Asia and Africa
Percentage of births attended by skilled health personnel (doctor, nurse or midwife), 2007–2012

                                                     

             


Source: SOWC 2013, UNICEF global databases 2012, from Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), and other nationally representative sources.   
Note: Global estimates are based on a subset of 130 countries, covering 83% of births in the world. Regional estimates represent data from countries covering at least 50% of regional births.

The urban-rural gap of delivery care

There are substantial disparities in delivery care across and within regions. Globally, just over half of all births in rural areas are attended by skilled health personnel compared with 84 per cent in urban areas. Some of the greatest differentials can be seen in some African regions where women in urban areas are almost twice as likely as women in rural areas to deliver with a skilled health professional in attendance.

 

Women who live in urban areas are more likely than women in rural areas to be assisted during delivery by a skilled birth attendant
Percentage of births attended by skilled health personnel (doctor, nurse or midwife) by area of residence, 2007–2012

             

Source: SOWC 2013, UNICEF global databases 2012, from MICS, DHS and other nationally representative sources.
Note: Global estimates are based on a subset of 83 countries covering 67% of urban births and 88% of rural births. Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate regional averages for CEE/CIS region and Latin America and the Caribbean.

 

Wealth is a marked differential for delivery care

Globally, large disparities are prevalent across household wealth quintiles. Women in the wealthiest households are almost three times as likely as women in the poorest households to have a skilled birth attendant at delivery (85 per cent versus 31 per cent). Differences across wealth quintiles are largest in sub-Saharan Africa and South Asia.

 

Women in poorest settings are less likely to deliver with skilled health personnel in attendance
Percentage of births attended by skilled health personnel (doctor, nurse or midwife), by wealth quintiles, 2007-2012

                     

Source: SOWC 2013, UNICEF global databases 2012, from MICS, DHS and other nationally representative sources.
* Excludes China
Note: Global estimates are based on subset of 71 countries covering 68% of births (excluding China, for which comparable data are not available). Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate regional averages for CEE/CIS, Latin America and Caribbean as well as Middle East and North Africa regions.


Delivery in health facilities

It is important to note that in many countries, particularly middle- and high-income countries, a large proportion of births occur in health facilities, and thus are attended by skilled health personnel with greater access to appropriate equipment and supplies. For example, over 80 per cent of births in East Asia and Pacific as well as in Latin America and the Caribbean take place in health facilities. On the other hand, in sub-Saharan Africa and South Asia, less than half of deliveries take place in health facilities.

 

Institutional delivery varies greatly by region
Percentage of births delivered in a health facility, 2007–2012

                            

Source: SOWC 2013, UNICEF global databases 2012, from MICS, DHS and other nationally representative sources.
Note: Global estimates are based on a subset of 110 countries, covering 82% of births in the developing world. Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate the regional average for CEE/CIS.

 

Delivery by C-section

Caesarean section (C-section) is an essential part of comprehensive emergency obstetric care. It is estimated that in 5 to 15 per cent of births, babies need to be delivered by C-section. A C-section rate below 5 per cent indicates that some women who need the procedure are not undergoing it, which endangers their lives and those of their babies. Regional estimates suggest that women in sub-Saharan Africa lack access to this important, life-saving maternal health intervention at delivery, particularly those living in rural areas and in the poorest households (data not shown). On the other hand, some developing regions have coverage exceeding 15 per cent, which could indicate over-utilization of this intervention, exposing women to unnecessary risks associated with surgery.

 

C-sections may not be available to all women who need them
Percentage of births delivered via C-section, 2007-2012

             

Source: SOWC 2013, UNICEF global databases 2012, from MICS, DHS and other nationally representative sources.
Note: Global estimates are based on a subset of 107 countries, covering 84% of births in the developing world. Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate the regional average for CEE/CIS as well as Middle East and North Africa regions. 

References


UNICEF, The State of the World’s Children, UNICEF, New York, 2013 (forthcoming).

 

WHO, UNICEF, UNFPA and the World Bank, Trends in Maternal Mortality: 1990 to 2010, WHO, Geneva, 2012.

 

UNICEF, The State of the World's Children 2011: Adolescence - An age of opportunity, UNICEF, New York, 2011.


UNICEF, Progress for Children: Achieving the MDGs with Equity, Report No. 9, UNICEF, New York, 2011.


UNICEF, Progress for Children: A report card on maternal mortality, Report No. 7, UNICEF, New York, 2008.