Statistics and Monitoring Section
Division of Policy and Planning
Postal Address:Three United Nations Plaza, New York, NY 10017
Telephone: 1 212-303-7932
Fax: 1 212-735-4411
Dr. Lale Say
Medical Officer for Monitoring and Evaluation
Department of Reproductive Health and Research
World Health Organization
Postal Address:20 avenue Appia, Geneva, Switzerland
Telephone: +41 22 791 4816
Fax: +41 22 791 4171
Percentage of births attended by skilled health personnel (doctors, nurses or midwives) is the percentage of deliveries attended by health personnel trained in providing life saving obstetric care, including giving the necessary supervision, care and advice to women during pregnancy, labour and the post-partum period; conducting deliveries on their own; and caring for newborns. Traditional birth attendants, even if they receive a short training course, are not included.
The number of women aged 15-49 with a live birth attended by a skilled health personnel (doctors, nurses or midwives) during delivery is expressed as a percentage of women aged 15-49 with a live birth in the same period.
The indicator is a measure of a health system’s ability to provide adequate care for pregnant women. Concerns have been expressed that the presence of a skilled attendant may not adequately capture women’s access to good quality care, particularly when complications arise, and information on the supplies and equipment a skilled attendant may or may not have is lacking.
In addition, standardization of the definition of skilled health personnel is sometimes difficult because of differences in training of health personnel in different countries. Although efforts have been made to standardize the definitions of doctors, nurses, midwives and auxiliary midwives used in most household surveys, it is probable that many skilled attendants’ ability to provide appropriate care in an emergency depends on the environment in which they work.
Discrepancies are possible if there are national figures compiled at the health facility level. These would differ from the global figures, which are typically based on survey data collected at the household level.
In terms of survey data, some survey reports may present a total percentage of births attended by a skilled health professional that does not conform to the MDG definition (e.g., total includes provider that is not considered skilled, such as a community health worker). In that case, the percentage delivered by a physician, nurse, or a midwife are totaled and entered into the global database as the MDG estimate.
In some countries where skilled attendant at birth is not available, birth in a health facility (institutional births) is used instead. This is frequent among Latin American countries, where the proportion of institutional births is very high. Nonetheless, it should be noted that institutional births may underestimate the percentage of births with skilled attendant.
National-level household surveys, including Multiple Indicator Cluster Survey (MICS) and Demographic Health Surveys (DHS), are the most common source of data. These surveys are generally conducted every 3-5 years.
Some countries have representative data available through routine registration and these data are also included in the database.
Before acceptance into the global databases, UNICEF reviews the data in collaboration with WHO and verifies, if necessary, with field offices to clarify any questions regarding estimates. During this process, the national categories of skilled health personnel are verified, and so the estimates for some countries may include additional categories of trained personnel beyond doctors, nurses, and midwives.
There is no treatment of missing values. When the information needed to calculate the indicator is not available, the indicator is not estimated.
Data are available for over 170 countries.
The lag between the reference year and actual production of data series depends on the availability of the household survey for each country. In developing countries they typically take place every three to five years, with results published within a year of field data collection.
Data from national-level sources are compiled in the UNICEF global database. Latest available estimates of skilled health personnel at delivery are published annually, in December, by UNICEF in The State of the World’s Children report, and are available on
Regional and global estimates are based on population-weighted averages weighted by the total number of births. These estimates are presented only if available data cover at least 50% of total births in the regional or global groupings.
Estimates are published annually, in May by WHO in World Health Statistics (http://www.who.int/whosis/whostat/en/) and in December, by UNICEF in State of the World’s Children, and are available at www.childinfo.org.