Multiple Indicator Cluster Surveys Data dissemination and further analysis workshop

Multiple Indicator Cluster SurveysData dissemination and further analysis workshop

Maternal and Reproductive Health

MICS4 Data Dissemination and Further Analysis Workshop

Overview of MICS4 contents

• Core modules– Childbearing among

adolescents (3 tables)– Contraception (2 tables)– Antenatal care (3 tables)– Delivery care (2 tables)

• Other modules– Post-natal health care (6 tables)– Maternal mortality (1 table)

Table RH.1: Adolescent birth rate and total fertility rate, Country, 2010

Adolescent birth rate [1] (Age-specific fertility rate for

women age 15-19)

Total Fertility

RateArea Urban 30 2.3

Rural 77 2.8Mother's education

None 113 2.9Primary 70 2.5Secondary+

29 3.0

Wealth index quintile

Poorest 112 3.1Second 95 2.8Middle 97 3.0Fourth 36 2.4Richest 10 2.0

Total 59 2.6

Childbearing among adolescents

Calculations based data from the child mortality module (Brass questions) or birth historyPay attention to sample sizes, especially for breakdowns by background variables

NEW!

Table RH.1: Adolescent birth rate and total fertility rate, Country, 2010

Adolescent birth rate [1] (Age-specific fertility rate for

women age 15-19)

Total Fertility

RateArea Urban 30 2.3

Rural 77 2.8Mother's education

None 113 2.9Primary 70 2.5Secondary+

29 3.0

Wealth index quintile

Poorest 112 3.1Second 95 2.8Middle 97 3.0Fourth 36 2.4Richest 10 2.0

Total 59 2.6


Calculations based data from the child mortality module (Brass questions) or birth historyPay attention to sample sizes, especially for breakdowns by background variables

Number of births to women age 15-19 years, divided by the average number of women age 15-19 (during the one year

period preceding the survey)

Average number of children to which a woman will have given birth by the end

of her reproductive years if current fertility rates prevailed.

The total fertility rate (TFR) is calculated by summing the age-specific fertility rates

calculated for each of the 5-year age groups of women, from age 15 through to

age 49.

NEW!

ABR: Number of births per 1,000 adolescent girls aged 15–19.

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

Childbearing among adolescentsNEW!

Sum of the first two columns


• Two indicators -- Note that each indicator has a different denominator• Figures in the total row are based on women age 15-19 and 20-24 for live births

before age 15 and age 18, respectively.• Data from different cohorts provides trends

NEW!

Table RH.3: Trends in early childbearingPercentage of women who have had a live birth by age 15 and 18, by age groups, Country, 2010

Urban Rural AllPercentage of women with a live

birth before age 15

Number of women

Percentage of women with a live

birth before age 18

Number of women


birth before age 15

Number of women


birth before age 18

Number of women


birth before age 15

Number of women


birth before age 18

Number of

women

Age 15-19 .2 753 . 0 .7 1299 . 0 .5 2052 . 020-24 .6 882 10.3 882 1.5 1620 18.0 1620 1.2 2502 15.3 250225-29 1.4 983 11.1 983 2.3 1738 18.1 1738 1.9 2721 15.6 272130-34 1.8 722 16.6 722 2.3 1497 18.1 1497 2.2 2219 17.6 221935-39 2.6 536 13.1 536 2.0 1320 15.9 1320 2.2 1856 15.1 185640-44 2.4 380 17.4 380 1.4 1181 13.5 1181 1.7 1561 14.4 156145-49 2.4 192 10.5 192 .7 914 10.8 914 1.0 1106 10.8 1106

Total 1.4 4448 12.9 3695 1.6 9570 16.3 8271 1.6 14018 15.2 11966

Adolescent childbearing – a comparison of indicators

Indicator ValueAdolescent birth rate* (per 1000 women 15-19) 59

2010-2011 MICS4

*Adolescent birth rate: Age-specific fertility rate for women aged 15–19

Adolescent childbearing – a comparison of indictors

Indicator ValueAdolescent birth rate (per 1000 women 15-19) 5915-19 year old women who have had a live birth 8.5%

Example from MICS4

Adolescent childbearing – a comparison of indictors

Indicator ValueAdolescent birth rate (per 1000 women 15-19) 5915-19 year old women who have had a live birth 8.5%Live birth before age 18 (among 20-24 year olds) 15.3%

Example from MICS4

Contraception

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 currentl

y 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 mod-ern

meth-od

Any tradi-tional

meth-odAny

method1

Any method is an MDG indicator

Modern Traditional

How to define unmet need?

• Women with an unmet need for family planning are women who – are married or in union– are fecund – not using any method of contraception – report not wanting any more children or wanting

to delay the birth of their next child for at least two years

We also consider the following to have unmet need:

• Women* who are pregnant, but whose current pregnancy unwanted or mistimed

• Postpartum amenorrheic women* (not using contraception) whose last birth was unwanted or mistimed

*Married/in union

How to define unmet need?

Key indicator elements

• Marital status• Current use of contraception (any method)• Fecundity• Pregnant or amenorrheic• Desire for last birth• Desire for future births

Unmet need

Table RH.5: Unmet need for contraceptionPercentage of women age 15-49 years currently married or in union with an unmet need for family planning and percentage of demand for contraception satisfied, Country, Year

Met need for contraception Unmet need for contraception

Number of women currently

married or in union

Percentage of demand for

contraception satisfied

Number of women currently married or in union with need for contraception

For spacing

For limiting Total

For spacing

For limiting Total2

Region Urban-rural Age Education Wealth index quintiles Religion/Language/Ethnicity of household head Total

1 MICS indicator 5.3; MDG indicator 5.32 MICS indicator 5.4; MDG indicator 5.6

New MICS4 methodology – may make comparisons challenging

Note that met need for contraception includes both traditional and modern methods

MICS4 country example of unmet need

Met need for contra-ception -

For spacing


For limiting


Total

Unmet need for contra-ception –

For spacing

Unmet need for contra-ception – For limiting

Unmet need for contra-ception -

Total

Number of women

currently married or in union

Percentage of demand for contra-

ception satisfied

Number of women

currently married or in union

with need for contra-

ception19.1 58.2 77.3 2.4 2.1 4.5 2,653 94.4 2,171

Any method 77.2Any modern method 58.8

Any traditional method 18.5 Periodic abstinence/Rhythm 12.0

Withdrawal 6.2

RH4: Use of contraception

Note that met need for contraception includes both traditional and modern

methods

Antenatal care

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 careNo

antenatal care

received TotalAny skilled personnel1

Number of women who gave

birth in the preceding two

yearsMedical doctor

Nurse/ Midwife

Auxiliary midwife

Traditional birth

attendant

Community health worker Other

Key indicator: At least one ANC visit (MDG)

Personnel categories • Should have been modified in country

• MICS4 standard -- Skilled health personnel includes doctors, nurses, midwives, and auxiliary midwives. But double-check and document in

final report text

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 visitTwo visits

Three 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

Antenatal care

MDG indicator; for reporting ensure that 4+ can be derived from table

Watch out for… • Indicator definition (any provider)

• “don’t knows”

Table RH.8: Content of antenatal carePercentage of women age 15-49 years who had their blood pressure measured, urine sample taken, and blood sample taken as part of antenatal care, Country, Year

Percentage of pregnant women who had: Number of women who had a live birth in the preceding two

yearsBlood pressure

measuredUrine sample

takenBlood sample

taken

Blood pressure measured,

urine and blood sample taken1

Region Urban-rural Mother's age at birth Education Wealth index quintile Religion/Language/Ethnicity of household head Total

1 MICS indicator 5.6

Antenatal care

Delivery CareTable 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 atten-dant1

Percent delivered by C-section2

Number of women who had a live birth

in preceding two years

Medical doctor

Nurse/ Midwife

Auxiliary midwife

Traditional birth attend-

ant

Com-munity health worker

Relative/Friend Other

MDG indicator: Skilled attendant at delivery

MICS 4 standard -- Skilled health personnel includes doctors, nurses, midwives, and auxiliary midwives. But double-check and document in final report text

New indicator! C-section should be within 5%-15%

NEW!

Delivery CareTable 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 should have been modified in country

Possible to present additional categories

Continuum of reproductive and maternal health interventions

0102030405060708090

100 94 97

7185

7156 51

97 96

Pre-preg

Pregnancy (Antenatal Care)

Delivery Care

Continuum of reproductive and maternal health interventions

0102030405060708090

100 94 97

7185

7156 51

97 96

Pre-preg

Pregnancy (Antenatal Care)

Delivery Care

Gap!Gap!

Overview of MICS4 contents• Core modules

– Childbearing among adolescents (3 tables)

– Contraception (2 tables)– Antenatal care (3 tables)– Delivery care (2 tables)

• Other modules– Post-natal health care

(6 tables)– Maternal mortality (1 table)

Post-natal Health Checks

• New MICS4 module• 6 tables covering post-natal health checks for

both mother and child– Post-partum stay in health facility– Post-natal health checks for newborns– Post-natal care (PNC) visits for newborns– Post-natal health checks for mothers– Post-natal care (PNC) visits for mothers– Post-natal health checks for mothers and newborns

NEW!

The MICS4 Module

Institutional deliveries Non-institutional deliveries

With attendant Without attendantWhile in facility or at home following birth

Duration of post-partum stay in facility

Health check in facility after birth - before discharge

Health check from attendant before leaving mother & child after birth

Postnatal care visit(with information on timing, location & provider)

Health check after discharge

Health check after attendant leaves home after birth

Any health check

Postnatal health check (global indicator)

Health check in facility and/or health check after discharge (i.e. PNC visit within two days of delivery)

Health check from birth attendant and/or a health check after attendant leaves home (i.e. PNC visit within two days of delivery)

Health check (i.e. PNC visit within two days of delivery)

PNC Data from West African country MICS 2011

• West African country MICS 2011; unpublished data

• Place of delivery (Last births in last 2 years)– Facility births: 67 percent

• 74 percent stay in facility for more than 12 hours• 10 percent are discharged within 6 hours of delivery

• Survey data provide important programmatic insights – especially with detailed data on PNC visits

Health check

following birth

while in facility or at home

PNC visit

Same day

1 day following

birth

2 days following

birth

3-6 days following

birth

After first week

following birth

No PNC Visit

Missing/Don’t Know Total

Global Indicator:

PNHC

Number of last

births in the 2 years

prior to survey

Newborns Place of delivery Health facility 97.1 6.3 3.3 1.7 5.0 27.0 55.7 1.1 100.0 97.2 1434 Home 47.4 12.6 7.3 1.3 5.3 8.5 64.3 0.8 100.0 54.5 793 Total 80.9 8.5 4.5 1.6 5.0 21.0 58.5 1.0 100.0 83.3 2528Mothers Place of delivery

Health facility

97.5 3.2 1.4 0.9 4.0 16.7 73.4 0.4 100.0 97.5 1703

Home 47.3 7.9 4.9 0.9 3.4 4.3 78.4 0.1 100.0 51.6 793 Total 81.1 4.8 2.5 0.9 3.8 12.8 74.9 0.3 100.0 82.5 2528

PNC Data from West African country MICS 2011Similar patterns for mothers, but mothers are less likely to receive

a PNC visit

Majority receive a health check while in facility or at home (much less for home deliveries) – similar figures for newborns and mothers

21 percent receive a first PNC visit more than one week after

delivery

Only 41 percent receive a PNC visit

15 percent receive a PNC visit on the

same day, or one or two days following

delivery


• Health checks performed universally in facilities, but PNC visits may not be performed at all, or may be performed quite late

• In the case of home deliveries, less than half of birth attendants perform health checks on mothers and newborns

• More PNC visits for newborns than mothers – both for home and facility deliveries


Location of first PNC visit Provider of first PNC visit

HomePublic sector

Private sector Other Total

Doctor/ nurse/

midwifeAux.

Midwife

Community health worker TBA Total

Number of newborns/mothers of last births in 2 years prior survey with a PNC visit within first week

of life

Newborns

Place of delivery

Home 68.4 31.5 0.1 0.0 100.0 38.3 1.7 7.6 52.4 100.0 210

Health facility

12.3 73.6 14.1 0.0 100.0 95.6 1.7 2.7 0.1 100.0 277

Total 36.1 55.5 7.9 0.4 100.0 70.8 1.7 5.0 22.5 100.0 495

Mothers

Place of delivery

Home 66.6 33.2 0.2 0.0 100.0 41.0 2.1 10.0 47.0 100.0 129

Health facility

17.2 71.0 11.8 0.0 100.0 95.5 1.7 1.6 1.1 100.0 146

Total 39.2 53.9 6.4 0.0 100.0 70.5 1.8 5.5 22.2 100.0 280

Majority of home deliveries receive PNC visits at home; more than half have PNC visits with a TBA

Very similar patterns for newborns and mothers

Facility deliveries return to a facility for a PNC visit (88 %)Almost all are seen by a doctor/midwife/nurse


Possible to use MICS data to uncover differentials – for example:

– 80 percent of both mothers and newborns receive PNHC

– Newborns in rural areas and poorest households lag behind, at 73 and 63 percent

Per cent of both mothers and newborns receiving a health check in the facility or at home, or a PNC visit

within two days of birth

To conclude

• Substantial increase in PNC data availability due to inclusion in MICS– 18 surveys in 2009-2012– Many more expected in MICS5 (2012-2014)

• More data will also mean better understanding of how the module is working

Further use of the data

Coverage of interventions varies across the continuum of care

Source: Countdown to 2015: The 2012 report

Tracking Progress on Child and Maternal Nutrition

Brainstorming

• Focus on adolescents – coverage of maternal health services

• Maternal health…– fertility desires by background characteristics

• HIV and maternal care (knowledge, testing during ANC)

• Malaria in pregnancy (provision of IPTp during ANC visits)

Thank you!

Multiple Indicator Cluster Surveys Data dissemination and further analysis workshop

Documents

Transcript of Multiple Indicator Cluster Surveys Data dissemination and further analysis workshop