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)

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 rateAdolescent birth rates and total fertility rates, Country, Year

  Adolescent birth rate1

(Age-specific fertility rate for women age 15-19)

Total fertility

rateRegion    Urban-rural residence

 

Women’s education

 

Wealth index quintile

 

Religion/Language/Ethnicity of household head   Total    

1 MICS indicator 5.1; MDG indicator 5.4

Childbearing among adolescents

Table RH.1: Adolescent birth rate and total fertility rateAdolescent birth rates and total fertility rates, Country, Year

  Adolescent birth rate1

(Age-specific fertility rate for women age 15-19)

Total fertility

rateRegion    Urban-rural residence

 

Women’s education

 

Wealth index quintile

 

Religion/Language/Ethnicity of household head   Total    

1 MICS indicator 5.1; MDG indicator 5.4

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!

Childbearing among adolescentsTable RH.2: Early childbearingPercentage of women age 15-19 years who have had a live birth or who are pregnant with the first child and percentage of women age 15-19 years who have begun childbearing, percentage of women who have had a live birth before age 15, and percentage of women age 20-24 who have had a live birth before age 18, Country, Year

  Percentage of women age 15-19 who: Number of

women age 15-

19

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

age 181

Number of women age 20-24

 

Have had a live birth

Are pregnant with first

child

Have begun child-

bearing

Have had a live birth

before age 15    Region                  Urban-rural residence  Education  Wealth index quintile  Religion/Language/Ethnicity of household head     Total                  

1 MICS indicator 5.2

Sum of first two columns

NEW!

Childbearing among adolescentsTable RH.3: Trends in early childbearingPercentage of women who have had a live birth, by age 15 and 18, by residence and age group,Country,Year

  Urban Rural All

 

Percentage 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  

Percentage 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  

Percentage of

women with a

live birth before age 15

Number of

women

Percentage of

women with a

live birth before age 18

Number of

womenAge                             15-19 na na na na na na 20-24   25-29   30-34   35-39   40-44   45-49     Total                            

• Two indicators -- Note that each indicator has a different denominator• Figures in the total row are based on women age 15-49 and 20-49 for live births

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

NEW!

Adolescent childbearing – a comparison of indictors

Indicator Value

Adolescent birth rate 22

Unpublished example from a MICS4 survey

Adolescent childbearing – a comparison of indictors

Indicator Value

Adolescent birth rate 2215-19 year old women who have had a live birth 2%

Unpublished example from a MICS4 survey

Adolescent childbearing – a comparison of indictors

Indicator Value

Adolescent birth rate 2215-19 year old women who have had a live birth 2%

Live birth before age 18 (among 20-24 year olds) 16%

Unpublished example from a MICS4 survey

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

currently

married or

in union

Fe-male sterili

-zatio

n

Male sterili

-zatio

n IUDInjectables

Im-plant

s Pill

Male con-dom

Fe-male con-dom

Dia-phrag

m/Foam/Jelly LAM

Periodic

abstin-

ence

With-draw

al Other

Any mod-ern

meth-od

Any tradi-tional meth-

od

Any 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

Met need for contra-ception -

For limiting

Met need for contra-ception -

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 Total

Any 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 careNEW!

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!

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!

• MICS4 – now recommends direct sisterhood method (survivorship of all siblings)

• Limitations include:– Reference period usually 7 years or 10 years

before the survey– Confidence intervals are very wide– Studies indicate that both male and female

mortality underestimated

Maternal mortality

Maternal mortalityTable RH.17: Maternal mortalityDirect estimates of maternal mortality for the 0-6 years preceding the survey, Country, Year

 Maternal deaths

Exposure (years)

Mortality rates (per

1000)

Proportion of maternal deaths to

female deathsAge        

15-19  20-24  25-29  30-34  35-39  40-44  45-49     

Total           

General fertility rate  Maternal mortality ratio1      

1 MICS indicator 5.13; MDG indicator 5.1Maternal mortality ratio is calculated as the maternal mortality rate divided by the general fertility rateThe maternal mortality rate and general fertility rate are age-adjusted

Trend Estimation from Sibling Histories with 95% Confidence Intervals (Namibia)

Estimates are averages over long periods (here 7 or 9 years) and 95% confidence intervals are large

0

100

200

300

400

500

600

Pre

gnan

cy-R

elat

ed M

orta

lity

Rat

io

1985 1990 1995 2000 2005Year

1992 DHS 2000 DHS2007 DHS

Source: Ken Hill – UN maternal mort workshop,Nairobi December 2010

Further use of the data

Tracking Progress on Child and Maternal Nutrition

Brainstorming

• Focus on adolescents • Maternal health…

– fertility desires– Empowerment (Attitude towards domestic

violence)• HIV and maternal care (knowledge, testing

during ANC)

Thank you!