1. Multiple Indicator Cluster Surveys Data dissemination and further analysis workshop Maternal and Reproductive Health MICS4 Data Dissemination and Further Analysis Workshop

2. 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)

3. Childbearing among adolescents Calculations based data from the child mortality module (Brass questions) or birth history Pay attention to sample sizes, especially for breakdowns by background variables NEW! Table RH.1: Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates, Country, Year Adolescent birth rate 1 (Age-specific fertility rate for women age 15-19) Total fertility rate Region 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

4. Childbearing among adolescents Table RH.1: Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates, Country, Year Adolescent birth rate 1 (Age-specific fertility rate for women age 15-19) Total fertility rate Region 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 history Pay 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!

5. Childbearing among adolescents Table RH.2: Early childbearing Percentage 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 18 1 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!

6. Childbearing among adolescents Table RH.3: Trends in early childbearing Percentage of women who have had a live birth, by age 15 and 18, by residence and age group,Country,Year UrbanRuralAll Percenta ge of women with a live birth before age 15 Number of women Percenta ge of women with a live birth before age 18 Number of women Percenta ge of women with a live birth before age 15 Number of women Percenta ge of women with a live birth before age 18 Number of women Percenta ge of women with a live birth before age 15 Number of women Percenta ge of women with a live birth before age 18 Number of women Age 15-19na 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!

7. Adolescent childbearing – a comparison of indictors Indicator Valu e Adolescent birth rate22 Unpublished example from a MICS4 survey

8. Adolescent childbearing – a comparison of indictors Indicator Valu e Adolescent birth rate22 15-19 year old women who have had a live birth 2% Unpublished example from a MICS4 survey

9. Adolescent childbearing – a comparison of indictors Indicator Valu e Adolescent birth rate22 15-19 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

10. Contraception Table RH.4: Use of contraception Percentage 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 meth od Percent of women (currently married or in union) who are using: Num ber of wom en curre ntly marri ed or in union Fe- male sterili - zatio n Male sterili - zatio nIUD Inject ables Im- plant sPill Male con- dom Fe- male con- dom Dia- phrag m/ Foa m/Jell yLAM Perio dic absti n- ence With- draw alOther Any mod- ern meth- od Any tradi- tional meth- od Any meth od 1 Any method is an MDG indicator Modern Traditional

11. 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

12. 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?

13. Key indicator elements Marital status Current use of contraception (any method) Fecundity Pregnant or amenorrheic Desire for last birth Desire for future births

14. Unmet need Table RH.5: Unmet need for contraception Percentage 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 limitingTotal For spacing For limitingTotal 2 Region Urban-rural Age Education Wealth index quintiles Religion/Language/Ethnicity of household head Total 1 MICS indicator 5.3; MDG indicator 5.3 2 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

15. 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- ception 19.158.277.32.42.14.52,65394.42,171 Any method 77.2 Any 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

16. Antenatal care Table RH.6: Antenatal care coverage Percent 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 antenata l care receivedTotal Any skilled personnel 1 Number of women who gave birth in the preceding two years Medical doctor Nurse/ Midwife Auxiliary midwife Traditiona l birth attendant Communi ty health workerOther 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

17. Table RH.7: Number of antenatal care visits Percent 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 visitsOne visit Two visits Three visits 4 or more visits 1 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 NEW! MDG indicator; for reporting ensure that 4+ can be derived from table Watch out for… Indicator definition (any provider) “don’t knows”

18. Table RH.8: Content of antenatal care Percentage 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 years Blood pressure measured Urine sample taken Blood sample taken Blood pressure measured, urine and blood sample taken 1 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

19. Delivery Care Table RH.9: Assistance during delivery Percent 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- antTotal Delivery assisted by any skilled atten- dant 1 Percent delivered by C-section 2 Number of women who had a live birth in preceding two years Medical doctor Nurse/ Midwife Auxiliary midwife Traditio nal birth attend- ant Com- munity health worker Relative /FriendOther 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!

20. Delivery Care Table RH.10: Place of delivery Percent 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 facility 1 Number of women who had a live birth in preceding two years Public sector health facility Private sector health facilityHomeOther 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

21. Continuum of reproductive and maternal health interventions Pre- preg Pregnancy (Antenatal Care) Delivery Care

22. Continuum of reproductive and maternal health interventions Pre- preg Pregnancy (Antenatal Care) Delivery Care Gap!

23. 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!

24. 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

25. Table RH.17: Maternal mortality Direct 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 deaths Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total General fertility rate Maternal mortality ratio 1 1 MICS indicator 5.13; MDG indicator 5.1 Maternal mortality ratio is calculated as the maternal mortality rate divided by the general fertility rate The maternal mortality rate and general fertility rate are age-adjusted

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

27. Further use of the data

29. Tracking Progress on Child and Maternal Nutrition

30. Brainstorming Focus on adolescents Maternal health… –fertility desires –Empowerment (Attitude towards domestic violence) HIV and maternal care (knowledge, testing during ANC)

31. Thank you!