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!