Number of births to HIV-positive women attended by skilled health personnel

Background

The presence of a skilled birth attendant at delivery has been associated with a 20-percent reduction in the risk of death or stillbirth caused by intrapartum complications. The United Nations estimated in 2015 that 17.8 million women in the world are living with HIV, and in sub-Saharan Africa (SSA) alone, women constituted 56 percent of all new HIV infections among adults. And, although there has been a global reduction in the maternal mortality ratio, 216 mothers still die per 100,000 live births, and this number reaches as high as 546 deaths in SSA. Coexisting high levels of both maternal mortality and HIV in these contexts make the fact that an estimated 90 percent of deliveries still occur at home—which equates to 60 million women delivering without assistance from a skilled birth attendant—quite concerning. This is a key indicator to measure improvement in women’s health. The proportion of deliveries that involve skilled birth attendance has stagnated at 40 percent in SSA, and many deliveries take place outside of the formal health care system, with support from trained and untrained traditional birth attendants or family members. Global goals call for a reduction in the number of new HIV infections in infants from 40,000 to 20,000 by 2020 and call for 95 percent of pregnant women to have access to lifelong treatment. 

Rural residency, delivery at home, failure to uptake antiretrovirals at birth, and mixed feeding are factors associated with mother-to-child transmission (MTCT) of HIV. Women from rural areas are less likely to attend antenatal care (ANC) clinics, and ANC clinics in rural areas equipped with prevention of mother-to-child transmission (PMTCT) services are limited. Skilled birth attendance at a health facility reduces risk of MTCT, owing to increased likelihood of appropriate administration of antiretroviral prophylaxis to the mother during delivery and infant at birth, but many women do not have access to this option. Community programs are essential to ensure that HIV-positive pregnant women are mobilized and educated to increase uptake of PMTCT interventions, institutional delivery, and proper follow-up for infants. It has also been demonstrated that, when trained adequately, traditional birth attendants should participate in PMTCT and ANC service provision and can contribute to increased uptake and coverage for services. Community programs that provide transport to clinics and recruit and train volunteers to provide counseling and increase awareness to pregnant and breastfeeding women with HIV have been shown to increase antiretroviral therapy enrolments.

Numerator

Number of HIV-positive pregnant women who were assisted by a nurse, doctor, or midwife during a delivery that occurred during the reporting period

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

Skilled health personnel can be defined as an accredited health professional, including a midwife, doctor, nurse, or auxiliary nurse/midwife who has been educated and trained to a certain skill level required to manage uncomplicated pregnancies, childbirth, and the immediate postnatal period, and manage and refer complicated pregnancies. Traditional birth attendants and community health workers cannot be counted as skilled health personnel.

Traditional birth attendants and community workers can gather these data by tracking the number of pregnant women in their communities, ensuring that they are linked to ANC services, educating them on PMTCT and HIV, and linking them to testing for HIV through the opt-out strategy. The opt-out strategy allows women to opt out of HIV testing after being given HIV counseling and information by a service provider; it has been shown to be effective in getting women to agree to HIV testing HIV. Poor monitoring of PMTCT services has been shown to lead to poor retention of HIV-positive mothers in treatment, which is why effective community and facility-based monitoring of this indicator is essential. Community workers are essential to efforts to retain and link HIV-positive pregnant women and HIV-exposed infants to care; their primary contributions can include reducing HIV-related stigma and helping women disclose their status to families and partners to seek support. When a community worker has linked the HIV-positive pregnant women to a skilled birth attendant and PMTCT services for delivery, the community worker can count a woman towards this indicator. If this information is unknown, community workers can also ask HIV-positive pregnant women if they delivered their child during the reporting period and whether that birth was assisted by a nurse, midwife, or doctor.

Data source

This information is most often tracked by community workers through their community folders, monthly reports, and registers.

Disaggregation

  • Age (15–49)
  • Sex
  • Location of delivery
  • Key population type (female sex workers, trans men, and women who inject drugs)

Data quality considerations

This indicator only measures whether births were attended during the reporting period but does not look at whether providers were successful in preventing mother-to-child transmission or preventing maternal or infant death. Service delivery sites may not be equipped to provide PMTCT services, especially in rural areas, and community workers should ensure that they locate a facility that offers the service, which should be done at the time when ANC services are needed. The overall number reported for this indicator should be equal to the sum of the numbers of people in each disaggregation type. Only one type of age disaggregation should be used throughout, and overlap should be avoided.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

HIV-exposed births attended by skilled personnel

Category

Prevention of Mother-to-Child Transmission, HIV Prevention

References

Delivery Care. (2016). Retrieved from https://data.unicef.org/topic/maternal-health/delivery-care/

Facts and figures: HIV and AIDS. (n.d.). Retrieved from http://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures

Maternal Mortality. (n.d.). Retrieved from https://data.unicef.org/topic/maternal-health/maternal-mortality/

Perez, F., Aung, K. D., Ndoro, T., Engelsmann, B., & Dabis, F. (2008). Participation of traditional birth attendants in prevention of mother-to-child transmission of HIV services in two rural districts in Zimbabwe: A feasibility study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19061506

Prevention of mother-to-child transmission (PMTCT) of HIV. (2018). Retrieved from https://www.avert.org/professionals/hiv-programming/prevention/prevention-mother-child#footnoteref14_8xwktnq

Wudineh, F., & Damtew, B. (2016). Mother-to-child transmission of HIV infection and its determinants among exposed infants on care and follow-up in Dire Dawa City, Eastern Ethiopia. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771871/

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