Percent of all births in EmOC facilities

The percent of all births in an area that take place in emergency obstetric care (EMoC) facilities (basic or comprehensive).

This indicator is calculated as:

(Number of women registered as having given birth in facilities classified as EMoC facilities / Estimate of all the live births in the area, regardless of where the birth takes place) x 100

Although the name of the indicator is "Percent of births in EmOC facilities", in practice the numerator is the number of women giving birth and not the number of infants born. It is recognized that the number of births will be slightly higher than the number of women giving birth, because of multiple births; however, the extra effort needed to count births rather than women giving birth might not be necessary, nor is it likely to change the conclusions drawn from the results.

EmOC services are defined as:

  1. Administration of parenteral antibiotics;
  2. Administration of uterotonic drugs (i.e. parenteral oxytocin);
  3. Administration of parenteral anticonvulsants for pre-eclamsia and eclampsia (i.e. magnesium sulphate);
  4. Manual removal of the placenta;
  5. Removal of retained products (e.g.,manual vacuum aspiration);
  6. Perform assisted vaginal delivery (e.g., vacuum extraction, forceps); and 
  7. Perform surgery (e.g., cesarean section); and
  8. Perform blood transfusion.


Facilities are divided into those that provide "basic" and "comprehensive" EmOC. If a facility has performed each of the first six functions in the past three months, it qualifies as providing "basic" EmOC. If it has provided all eight of the functions, it qualifies as a "comprehensive" EmOC facility.


Knowledge of each health facility’s EmOC status, which is made available from the results of routine monitoring or needs assessment


Health facility records


About 15% of all pregnancies will experience life-threatening obstetric complications.  Even more concerning is that health care providers can seldom predict who will experience these complications.  That is why all women and newborns must have access to emergency care (AMDD, 2011).

This indicator was originally proposed to determine whether women are using the EmOC facilities identified by availability of EmOC services and geographical distribution of EmOC facilities, and it serves as a crude indicator of the use of obstetric services by pregnant women. Overall, this indicator shows the volume of maternity services provided by facilities. If there appears to be under-use, the reasons should be explored. To increase use, emphasis should be placed on enabling women with complications to use EmOC facilities. The first goal of programs to reduce maternal mortality should be to ensure that 100% of women with obstetric complications have access to functioning emergency facilities.


Even if the use of health facilities (including EmOC facilities) is fairly high, it is worthwhile investigating which women are not using them. Certain factors strongly affect use of services in a particular area, such as distance to the facility, prevalence of ethnic or religious minority groups, level of education (often an indication of social status), the reputation of the facility and poverty. Information on some of these factors, such as residence, may already be available in health facility records, and records can be reviewed to determine whether women come from all parts of the catchment area or only from the town in which the facility is located.


access, emergency, safe motherhood (SM)

National Needs Assessment for Emergency Obstetric and Newborn Care.  Averting Maternal Death and Disability (AMDD).  Accessed June, 2011.  http://www.amddprogram.org/d/content/national-needs-assessments-emergency-obstetric-and-newborn-care

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