Skilled Birth Attendance

“A skilled birth attendant is an accredited health professional — such as a midwife, doctor or nurse — who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.” (WHO, ICM and FIGO, 2004)

Skilled attendance at birth is the first of three coverage indicators used to assess progress against the SDG targets for maternal and newborn health. Skilled birth attendance has two key components - a skilled attendant and an enabling environment. The term skilled attendant refers to an accredited health professional - such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancy, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns. The enabling environment is less clearly defined, but equipment, supplies, drugs, transport, referral, regulatory frameworks and policies are cited as components.

Latest estimates show that globally 73% of births are attended by skilled health personnel; this ranges from 54% in the African Region to 99% in the European region. Despite the heavy reliance on the proportion of births attended by a skilled attendant as the key indicator for measuring progress towards the achievement of MDG 5, there is little consistency in how this is monitored and evaluated in the various country settings.  

The State of the World’s Midwifery 2014 defines midwifery asthe health services and health workforce needed to support and care for women and babies, including sexual and reproductive health and especially pregnancy, labour and postnatal care. This includes a full package of sexual and reproductive health services, including preventing mother-to child transmission of HIV, preventing and treating sexually transmitted infections and HIV, preventing unwanted pregnancy, dealing with the consequences of unsafe abortion and providing safe abortion in circumstances where it is not against the law”. This definition is wider than, for example, the Medical Subject Headings definition, introduced in 1966, which simplifies midwifery to “the practice of assisting women in childbirth”.

The majority of low- and middle-income countries are endeavouring to expand and deliver equitable midwifery services, but  comprehensive, disaggregated data for determining the availability, accessibility, acceptability and quality of skilled birth attendance and/or midwifery are generally not available.

Recent examples of our work in this thematic area:

  • CMNH has conducted studies to explore the scope of practice, factors that enable or hinder healthcare workers providing SBA and solutions to providing an enabling environment.
  • We completed a multi-country study to assess the contribution of Community-based Health Workers in providing care during and after pregnancy and at the time of birth in sub-Saharan Africa and Southeast Asia.
  • In 2018, CMNH and the Foundation for Research in Community Health (FRCH) continued to work together on a programme to improve the quality of care provided by Auxiliary Nurse Midwives in India.
    Dr Nerges Mistry, Director, Foundation for Research in Community Health “No words are enough to describe the team and splendid volunteers who drove the programme to great success. We look forward to further interaction with CMNH.”