Who is assisting women during childbirth and how competent are they? The challenge of measuring skilled health personnel or skilled birth attendants – in a meaningful and comparative way

About this Research Topic

Background

Skilled health personnel or “Skilled Birth Attendants” (SBA) providing care during childbirth was a key indicator in the Millennium Development Goals (MDGs) framework. It is also currently part of the Sustainable Development Goals (SDGs) framework for measuring progress towards improving maternal and newborn health outcomes. The rationale for the use of this indicator is that maternal mortality can be difficult to measure, and that if women and newborns are cared for during childbirth by skilled health personnel, a reduction in both maternal and newborn mortality is achievable.

The way that coverage of skilled health personnel is measured and reported currently in many low-and-middle income countries is mainly through population-based household surveys such as Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). In these surveys, women of reproductive age are asked who assisted with their deliveries in the last two years (in MICS), or five years (in DHS), preceding the survey. The questionnaires are based on a list of health professionals who provide childbirth care, and who is classified as “skilled” (competent) in the analysis is developed in collaboration with the National Government.

There are a number of challenges with this approach. Firstly, evidence from validation studies suggest that women’s recall is not always reliable in identifying the type of health professional(s) that assisted them during childbirth. Another challenge is that health professionals with different levels of competencies and years of training are classified as skilled birth personnel in different countries – meaning some countries report relatively high levels of skilled birth attendance, when actually women and newborns are being cared for by relatively unskilled health professionals. Finally, it has always been acknowledged that these personnel need to work in an enabling environment – but no measure of the enabling environment has so far been included in estimating coverage of skilled health personnel.

These factors may help to explain why some countries who have reported relatively high levels of birth attendance by skilled health personnel, have not seen maternal and neonatal mortality reduced proportionally.

To address these challenges, WHO, UNICEF, UNFPA, the International Confederation of Midwives (ICM), the International Council of Nurses (ICN), the International Federation of Gynecology and Obstetrics (FIGO) and the International Pediatric Association (IPA) initiated a process to clarify and refine the definition of the widely used term and indicator “skilled birth attendant” (SBA). The outcome was a revised definition (2018 definition and statement) of skilled health personnel. In this definition, the knowledge and skills of health professionals caring for women during childbirth were clearly stated – as well as training and enabling environment components needed.

The measurement of the indicator has not changed despite this change in definition. We are now in the situation where an indicator that is intended to measure progress may, in fact, give a false sense of security and mask huge problems with actual care provided. In this Research Topic we are asking for articles on how we can get a clearer sense of the quality of care that skilled personnel are providing women during childbirth, and suggestions of how to improve measurement of this.

We welcome manuscript contributions on any of the following topics:

• Optimum ways to measure skills, knowledge, practice and working environment of skilled personnel providing care to women and newborns in a way that is nationally/internationally comparable;
• Strategies that can be used to improve how skilled health personnel are measured through population surveys – i.e., DHS/MICS;
• Uses of HMIS/DHIS data to provide more information on this topic;
• Designing, implementing, and evaluating curricula for skilled health personnel to ensure that it takes account of local needs and context, and that it ensures international standards are met;
• Measuring the quality of skilled birth personnel training - including skills of teachers, the environment in which they are working, and supervision and mentoring – in a way that allows for international comparison and facilitates accountability;
• Alternative global indicators - using routinely collected data - that provide internationally comparable data on the quality of childbirth care being provided;
• Assessments of whether global indicators appropriately recognise the different contexts in which countries are working;
• Usefulness of the SBA indicator.


We would like to acknowledge Dr. Joanne Welsh who have have acted as coordinators and have contributed to the preparation of the proposal for this Research Topic.

Keywords: Childbirth, skilled health provider, measurement, maternal and neonatal mortality

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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