Are we there yet? Challenges in measuring

MDG5 achievements

Tiziana LeoneLSE Health

MDG 5Target 5.A.

Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

5.1 Maternal mortality ratio5.2 Proportion of births attended by skilled health personnel

Target 5.B.

Achieve, by 2015, universal access to reproductive health

5.3: Contraceptive prevalence rate5.4: Adolescent birth rate5.5: Antenatal care coverage5.6: Unmet need for family planning

Target 5.b

Progress so far

0

1

2

3

4

5

6

MDG 5

Lancet 1990-2008

UN 1990-2005

Poor data

• If we look at the top 30 countries for Maternal deaths only South Africa, India and Chian have some vital registration system in place

• Latest publication relies on very few observations for the countries with the highest mortality with massive confidence intervals as a result

Not just maternal deaths

• 40 million babies die unregistered each year

• 40 million people die unregistered each year

• 85 countries with 66% of the world’s population do not have reliable cause of death statistics

Contraceptive use

Some facts

Sample selection

Methods

• Inclusion of data quality ratings • This would need to take into account the type of data (eg; survey vs vital statistics) as well as the

reliability of the data (e.g.: level of coverage of VT or adjustment factor of census data)• Integration of datasources• Use of multilevel modelling to account of national policies variations• Weighting to account of data quality ratings• Revision of the concept of unmet need• More emphasis needs to be given to:• Differential analysis• Variations in geographic access • Quality of care • More stress on post-partum care and abortion

DeterminantsDemographic Socio-

economicCommunity/network

Age Residence Talked about FP

Parity Ethnicity Visited Health centre

Marital status Religion Visited by FP worker

Number of unions

Wealth quintile Watch TV

Age at first birth Listens to radio

Whether heard of FP from TV radio or newspapers

Median level of education within cluster

Percentage sterilised women within cluster

Bivariate results

Discussing FP issues negatively significant Wealth not significant (wealthier women

slightly less likely) Hearing about FP from radio and newspaper

negatively significant Not significant when parity considered

Way forwards

Make every maternal death count Through civil registration,

confidential enquiries and use of IT

Conclusions

• There is some evidence of a decline in MM and increase of other MDG5 indicators but that’s a global level

• Progress of intervention is slow especially in SSA

• Need for better statistics and statisticians…• Statistics have managed to engage policy

makers