padua SIS 2010


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padua SIS 2010

  1. 1. Are we there yet? Challenges in measuring MDG5 achievements Tiziana Leone LSE Health
  2. 2. MDG 5 <ul><li>Target 5.A. </li></ul><ul><ul><li>Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio </li></ul></ul><ul><li>5.1 Maternal mortality ratio 5.2 Proportion of births attended by skilled health personnel </li></ul><ul><li>Target 5.B. </li></ul><ul><li>Achieve, by 2015, universal access to reproductive health </li></ul><ul><li>5.3: Contraceptive prevalence rate 5.4: Adolescent birth rate 5.5: Antenatal care coverage 5.6: Unmet need for family planning </li></ul>
  3. 3. Target 5.b
  4. 6. Progress so far
  5. 7. Poor data <ul><li>If we look at the top 30 countries for Maternal deaths only South Africa, India and Chian have some vital registration system in place </li></ul><ul><li>Latest publication relies on very few observations for the countries with the highest mortality with massive confidence intervals as a result </li></ul>
  6. 8. Not just maternal deaths <ul><li>40 million babies die unregistered each year </li></ul><ul><li>40 million people die unregistered each year </li></ul><ul><li>85 countries with 66% of the world’s population do not have reliable cause of death statistics </li></ul>
  7. 9. Contraceptive use
  8. 10. Some facts
  9. 11. Sample selection
  10. 12. Methods <ul><li>Inclusion of data quality ratings </li></ul><ul><li>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) </li></ul><ul><li>Integration of datasources </li></ul><ul><li>Use of multilevel modelling to account of national policies variations </li></ul><ul><li>Weighting to account of data quality ratings </li></ul><ul><li>Revision of the concept of unmet need </li></ul><ul><li>More emphasis needs to be given to: </li></ul><ul><li>Differential analysis </li></ul><ul><li>Variations in geographic access </li></ul><ul><li>Quality of care </li></ul><ul><li>More stress on post-partum care and abortion </li></ul>
  11. 13. Determinants Whether heard of FP from TV radio or newspapers Listens to radio Age at first birth Watch TV Wealth quintile Number of unions Percentage sterilised women within cluster Median level of education within cluster Visited by FP worker Religion Marital status Visited Health centre Ethnicity Parity Talked about FP Residence Age Community/network Socio-economic Demographic
  12. 14. Bivariate results <ul><li>Discussing FP issues negatively significant </li></ul><ul><li>Wealth not significant (wealthier women slightly less likely) </li></ul><ul><li>Hearing about FP from radio and newspaper negatively significant </li></ul><ul><ul><li>Not significant when parity considered </li></ul></ul>
  13. 15. Way forwards <ul><li>Make every maternal death count </li></ul><ul><li>Through civil registration, confidential enquiries and use of IT </li></ul>
  14. 16. Conclusions <ul><li>There is some evidence of a decline in MM and increase of other MDG5 indicators but that’s a global level </li></ul><ul><li>Progress of intervention is slow especially in SSA </li></ul><ul><li>Need for better statistics and statisticians… </li></ul><ul><li>Statistics have managed to engage policy makers </li></ul>