Percent of women discharged from facilities in less than 24 hours after childbirth
The percent of women who delivered in a health care or emergency obstetric care (EmOC) facility during a specified time period, who are discharged less than 24 hours after childbirth. Ideally, this indicator is calculated for all facilities rather than just for EmOC facilities, such as community-based facilities and district hospitals.
WHO/UNICEF/UNFPA (2010) include this indicator in its core list for evaluating recommended packages of interventions for postpartum care and ties it to the component ‘Essential promotive and preventive care following childbirth for 24 hours to 6 weeks.’ Related indicators on health facility policies and the percent of women monitored for at least 24 hours are listed under postpartum care interventions by USAID/CORE Group (2004).
This indicator is calculated as:
(Number of women who deliver in a health facility who are discharged less than 24 hours after childbirth / Total number of women who delivered in a health facility during a specified time period) x 100
Data can be used from facility records, health information systems (HIS), and specialized surveys that include community-based facility deliveries. The data can be disaggregated by the type of facility (public, private, non-governmental, community based) and by other relevant factors such as districts and urban/rural location.
If targeting and/or linking to inequity, classify facilities by location (poor/not poor) and disaggregate the women referenced by location.
Facility records; HIS; and specialized surveys
This indicator reflects the percent of women who are placed at increased risk for postpartum mortality and morbidity due to early discharge after delivery, and can serve as a proxy for quality of postpartum care services. The initial 24 hours after delivery is a high risk time frame for complications and 45 percent of maternal deaths occur within this period (WHO, 2005). At the same time, nearly half of all newborn deaths occur within 24 hours of delivery (UNICEF, 2011). The recommended best practice for health care facilities is to monitor all mothers and newborns for at least 24 hours (USAID/Core Group 2004; CARE/CDC, 2001; WHO/UNFPA/UNICEF/World Bank, 2006; WHO/UNICEF/UNFPA, 2010). This indicator relates directly to achieving Millennium Development Goals #5. improve maternal health and #4. reduce child mortality.
This indicator measures monitoring of women for 24 hours following delivery as one component of quality postpartum care. However, it does not address other aspects of quality care, such as the level of monitoring (e.g., is the facility too overcrowded for adequate monitoring), if skilled attendants are available at all times, and if there are necessary drugs, equipment, and supplies to effectively manage complications.
quality, safe motherhood (SM)
CARE/CDC, 2001, The Healthy Newborn: A reference Manual for Program Managers, Part 4, Atlanta, GA: CDC. http://www.k4health.org/toolkits/pc-mnh/healthy-newborn-reference-manual-program-managers
USAID/Core Group, 2004, Maternal and Newborn Standards and Indicators Compendium, Washington DC: USAID/CORE Group. https://www.mchip.net/sites/default/files/Maternal_and_Newborn_Standards_and_Indicators_Compendium_2004.pdf
WHO, 2005, World Health Report 2005: Facts and Figures, Geneva: WHO. http://www.who.int/whr/2005/media_centre/facts_en.pdf
WHO/UNICEF/UNFPA, 2010, Packages of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and Child Health, Geneva: WHO. http://www.who.int/making_pregnancy_safer/documents/fch_10_06/en/index.html
WHO/UNFPA/UNICEF/World Bank, 2006, Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice, Geneva: WHO. http://apps.who.int/medicinedocs/en/m/abstract/Js23076en/
UNICEF, 2011. Maternal and newborn health. http://www.unicef.org/health/index_maternalhealth.html