In-patient health care provider

91 HEALTH Figure 9.2 presents the percentage of women aged 15-49 with a live birth in the ive years preceding the survey by the number of TT injections received during the last pregnancy. Overall and for pregnancies of rural women, full protection was recorded for just over one-third 35 percent of the women. For urban women the corresponding share was higher, but still close to half 46 percent did not receive the required two injections. Kuchi women are very much deprived of TT coverage, as 84 percent did not receive any injection at all during their last pregnancy. Figure 9.2: Women aged 15-49 with a live birth in the ive years preceding the survey, by residence, and by the number of TT injections received during the last pregnancy in percentages 10 20 30 40 50 60 70 80 90 Urba n Rura l Kuchi Na tiona l 46 57 84 57 12 8 3 9 43 35 13 35 No 1 2 or more

9.4 Maternal health

Reproductive health implies that women have the right of access to appropriate health care services that will enable them to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. A limited and non-representative survey in 2002 suggested a maternal mortality ratio MMR of at least 1,600 per 100,000 births, which would imply that the life-time risk of women dying to pregnancy-related causes was at least one in nine Bartlett et al. 2005. These igures would rank Afghanistan among the very highest in the world in terms of maternal mortality.

9.4.1 Ante-natal care

Skilled antenatal care ANC services present opportunities for reaching pregnant women with interventions that may be vital to their health and that of their infants. These interventions include medical check-ups, referrals of pregnancies that could result in complicated deliveries, and information about managing pregnancies and deliveries, immunization, breastfeeding and child spacing. Overall, 51 percent of women reported at least one visit to or of skilled ANC providers doctors, nurses or midwives. Use of skilled ANC services during a woman’s last pregnancy in urban and rural areas was, respectively, in 78 and 46 percent of the cases Figure 9.3, panel a. The proportion of women using skilled ANC services was lowest among the Kuchi women 23 percent. Some 49 percent of the women did not receive any care at all 22 percent in urban areas and 54 percent in rural areas. Education was signiicantly associated with skilled antenatal care, and especially the difference between women with no education and primary education is notable: 80 percent of the latter received ante-natal care, whereas only 49 of the former did so. Women with higher education approach universal coverage. Age of mother was also clearly associated with the use of skilled ANC services.