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burden for Afghan women. Each subsequent pregnancy exposes them to the risk of severe bleeding, infections, obstructed labour and eclampsia,
most of which can be averted in an effective care health system.
Currently pregnant women
Table 8.8 reports pregnancy status for currently married women, as well as for all women of reproductive age, regardless of marital
status. Pregnancy among all women of reproductive age is 17 percent overall. The pregnancy rate is only 6 percent among 15-
19-year-olds due to the relatively limited number of married girls in that age bracket. The rate increases to 23 percent among 20-24 year-olds and peaks at 27 percent among those 25-29 years old, before declining for older ages.
Among currently married women, of whom nearly a quarter are currently pregnant, pregnancy rates are highest among 15-19-year-olds 36 percent and steadily decline with age, dropping off more sharply after 39 years of
age. The decline is likely the result of increasing proportions of women using effective methods of family planning see Section 8.4.1 and – from age 40 onwards – rapidly falling fecundity. The data show that early marriage – before age
20 – implies high probability for getting pregnant, in turn implying high risks of medical complications and maternal death.
Table 8.8 Percentage pregnant women among all women and currently married women, by a. residence, b. age
a. Residence Currently
married All women
b. Age Currently
married All women
Urban 17.0
9.7 15-19
36.4 6.3
Rural 25.7
18.5 20-24
33.2 22.9
Kuchi 29.6
22.8 25-29
30.6 27.2
30-34 26.2
24.2 35-39
22.5 20.9
40-44 10.1
9.0 45-49
5.1 4.5
Total 24.5
16.9 Total
24.5 16.9
Current pregnancy status varied by residence, with significantly higher proportions of rural women indicating they were pregnant 26 percent among currently married women and 19 percent among all women compared with urban women 17
percent among currently married and 10 percent among all women. Still higher proportions of Kuchi women reported being pregnant at the time of the survey, with more then one-fifth of all Kuchi women of reproductive age currently pregnant.
Birth intervals
Birth spacing, defined as the time elapsed between two successive births
9
, is one of the key indicators in reproductive health. According to the World Health Organization, “after a live birth, the recommended interval before attempting the
next pregnancy is at least 24 months in order to reduce the risk of adverse maternal, perinatal and infant outcomes” WHO 2005.
Nearly one third of women had a birth interval of less than 18 months and more than half of the women had an interval of less than 24 months, the minimum recommended by WHO
Table 8.9. There are, however, differences between the more and less recent birth intervals: between the last and second-to-last birth, 48 percent of women had an interval of
less than 24 months, whereas between the second-to-last and third-to-last birth, 78 percent of women had an interval of less than 24 months.
MDG Indicator 5.4: Adolescent birth rate, per 1,000 women
The adolescent birth rate represents the risk of childbearing among adolescent women 15 to 19
years of age. It measures the annual number of births to women 15 to 19 years of age per 1,000
women in that age group.
For Afghanistan, an adolescent birth rate of 122 was found. This is very high in international
perspective.
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In this report, only surviving live births were included due to limited information regarding dead children and still births. Therefore, the true average birth intervals are likely to be even shorter than the ones presented here.
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Table 8.9 Distribution of birth intervals, by birth interval ordera
Birth interval Birth interval order
a
Last to second-to-last birth Second-to-last to-third-to-last birth
All birth intervals Percentage
Cumulative percentage
Percentage Cumulative
percentage Percentage
Cumulative percentage
Less than 18 months 24
24 52
52 29
29. 18-23 months
24 48
27 78
24 53
24-35 months 37
85 19
98 34
87 36-47 months
13 98
2 99
11 98
48 months and more 2
100 1
100 2
100
Total 100
100 100
a All births 60 months before the survey
For the interval between the last and second-to-last births, education and residential area rural, urban and Kuchi did not have significant association with the length of a birth interval. However, there were significant differences in birth
spacing among different age groups. Adolescent women 15-19 years of age are most likely to face the greatest risks associated with short birth intervals: 59 percent of women in this age group had a birth interval of less than 24 months,
compared to 47 percent of women age 20 to 39. Similar patterns were also present between the second-to-last and third-to-last births: again only age was significantly associated with the length of birth interval, and the prevalence of
short less than 24 months birth intervals among adolescent women was higher 89 percent, compared to women aged 20-39 77 percent. Since the question was related to live births in the five years preceding the survey, the significance
of age in this case can partly be explained by lowered fertility among women in higher age groups. However, the figures show that adolescent women do not only face additional maternal health risks due to their physical immaturity, but also
to a more rapid succession of pregnancies and births.
8.5 Disability
8.5.1 Conceptualisation and analysis of disability
Disability is a difficult concept to measure. According to the WHO’s International Classification of Functioning, Disability and Health ICF,
disability is an umbrella term, covering impairments problems in body function or structure, activity limitations difficulties encountered by an
individual in executing a tasks or actions, and participation restrictions problems experienced by an individual in involvement in life situations.
Consequently, the definition acknowledges that disability reflects an interaction between features of a person’s body and features of the
society in which he or she lives. In other words, people tend to assess any impairment and its severity in accordance with, for instance, their
age, life stage, sex or work, or the demands of society. In addition, various methodologies to measure disabilities yield different results.
Therefore it is hazardous to compare disability statistics from different countries, or even groups within countries, such as men and women.
Unlike the 2005 NRVA, the 20078 round included a full module that permits the measurement of disability for specification, see Box ‘The Washington Group on Disability Statistics’. In addition, the module asked questions about the cause and
the timing of the onset of the problem.
In 2005, the National Disability Survey in Afghanistan NDSA was conducted in Handicap International 2006. The survey results indicated that within the overall poor context of the country, no or only minimal difference between households
of persons with disability and non-disabled households can be observed. Consequently, and in view of the scope of the present report, only disability analysis at individual level is performed here. The difference in applied methodology does
not allow direct comparison of results between NDSA and NRVA.
The Washington Group on Disability Statistics
The questions used in the NRVA are largely in line with the ‘short set of questions’ recommended
by the Washington Group for censuses and multi- purpose surveys. It involves questions on five types
of disability difficulty with seeing, hearing, walking, self-care and remembering, and for each assesses
the level of severity no difficulty, some difficulty, a lot of difficulty, cannot perform the function at all.
In accordance with the recommendations, in the present analysis, a person is considered disabled if
he or she scores at least ‘a lot of difficulty’ on at least one of the disability types.
