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141
Patterns by background characteristics
Women who delivered in a health facility were much more likely to receive a postnatal checkup
within the first 2 days after giving birth than those delivering outside a health facility 63 versus
18 Table 9.9.
Eighty percent of mothers with more than a secondary education received a timely postnatal
checkup, as compared with 35 of women with no education.
Women from the wealthiest households were almost twice as likely to receive timely postnatal care as women from the lowest wealth quintile 58 versus 31.
There were large provincial differences in receipt of postnatal care in the first 2 days after delivery.
Herat had the highest percentage of women with a postnatal checkup 78, followed by Faryab 66 and Panjsher 64; women in Urozgan 5 and Nooristan 1 were least likely to receive
a postnatal checkup.
Type of Provider
Thirty-three percent of women received a postnatal checkup from a doctor or nursemidwife, while 3 received care from an auxiliary nursemidwife. Overall, 36 of postnatal checkups in the 2 days after
delivery were carried out by skilled providers Table 9.10.
9.5.2 Postnatal Health Checks for Newborns
According to WHO, postnatal care services for newborns should start as soon as possible after birth because many neonatal deaths occur within the first 48 hours of life WHO 2015b. In Afghanistan, only
9 of last-born infants in the 2 years preceding the survey received a postnatal checkup in the first 2 days
after birth Table 9.11. Patterns by background characteristics
Newborns of birth order 6 or above 8 are less likely to receive a timely postnatal checkup than
newborns of birth order 1 12 Table 9.11.
Infants delivered in a health facility are twice
as likely to receive a postnatal check within 2 days after birth as infants delivered outside a
health facility 13 versus 6.
The percentage of newborns with a postnatal checkup is higher in urban areas than in rural
areas 13 versus 8 Figure 9.7.
There is a strong association between mother’s
education and timely newborn postnatal checkups. Only 9 of newborns whose
mothers have no education receive a postnatal checkup, as compared with 22 of newborns
whose mothers have more than a secondary education.
Type of Provider
Eight percent of newborns received a postnatal check within 2 days after birth from a skilled provider
doctor, nursemidwife, or auxiliary nursemidwife Table 9.12.
Figure 9.7 Postnatal care by place of delivery
52
13 36
8
40 9
Women Newborns
Percentage of last births in the 2 years before the survey for which women and
newborns received a postnatal check within 2 days after birth
Urban Rural
Total
142
• Maternal Health Care
9.6 P
ROBLEMS IN
A
CCESSING
H
EALTH
C
ARE Problems in accessing health care
Women were asked whether each of the following factors is a big problem in seeking medical advice or treatment for themselves when they are sick:
getting permission to go to the doctor.
getting money for advice or treatment.
distance to a health facility.
not wanting to go alone.
Sample: Women age 15-49
The MoPH has scaled up health service delivery in Afghanistan through its Basic Package of Health Services and Essential Hospital Services, which includes more than 2,200 health facilities in all 34
provinces MoPH 2010. However, information on whether women can access these services is important. According to the 2015 AfDHS, 89 of Afghan women reported having one or more problems in accessing
health care for themselves. The most commonly reported problem was not wanting to go alone 70, followed by distance to a health
facility 67, getting money for treatment 67, and getting permission to go for treatment 51
Table 9.13. Patterns by background characteristics
Problems in accessing health
care services are more predominant in rural areas
92 than in urban areas 78.
There is a strong negative
association between women’s level of education and
problems in accessing health care. Ninety-one percent of
women with no education reported at least one problem
in accessing health care services, as compared with
54 of women with more than a secondary education
Figure 9.8.
Women in the lowest wealth quintile are more likely to face problems in accessing health care
services 94 than women in the highest quintile 77.
Figure 9.8 Women with at least one problem in accessing health care by education
91 80
75 54
89
No education
Primary Secondary More than
secondary Total
Percentage of ever-married women age 15-49
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143
L
IST OF
T
ABLES
For more information on maternal health care, see the following tables:
Table 9.1 Antenatal care
Table 9.2 Number of antenatal care visits and timing of first visit
Table 9.3 Components of antenatal care
Table 9.4 Knowledge of symptoms of pregnancy complications
Table 9.5 Men’s participation during ANC visits
Table 9.6 Tetanus toxoid injections
Table 9.7 Place of delivery
Table 9.8 Assistance during delivery
Table 9.9 Timing of first postnatal checkup for the mother
Table 9.10 Type of provider of first postnatal checkup for the mother
Table 9.11 Timing of first postnatal checkup for the newborn
Table 9.12 Type of provider of first postnatal checkup for the newborn
Table 9.13 Problems in accessing health care
144
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Table 9.1 Antenatal care Percent distribution of women age 15-49 who had a live birth in the 5 years preceding the survey by antenatal care ANC provider during the
pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Afghanistan 2015
Antenatal care provider Percentage
receiving antenatal
care from a skilled
provider
1
Background characteristic
Doctor Nurse
midwife Auxiliary
nurse midwife
Community health
worker Traditional
birth attendant Other
Missing No ANC Total
Number of women
Mothers age at birth
20 31.7
23.5 3.5
0.1 2.5
0.2 0.1
38.4 100.0
58.7 2,218
20-34 30.5
24.2 3.1
0.1 3.3
0.0 0.2
38.4 100.0
57.9 14,245
35-49 31.1
28.4 2.1
0.1 2.3
0.0 0.3
35.7 100.0
61.6 3,169
Birth order
1 36.0
27.3 3.5
0.1 2.8
0.1 0.1
30.1 100.0
66.8 3,027
2-3 31.7
23.9 3.3
0.1 3.6
0.0 0.2
37.1 100.0
59.0 6,224
4-5 30.0
23.1 2.4
0.3 3.8
0.1 0.3
40.0 100.0
55.5 4,733
6+ 27.4
25.9 2.9
0.1 1.9
0.0 0.3
41.5 100.0
56.3 5,648
Residence
Urban 46.1
24.8 0.9
0.1 0.6
0.1 0.1
27.4 100.0
71.7 4,559
Rural 26.1
24.8 3.7
0.1 3.8
0.0 0.3
41.2 100.0
54.6 15,073
Province
2
Kabul 42.8
22.8 0.5
0.4 0.5
0.4 0.1
32.5 100.0
66.1 2,385
Kapisa 2.9
72.5 0.5
0.0 0.3
0.0 0.2
23.7 100.0
75.9 129
Parwan 18.5
58.8 10.3
0.0 0.0
0.0 0.0
12.4 100.0
87.5 437
Wardak 11.8
43.0 12.2
0.0 0.1
0.0 1.4
31.6 100.0
66.9 249
Logar 51.7
22.7 0.0
0.2 0.0
0.0 0.0
25.3 100.0
74.4 276
Nangarhar 71.6
5.4 0.1
0.0 0.5
0.0 0.3
22.1 100.0
77.2 576
Laghman 54.1
18.0 3.2
0.5 2.4
0.0 0.0
21.7 100.0
75.4 428
Panjsher 53.7
15.7 0.0
0.0 0.5
0.0 0.5
29.6 100.0
69.4 26
Baghlan 5.9
36.2 2.6
0.0 11.3
0.0 1.8
42.2 100.0
44.7 504
Bamyan 3.5
68.2 0.3
0.9 0.0
0.0 0.0
27.0 100.0
72.0 206
Ghazni 19.6
8.6 5.1
0.0 2.9
0.0 1.3
62.4 100.0
33.3 638
Paktika 11.2
8.0 18.3
0.1 1.4
0.0 0.2
60.7 100.0
37.5 525
Paktya 21.3
4.9 33.7
0.0 0.5
0.1 1.7
37.8 100.0
59.9 347
Khost 63.9
7.2 1.0
0.0 0.0
0.0 0.0
27.8 100.0
72.1 580
Kunarha 12.9
2.6 0.5
0.0 0.4
0.0 0.2
83.5 100.0
15.9 421
Nooristan 5.9
4.4 0.7
0.0 0.0
0.0 0.0
89.0 100.0
11.0 184
Badakhshan 26.3
10.4 1.7
0.0 0.4
0.0 0.0
61.1 100.0
38.4 650
Takhar 39.5
25.8 0.0
0.0 0.0
0.0 0.0
34.8 100.0
65.2 751
Kunduz 51.3
19.1 0.2
0.0 5.5
0.0 0.1
23.8 100.0
70.6 760
Samangan 1.2
43.9 1.7
0.0 0.6
0.0 0.9
51.7 100.0
46.8 225
Balkh 44.6
38.0 1.9
0.3 0.6
0.0 0.0
14.5 100.0
84.6 1,232
Sar-E-Pul 5.8
56.2 0.0
0.3 4.9
0.0 0.1
32.7 100.0
62.0 430
Ghor 20.7
30.9 7.3
0.0 0.7
0.0 0.0
40.4 100.0
58.8 542
Daykundi 4.9
36.3 1.4
0.0 0.2
0.0 0.7
56.4 100.0
42.7 216
Urozgan 4.5
8.6 6.0
0.0 0.3
0.0 0.3
80.3 100.0
19.1 200
Kandahar 28.0
14.1 6.1
0.0 0.6
0.0 0.2
51.0 100.0
48.2 1,631
Jawzjan 16.1
37.6 0.5
0.0 0.0
0.1 0.3
45.3 100.0
54.2 398
Faryab 23.7
49.7 0.1
0.2 6.2
0.0 0.0
20.0 100.0
73.5 1,451
Helmand 16.7
13.1 0.9
0.0 0.5
0.0 0.2
68.6 100.0
30.7 568
Badghis 4.2
14.6 1.6
0.0 3.9
0.0 0.4
75.3 100.0
20.4 499
Herat 49.3
20.3 0.2
0.0 18.2
0.0 0.0
11.9 100.0
69.8 1,465
Farah 16.1
23.7 1.3
0.0 2.7
0.0 0.0
56.3 100.0
41.0 493
Nimroz 9.2
27.3 0.3
0.0 0.9
0.0 0.0
62.2 100.0
36.9 195
Education
No education 27.9
23.4 3.4
0.1 3.3
0.0 0.3
41.5 100.0
54.7 16,279
Primary 36.1
33.3 1.7
0.3 2.3
0.0 0.3
26.1 100.0
71.0 1,596
Secondary 48.6
30.8 1.0
0.0 0.9
0.3 0.1
18.5 100.0
80.3 1,432
More than secondary 65.7 27.5
0.8 0.0
0.0 0.0
0.0 5.9
100.0 94.1
325
Wealth quintile
Lowest 19.9
28.0 2.6
0.2 4.6
0.0 0.3
44.5 100.0
50.4 3,914
Second 22.9
23.3 3.8
0.1 5.2
0.0 0.3
44.5 100.0
50.0 3,964
Middle 26.3
22.8 4.6
0.0 3.8
0.0 0.2
42.2 100.0
53.7 4,020
Fourth 35.0
25.8 2.9
0.3 1.1
0.1 0.2
34.6 100.0
63.7 4,056
Highest 50.9
24.2 1.0
0.1 0.3
0.2 0.1
23.2 100.0
76.1 3,679
Total 30.7
24.8 3.0
0.1 3.0
0.1 0.2
38.0 100.0
58.6 19,632
Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation.
1
Skilled provider includes doctor, nurse, midwife, and auxiliary nursemidwife.
2
Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates.
Maternal Health Care •
145
Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 who had a live birth in the 5
years preceding the survey by number of antenatal care ANC visits for the most recent live birth, and by the timing of the first visit, and among
women with ANC, median months pregnant at first visit, according to residence, Afghanistan 2015
Number and timing of ANC visits
Residence Urban
Rural Total
Number of ANC visits
None 27.5
41.4 38.2
1 11.2
12.2 12.0
2-3 27.7
30.8 30.1
4+ 31.7
13.6 17.8
Dont knowmissing 1.9
2.0 2.0
Total 100.0
100.0 100.0
Number of months pregnant at time of first
ANC visit
No antenatal care 27.5
41.4 38.2
4 41.7
26.5 30.0
4-5 16.7
17.7 17.5
6-7 8.9
9.5 9.3
8+ 3.4
2.8 2.9
Dont knowmissing 1.8
2.1 2.1
Total 100.0
100.0 100.0
Number of women 4,559
15,073 19,632
Median months pregnant at first visit for those with
ANC 3.6
4.2 4.0
Number of women with ANC 3,306
8,834 12,141
146
• Maternal Health Care
Table 9.3 Components of antenatal care Among women age 15-49 with a live birth in the 5 years preceding the survey, the percentage who took iron tablets or syrup
and drugs for intestinal parasites during the pregnancy of the most recent birth, and among women receiving antenatal care ANC for the most recent live birth in the 5 years preceding the survey, the percentage receiving specific antenatal
services, according to background characteristics, Afghanistan 2015 Among women with a live birth in
the past 5 years, the percentage who during the pregnancy of their
last birth: Among women who received antenatal care for their most
recent birth in the past 5 years, the percentage with selected services
Background characteristic
Took iron tablets or
syrup Took
intestinal parasite
drugs Number of
women with a live
birth in the past 5
years Informed of
signs of pregnancy
complicatio ns
Blood pressure
measured Urine
sample taken
Blood sample
taken Number of
women with ANC
for their most
recent birth
Mothers age at birth
20 38.6
3.5 2,218
50.9 78.4
40.5 28.4
1,366 20-34
42.7 3.0
14,245 56.2
78.2 39.7
31.4 8,745
35-49 43.8
2.7 3,169
57.1 80.7
38.3 24.5
2,030
Birth order
1 44.1
3.0 3,027
55.0 79.2
47.0 35.8
2,113 2-3
43.6 3.3
6,224 56.5
78.9 38.1
30.0 3,908
4-5 42.1
2.5 4,733
57.3 76.2
38.2 27.7
2,826 6+
40.4 3.1
5,648 54.1
80.2 37.6
27.8 3,294
Residence
Urban 50.1
2.9 4,559
51.4 80.4
48.9 43.7
3,306 Rural
40.1 3.1
15,073 57.4
78.0 36.0
24.7 8,834
Province
1
Kabul 56.6
4.0 2,385
58.8 75.0
59.3 54.8
1,608 Kapisa
48.5 1.2
129 38.6
18.1 26.2
19.6 99
Parwan 71.8
3.8 437
34.0 60.0
45.8 20.2
382 Wardak
64.7 0.8
249 30.0
97.4 59.1
29.1 170
Logar 57.8
2.5 276
70.4 73.3
65.2 50.1
206 Nangarhar
65.7 0.9
576 42.9
92.7 35.7
35.1 449
Laghman 60.1
5.4 428
81.5 88.2
56.6 40.8
335 Panjsher
57.4 15.1
26 45.2
90.6 79.5
70.5 18
Baghlan 43.9
0.9 504
61.6 42.8
53.1 25.0
283 Bamyan
62.8 4.8
206 73.6
84.6 48.4
36.7 150
Ghazni 18.2
11.9 638
55.4 84.2
53.8 41.6
231 Paktika
46.4 4.0
525 90.8
93.2 37.7
43.9 205
Paktya 34.9
1.8 347
41.7 76.8
33.2 25.3
211 Khost
32.6 4.8
580 30.9
97.0 65.1
75.0 419
Kunarha 22.5
1.9 421
11.2 70.7
40.7 45.0
70 Nooristan
3.4 0.0
184 32.8
92.4 22.0
26.2 20
Badakhshan 29.6
2.4 650
70.4 95.5
39.7 39.0
253 Takhar
24.2 0.2
751 21.6
19.7 14.9
17.4 490
Kunduz 42.3
2.9 760
56.9 88.7
27.8 24.3
578 Samangan
23.0 0.6
225 45.4
59.7 30.4
23.8 109
Balkh 50.3
0.3 1,232
65.2 97.9
34.1 28.6
1,053 Sar-E-Pul
34.0 0.5
430 57.9
90.5 36.8
20.6 289
Ghor 45.7
3.4 542
77.9 92.7
10.6 9.7
323 Daykundi
18.2 2.0
216 36.0
62.7 16.8
16.7 94
Urozgan 25.0
0.3 200
61.1 98.4
10.3 27.2
39 Kandahar
13.2 1.2
1,631 36.4
76.9 32.4
21.7 797
Jawzjan 16.2
1.1 398
31.9 18.3
40.3 12.2
216 Faryab
69.6 4.6
1,451 61.0
89.5 29.2
8.8 1,160
Helmand 9.0
3.8 568
83.4 92.5
70.2 67.3
178 Badghis
13.5 0.6
499 52.1
76.1 9.5
5.9 122
Herat 74.0
4.0 1,465
68.1 79.7
37.6 16.4
1,291 Farah
16.6 7.6
493 76.3
69.0 21.0
25.1 215
Nimroz 41.1
0.5 195
15.2 71.3
9.2 14.9
74
Education
No education 38.6
2.9 16,279
54.2 78.6
38.1 27.8
9,491 Primary
55.8 1.4
1,596 57.2
78.7 42.2
32.1 1,176
Secondary 63.8
5.4 1,432
62.9 78.8
47.2 38.4
1,167 More than secondary 72.0
7.1 325
72.9 81.3
45.3 51.7
306
Wealth quintile
Lowest 37.0
1.6 3,914
60.3 78.2
24.3 14.5
2,162 Second
35.9 3.2
3,964 58.0
73.5 30.0
21.8 2,190
Middle 39.8
3.3 4,020
55.3 77.3
41.1 27.4
2,315 Fourth
44.7 3.7
4,056 54.2
81.1 48.3
37.1 2,650
Highest 55.4
3.2 3,679
52.5 81.9
49.1 43.2
2,823 Total
42.4 3.0
19,632 55.8
78.7 39.5
29.9 12,141
1
Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates.
Maternal Health Care •
147
Table 9.4 Knowledge of symptoms of pregnancy complications Among women receiving antenatal care ANC for the most recent live birth in the 5 years preceding the survey, the percentage with knowledge of
