8.4.1 Current use of family planning methods
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Family planning benefits the health and well-being of women and families. Using contraception can help to avoid unwanted
pregnancies and space births, as well as to protect against sexually transmitted diseases, including HIVAIDS, and provide other health
benefits. As in other countries, a certain, but unknown number of pregnancies in Afghanistan are unplanned and unwanted, reflecting
an unmet need of contraception and leading to a large reproductive burden. Each pregnancy multiplies a woman’s chance of dying
from complications of pregnancy or childbirth. However, many Afghan women face difficulties in supply of and information about
contraception, especially modern contraceptive methods that are generally more effective and reliable than traditional methods.
The proportion of women using at least one method of modern family planning in Afghanistan is relatively low: only 15 percent of currently married women. However, there were significant differences between women across different
provinces. As Figure 8.3 shows, respondents from urban areas were more likely to use modern family planning methods
than those from rural areas 28 percent versus 13 percent.
Figure 8.3 Percentage women up to age 49 currently using modern contraceptives
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Contraceptive methods – modern and traditional
For analytical convenience, contraceptive methods are often classified as either modern or traditional.
Modern methods include female and male sterilization, oral hormonal pills, intra-uterine devices IUDs, male
and female condoms, injectables, implants, vaginal barrier methods and emergency contraception.
Traditional methods
include rhythm
periodic abstinence, withdrawal, lactational amenorrhea method
breastfeeding and folk methods.
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Questions on use of family planning methods were asked only of currently married, non-pregnant women. However, use of modern contraception was calculated by including all women, including women who are pregnant or unsure of their pregnancy status, in the denominator. Limiting the family planning indicator to only
non-pregnant married women results in a rate of modern contraceptive use of 21 percent.
Women with at least primary levels of education had twice the likelihood of using modern contraception than those with no
education 31 percent versus 14 percent. Contraceptive use was also significantly associated with woman’s age, as it was
rising with each successive age group until the 45-49 cohort. The proportion women in the 40-44-year-old age group using
modern contraceptive methods was three times than that for the 20-24-year-old group. Overall, the two most common methods
of modern family planning among all currently married women of reproductive age were contraceptive injections 6 percent
and oral contraceptive pills 5 percent. Female sterilization was low at 1 percent.
8.4.2 Use of maternal health care Antenatal 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 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. Following the Afghanistan Health Survey 2006, skilled providers of antenatal care services included
community health workers CHWs, in addition to doctors, midwives and nurses. As compared to NRVA 2005, visits for getting injections of tetanus toxoid were not excluded when estimating skilled ANC services use.
Overall, 36 percent of women reported the use of skilled ANC services. Around 17 percent saw a midwife, 13 percent
saw a doctor, less than one percent a nurse, and 3 percent a community health worker. Use of ANC services during a
woman’s last birth in urban areas was more than twice the rate in rural areas 71 and 30 percent, respectively. The proportion
of women using skilled ANC services was lowest among the Kuchi women 17 percent. Education was also significantly
associated with skilled antenatal care during pregnancy: women with primary education had twice the likelihood 67 percent of
using skilled ANC care during pregnancy compared to women with no formal education 33 percent. Women with secondary
school education and college education had even higher rates of antenatal care use 79 and 89 percent, respectively. Age of
mother was not significantly associated with the use of skilled ANC services.
Skilled attendance at birth
Skilled birth attendance SBA is considered to be the single most critical intervention for ensuring safe motherhood, because it
hastens the timely delivery of emergency obstetric and newborn care when life-threatening complications arise. It also implies
access to a more comprehensive level of obstetric care in case of complications requiring surgery or blood transfusions. The
proportion of births attended by skilled health personnel is an indicator of a health system’s ability to provide adequate care
for pregnant women.
The overall proportion of women delivering with a skilled birth attendant is very low in Afghanistan at 24 percent. More than a
third of women 37 percent delivered in the presence of relative or a friend. Use of traditional birth attendants is also common
33 percent. There are significant differences across provinces and among the nomadic, rural and urban populations. As with other indicators on use of health services, Kuchi women
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MDG Indicator 5.3: Contraceptive prevalence rate
The contraceptive prevalence rate is the percentage of women married or in-union aged 15 to 49 who are currently
using, or whose sexual partner is using, at least one method of contraception, regardless of the method used.
The overall contraceptive prevalence rate CPR was found to be 23 percent. This is a little lower than the corresponding
rate in Pakistan 26, and considerably lower than in Iran 74, Tajikistan 38 and the larger region of South Central
Asia 53. However, compared to the CPR of 10 percent in 2003 CSO-UNICEF 2003, it would signify a large increase.
MDG Indicator 5.5: Antenatal care coverage at least one visit
Antenatal care coverage at least one visit is the percentage of women aged 15-49 with a live birth that received antenatal
care provided by skilled health personnel at least once during pregnancy, as a percentage of women age 15-49 years with
a live birth. This is a recently introduced indicator to monitor progress towards Target 5.B – Achieving universal access to
reproductive health MDG 5 - improving maternal health.
The percentage of pregnant women receiving antenatal care in Afghanistan – 36 percent – is low in international
perspective. The comparable figure for Pakistan is 61 percent.
MDG Indicator 5.2: Proportion of births attended by skilled health personnel
With the overall proportion of births attended by skilled health personnel estimated at 24 percent, Afghanistan ranks 9th of
countries with the lowest percentages. Of its neighbouring countries, Pakistan has 54, Tajikistan 83 percent and Iran as
high as 97 percent. The average proportion in South Central Asia is 47 percent UNFPA 2008.
Even though the overall figure of skilled birth attendance is very low, is signifies a substantial increase compared to previous
estimates. The 2005 NRVA found a national rate of skilled birth attendant use of 15.8 percent –. and the MICS 2003 only 15
percent, implying an increase of skilled birth attendance of 60 percent since 2003
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