Health
82
Table 8.7 Percentage of 6-9-month-olds receiving complementary feeding, by a residence, b highest educational attainment of mother
Residence and education of mother
Complementary feeding
a. Residence
Urban 46
Rural 39
Kuchi 45
b. Educational attainment of mother
No education 40
Primary school 45
Secondary school 47
College or more 24
Total 41
The breastfeeding indicators should be interpreted with caution. The exclusive breastfeeding indicator varies considerably depending on whether or not feeding patterns during the first three days are included in calculation of the indicator. In
addition, mothers were not directly asked what liquids the child was given in the past 24 hours, which may more accurately capture exclusive breastfeeding patterns. Regarding complementary feeding, the NRVA 20078 does not contain specific
questions about the types of food that children were given in the last 24 hours, and therefore no information is available about the nutritional content and benefit of the complementary foods children are receiving. This is extremely important
in the context of Afghanistan, where dietary diversity can be extremely limited in certain areas of the country.
8.4 Reproductive health
6
Reproductive health implies that women and men are informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation, and the right of access to appropriate health care services that will enable
women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. Although there are no reliable national data on mortality available in Afghanistan, the latest estimate of the
maternal mortality ratio in Afghanistan is 1,600 per 100,000 live births Government of Afghanistan 2009, which would be the third highest in the world UNFPA 2008. The survival of mothers has enormous socio-economic ramifications
and is a crucial development priority in Afghanistan and internationally. The Afghanistan National Development Strategy aims for a 50 percent reduction of the maternal mortality ratio MMR from 1,600 in 2002 to 800 in 2015, and a further
decrease to 400 by 2020 Government of Afghanistan 2009.
Key strategies to reduce Afghanistan’s maternal mortality ratio are access to contraception to avoid unintended pregnancies, access to skilled care at the time of birth and timely access to quality emergency obstetric care. In addition,
early pregnancies, narrowly spaced births and high fertility exacerbate maternal mortality. The NRVA 20078 provides information on most of these issues, which are the subject of the following sub-sections. All MDG indicators mentioned
in this section refer to Goal 5 – improve maternal health.
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Methodological considerations underlying the analysis of various reproductive health issues are provided in Annex VI.B.
8.4.1 Current use of family planning methods
7
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
Health
83
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.
