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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.
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8.5.2 The distribution of the disabled population
The number of disabled people in Afghanistan amounted to 406 thousand, implying an overall disability prevalence of 1.6 percent. Some 188 thousand of these suffer from more than one disability. The prevalence for males was found to
be higher then for females: 1.9 against 1.4 percent. Overall, one household in every ten had one or more members with a disability. The NDSA reported a higher prevalence of disability, but this can at least partly be attributed to the capture
of more disability categories than the NRVA.
As can be seen in Figure 8.5, disability prevalence increases with age. This is the common and expected pattern, as
body functions tend to deteriorate with age, especially after age 60. Therefore, it is not surprising that despite their small share in the total population, age categories over age 50 comprise very large numbers of disabled. However, the largest
number of disabled – 57 thousand – is found in the age bracket 10-19, even though this number represents only around one percent of the population in that age group. The 2005 NDSA found a similar pattern.
Figure 8.5 Number of disabled people in thousands and disability prevalence, by age
The most frequent type of disability is problems with walking, followed by problems with seeing and remembering. Respectively 179, 137 and 96 thousand people suffer these problems. The finding that problems with walking and
moving have the highest prevalence is not very usual in disability distributions. However, in the past decades the risk of loosing feet or legs due to mines or UXO’s is exceptionally high in the specific context of Afghanistan.
8.5.3 Causes and consequences of disability
As ageing is the most common cause of disability, it should be expected that this will also be noticeable in Afghanistan. In addition, given the poor health conditions in the country, illnesses – importantly polio – are also supposed to contribute
to the prevalence of disability, and relatively more so at younger ages given the competing risk of ageing at higher age. In addition, the recent history of conflicts should be visible in the share of disability due to war and landmines.
Table 8.10 confirms these expectations. Overall, more than one third of disabilities was attributed to old age and illness. This concerns around the same number of males and females, although the relative share for males is lower, because
of their exposure to additional risks. These additional risks are largely related to higher male participation in ‘public’ activities. The number of male victims of traffic and work accidents, and of mines and war is significantly higher than the
corresponding figures for females. Overall 60 thousand people 13 percent reported to be disabled because of mines, explosives, conflict and war, but 49 thousand 82 percent of these are men. In the absence of large-scale conflict and
the progress in clearing mines and UXO’s, it is likely that the share of war- and mine-induced disability in the population will quickly decrease given the annual entry of very large new birth cohorts.
Disability may lead to exclusion effects and high vulnerability. This section limits itself to an assessment of disability consequences in terms of school attendance and labour force characteristics. With regard to school attendance,
Table 8.11 indicates that the probability that disabled primary-school age children attend primary school is half that of
