Education 1. Literacy Final NRVA 2005 Report

Afghanistan NRVA 2005 17

3.4. Health care

Women marry young, the most common age being 20. However, NRVA 2005 data show 52,700 cases of girls 10 or 11 years old being married 13 girls out of 1000 women. 9 Only 19 of the deliveries are born in suitable health facilities such as government hospitals or NGO health centres. The rest are home-delivered or by female neighbours or relatives; out of them 57 were delivered by female relatives or friends, and 41 were delivered by a traditional birth attendant. The map in Fig. 7 shows the distribution of married women in the households up to age 49 with knowledge on how to avoid pregnancy. Figure 7: Married women in the households up to age 49 with knowledge of how to avoid pregnancy In general, urban households have higher knowledge of methods to avoid pregnancy. The provinces of Kabul and Hirat, with a high literacy rate and urban populations, show the highest knowledge of birth control methods. Overall, only 31 of the married woman up to 49 years of age know or have heard about methods to avoid pregnancy. Of those, 44 said that they are using them. Specifically, 44 use the pill, 37 use injection, and 8 use condoms, 6 use early withdrawal, and 3 use sterilization. The percentage use of condoms, restricted to the married woman up to 49 years of age who stated that they are using contraceptive methodes, is 9 in urban areas, 7 in rural and 17 among the 9 Afghanistan registers 1600-2200 death women per 100,000 live births GOA, 2005 and each woman averages 6.6 live births in her life UNESOC, 2006, compounding to an 11-15 chance of dying due to motherhood. The World Health Organization has expressed that a nutritional gap, early marriages and domestic violence are other factors that exacerbate female mortality Technical Working Group No. 4, meeting held on 19 June 2005, Maternal Health, Millennium Development Goal No. 5, http:www.ands.gov.afmdgsgroups.asp. Furthermore, about 60-80 of the marriages in the country are forced marriages; many of those, especially in the rural areas, involve girls below the age of 15 and child marriages are about 40 of all marriages UNESOC, 2006 and Amnesty International, 2005. Afghanistan NRVA 2005 18 Kuchi. The high frequency of use among the Kuchi depends on the fact that the absolute number for Kuchi is lower than urban and rural households. Only a small proportion of Kuchi women are aware of methods to avoid pregnancy; out of them only some use a contraceptive method, and among them only some use condoms. Furthermore, Kuchi woman may not have as much access to other methods as settled population as well. The map in figure 8 depicts the distribution in use of condoms as one method to avoid contraception or sexually transmitted diseases. Figure 8: Condom use as contraceptive method by married women Culture and education, especially of women, are directly linked with the use of contraceptive methods. Afghanistan NRVA 2005 19 Table 6: Contraceptive methods used by married woman in the households up to age 49, out of those using any of these methods Categories Pill Condo m Injection Sterilization Early withdra w al No. weighted observ aa tions Kuchi 38 17 34 5 6 13,431 Rural 42 7 41 2 6 362,416 Urban 48 9 28 6 8 171,504 National Average 44 8 37 3 6 547,351 Barriers to health care and perceptions During 2005 the NSS project as part of the NRVA assessment also collected data from the female and male shuras within a community. This assessment was to record the perceived attitudes of the shuras, which traditionally play an important role in the self governance of the Afghan communities. The lack of health facilities and medical attention has been flagged by the shuras as high priority for public intervention. Nationally, most of the shuras responded that the closest health care facilities were clinics without beds basic health centres. Nuristan was the only province which consistently male or female shura responded that most of the health facilities were health posts. The most frequent answer among the households in Balkh, Jawzjan and Takhar is that hospitals are their closest health facility. In those communities that do not have a community health worker, the shuras were asked if they thought a health worker would go to the communities in an emergency. Sixty-seven percent of the female shura recorded that the community did not have a community worker within it and that most of them believed that the health worker would not visit the community, even in the case of emergency. The male shura responded with a higher level of scepticism than the female shura; 72 thought that help would not be provided in case of emergency. There is need to overcome the barriers in access to health care for all sectors of the population but especially for women. Women above 24 years of age have higher mortality rates than men of the same ages; this is probably related to deficiencies in health care and nutrition. The NRVA 2005 questionnaire did not address the types of health problems prevailing among women. Attention should be paid to the nexus health care and nutrition.

3.5 Housing and services

In the survey, households were asked to characterize their current dwelling. In addition, information was collected on main sources of lighting, electricity, cooking fuel, drinking water and sanitation. Also, the enumerators were instructed to make an evaluation of the housing facilities.

3.5.1 Housing Overall, single private housing was reported as the most frequent type of dwelling

72 while 17 of the households share a house with others. In the urban areas these figures are slightly different, with 63 private housing and 22 sharing housing. In recent years there has been a lot of migration into the urban areas, where