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Figure 9.2 presents the percentage of women aged 15-49 with a live birth in the ive years preceding the survey by the number of TT injections received during the last pregnancy. Overall and for pregnancies of rural women, full protection
was recorded for just over one-third 35 percent of the women. For urban women the corresponding share was higher, but still close to half 46 percent did not receive the required two injections. Kuchi women are very much deprived of TT
coverage, as 84 percent did not receive any injection at all during their last pregnancy.
Figure 9.2: Women aged 15-49 with a live birth in the ive years preceding the survey, by residence, and by the number of TT injections received during the last pregnancy in percentages
10 20
30 40
50 60
70 80
90
Urba n Rura l
Kuchi Na tiona l
46 57
84
57
12 8
3 9
43 35
13 35
No 1
2 or more
9.4 Maternal health
Reproductive health implies that women have the right of access to appropriate health care services that will enable them to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.
A limited and non-representative survey in 2002 suggested a maternal mortality ratio MMR of at least 1,600 per 100,000 births, which would imply that the life-time risk of women dying to pregnancy-related causes was at least one in nine Bartlett
et al. 2005. These igures would rank Afghanistan among the very highest in the world in terms of maternal mortality.
9.4.1 Ante-natal 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 interventions 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.
Overall, 51 percent of women reported at least one visit to or of skilled ANC providers doctors, nurses or midwives. Use of skilled ANC services during a woman’s last pregnancy in urban and rural areas was, respectively, in 78 and 46
percent of the cases Figure 9.3, panel a. The proportion of women using skilled ANC services was lowest among the
Kuchi women 23 percent. Some 49 percent of the women did not receive any care at all 22 percent in urban areas and 54 percent in rural areas.
Education was signiicantly associated with skilled antenatal care, and especially the difference between women with no education and primary education is notable: 80 percent of the latter received ante-natal care, whereas only 49 of the
former did so. Women with higher education approach universal coverage. Age of mother was also clearly associated with the use of skilled ANC services.
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For women without pregnancy complications, the WHO recommendation is to have at least four ANC visits as the
necessary minimum to provide adequate screening for pregnancy complications. Only 10 percent of the pregnant
women in the last ive years has realised this minimum, although urban women did so more than two times as
much. One-third of the women had two or three visits and about 9 percent had just one visit.
Figure 9.3: Women with a live birth in the ive years preceding the survey who received maternal health care during their last pregnancy, by selected characteristics in percentages
a. Ante-natal care at least one visit b. Skilled birth attendance
10 20 30 40 50 60 70 80 90 100 40-49
30-39 20-29
Under 20 Womans age
Tertiary Secondary
Primary None
Womans education Kuchi
Rural Urban
Place of residence Total
43.0 48.6
52.5 57.6
93.5 83.5
78.7 48.2
23.4 46.3
78.4 51.2
10 20 30 40 50 60 70 80 90 100 31.4
37.4 42.5
46.2 89.6
82.8 80.5
36.6 13.4
32.6 75.5
39.9
9.4.2 Skilled attendance at birth and place of delivery
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 2011-12 NRVA reports an overall proportion of women delivering with skilled birth assistance doctors,
nurses and midwives of 40 percent for the last delivery in the past ive years. Overall, traditional birth attendants
assisted in 44 percent of the deliveries, and family members or neighbours in 13 percent. All in all, some 1.7 million women were exposed to high risks of largely preventable
maternal mortality and morbidity during their last delivery.
As with ANC, there are large differences in the use of professional delivery care by background characteristics. Rural women are less than half as likely to be assisted by a skilled birth attendant as urban women 33 against 75 percent,
and for Kuchi women the likelihood is again less than half of that of rural women 13 percent Figure 9.3, panel b.
Provincial differences are presented in Figure 9.4.
MDG Indicator 5.5
Antenatal care coverage
51.2 percent
At least one visit:
9.9 percent
At least four visits:
MDG Indicator 5.2
Proportion of births attended by skilled health personnel
39.9 percent
