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are least likely to use skilled birth attendants 8 percent. In addition, 15 percent of rural women as compared to 69 percent of urban women reported using skilled birth attendants for their last birth.
Figure 8.4 shows the percentage of SBA deliveries by province. It can be observed that 15 out of 33 provinces for which data are available have proportions of skilled birth percentages below 10. Three provinces stand out because of high
shares of women receiving birth attendance: Wardak 60 percent, and Logar and Kabul each 73 percent. It should be noticed that the provinces with presently the highest percentage of SBA deliveries are the ones that experienced the
most improvement since 2003, indicating that fast improvements are possible with targeted health care programmes.
There are also significant differences in use of skilled birth attendants between women with different levels of education. Women with primary education were more likely to use skilled birth attendants than women with no education
57 percent versus 20 percent. The proportion of women with college education or higher that used skilled providers during their delivery was 93 percent.
Figure 8.4 Percentage of women using skilled birth attendants, by province
8.4.3 Fertility and pregnancy patterns
Over the years research has consistently demonstrated that pregnancies and births at young and old ages, having many children and closely spaced births involve significant health and survival risks for mothers and their children. Thus, the effect
of waiting 36 months to conceive again would avoid 25 percent of under-five deaths Rutstein 2008. Worldwide, pregnancy is a leading cause of death for those aged 15 to 49, but mothers aged 15 to 19 are twice as likely to die in childbirth as those
in their 20s UNFPA 2008.
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The estimated total fertility rate of 6.3 see Section 3.4.1 indicates a high reproductive health
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Girls under age 15 are even five times as likely to die as women in their 20s. A teenage mother is at greater risk than women over age 20 for pregnancy complications, such as premature labour, anemia and high blood pressure.
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burden for Afghan women. Each subsequent pregnancy exposes them to the risk of severe bleeding, infections, obstructed labour and eclampsia,
most of which can be averted in an effective care health system.
Currently pregnant women
Table 8.8 reports pregnancy status for currently married women, as well as for all women of reproductive age, regardless of marital
status. Pregnancy among all women of reproductive age is 17 percent overall. The pregnancy rate is only 6 percent among 15-
19-year-olds due to the relatively limited number of married girls in that age bracket. The rate increases to 23 percent among 20-24 year-olds and peaks at 27 percent among those 25-29 years old, before declining for older ages.
Among currently married women, of whom nearly a quarter are currently pregnant, pregnancy rates are highest among 15-19-year-olds 36 percent and steadily decline with age, dropping off more sharply after 39 years of
age. The decline is likely the result of increasing proportions of women using effective methods of family planning see Section 8.4.1 and – from age 40 onwards – rapidly falling fecundity. The data show that early marriage – before age
20 – implies high probability for getting pregnant, in turn implying high risks of medical complications and maternal death.
Table 8.8 Percentage pregnant women among all women and currently married women, by a. residence, b. age
a. Residence Currently
married All women
b. Age Currently
married All women
Urban 17.0
9.7 15-19
36.4 6.3
Rural 25.7
18.5 20-24
33.2 22.9
Kuchi 29.6
22.8 25-29
30.6 27.2
30-34 26.2
24.2 35-39
22.5 20.9
40-44 10.1
9.0 45-49
5.1 4.5
Total 24.5
16.9 Total
24.5 16.9
Current pregnancy status varied by residence, with significantly higher proportions of rural women indicating they were pregnant 26 percent among currently married women and 19 percent among all women compared with urban women 17
percent among currently married and 10 percent among all women. Still higher proportions of Kuchi women reported being pregnant at the time of the survey, with more then one-fifth of all Kuchi women of reproductive age currently pregnant.
Birth intervals
Birth spacing, defined as the time elapsed between two successive births
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, is one of the key indicators in reproductive health. According to the World Health Organization, “after a live birth, the recommended interval before attempting the
next pregnancy is at least 24 months in order to reduce the risk of adverse maternal, perinatal and infant outcomes” WHO 2005.
Nearly one third of women had a birth interval of less than 18 months and more than half of the women had an interval of less than 24 months, the minimum recommended by WHO
Table 8.9. There are, however, differences between the more and less recent birth intervals: between the last and second-to-last birth, 48 percent of women had an interval of
less than 24 months, whereas between the second-to-last and third-to-last birth, 78 percent of women had an interval of less than 24 months.
MDG Indicator 5.4: Adolescent birth rate, per 1,000 women
The adolescent birth rate represents the risk of childbearing among adolescent women 15 to 19
years of age. It measures the annual number of births to women 15 to 19 years of age per 1,000
women in that age group.
For Afghanistan, an adolescent birth rate of 122 was found. This is very high in international
perspective.
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In this report, only surviving live births were included due to limited information regarding dead children and still births. Therefore, the true average birth intervals are likely to be even shorter than the ones presented here.
