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Institutional deliveries are least common in Badghis 6 and Nooristan 1 Figure 9.4.
Figure 9.4 Institutional deliveries by province
Percentage of live births in the 5 years preceding the survey that were delivered at a health facility
9.4.2 Skilled Assistance during Delivery
Skilled assistance during delivery Births delivered with the assistance of doctors and nursemidwives.
Sample: All live births in the 5 years before the survey
Half of all deliveries in Afghanistan are assisted by a skilled provider 51, that is, a doctor, nurse,
midwife, or auxiliary nursemidwife Table 9.8, Figure 9.5. One-third of births are assisted by
traditional birth attendants, and 15 are assisted by relatives.
Patterns by background characteristics
Skilled assistance during delivery declines
sharply with increasing birth order: 61 of first births have skilled assistance, as
compared with 44 of sixth- or higher-order births.
Urban deliveries are more likely to be assisted
by a skilled provider. Seventy-nine percent of urban and 42 of rural deliveries are assisted
by skilled providers.
Figure 9.5 Delivery assistance
Auxiliary nursemid-wife
34 Doctor
17 Relative
friend 15
Traditional birth
attendant 33
No one 1
Percent distribution of births in the 5 years before the survey
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Only 6 of deliveries in Badghis and 1 in
Nooristan are attended by a skilled provider. An overwhelming majority of births in
Nooristan are assisted by relatives 84.
The more education a woman has, the more likely it is that she will receive assistance from
a skilled provider at delivery. Ninety-seven percent of births among women with more
than a secondary education were assisted by a skilled provider, as compared with only 45
of births among women with no education.
Wealth affects whether or not a woman receives skilled assistance during delivery; the
likelihood of assistance from a skilled provider is more than three times higher among births in the highest wealth quintile than among those in the
lowest quintile 85 versus 24 Figure 9.6.
9.4.3 Delivery by Cesarean
Provision of quality emergency obstetric care, including cesarean sections, reduces maternal and neonatal mortality and complications. However, use of cesarean sections without medical need can place women at
risk of short-term and long-term health problems. WHO advises that cesarean sections be done only when medically necessary but does not recommend a specific rate for countries to achieve at the population
level. Research conducted by WHO has shown that increases in countries’ cesarean section rates up to 10 are associated with declines in maternal and neonatal mortality. However, increases in cesarean
sections beyond 10 are not associated with reductions in maternal and newborn mortality rates WHO 2015a. In Afghanistan, cesarean deliveries accounted for only 3 of all births in the 5 years prior to the
survey, indicating a missed opportunity to decrease maternal deaths Table 9.8. Patterns by background characteristics
The likelihood of cesarean deliveries increases with number of ANC visits. Nine percent of births
among mothers with four or more ANC visits were delivered via cesarean, as compared with 2 of births among mothers who received no ANC.
The cesarean delivery rate is higher in urban than rural areas 7 versus 2.
Mothers with more than a secondary education are more likely than those with no education to
undergo a cesarean section 11 versus 2.
The cesarean rate is higher among births in the highest wealth quintile than among those in the lowest quintile 7 versus 1.
9.5 P
OSTNATAL
C
ARE
9.5.1 Postnatal Health Check for Mothers
WHO recommends that women receive a postnatal health check within 24 hours after delivery WHO 2015b. In Afghanistan, 38 of mothers with a live birth in the 2 years prior to the survey received a
postnatal checkup within 24 hours after delivery. Overall, 40 of mothers received a postnatal checkup in
the first 2 days after delivery, and 56 did not have any postnatal checkup Table 9.9.
Figure 9.6 Delivery assistance by wealth
24 37
44 65
85 50
Lowest Second Middle Fourth Highest Total
Percentage of live births in the 5 years before the survey assisted by a skilled
provider
Wealthiest Poorest
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Patterns by background characteristics
