92
HEALTH
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
93
HEALTH
Educational attainment of the women has a positive effect on the probability of skilled birth attendance, but the effect is strongest for women who proceed from no education at all to primary education. Also, younger women increasingly rely
on skilled birth attendance.
Figure 9.4: Percentage of women with a live birth in the ive years preceding the survey who were assisted by skilled birth attendants at last delivery, by province
The level of 36 percent of deliveries taking place in health facilities is close to that of skilled birth attendance. Overall, close to two-thirds of deliveries 63 percent take place at home. Rural deliveries take place in health institutions in only
29 percent of the cases, while the corresponding urban share is more than three times as high 69 percent. Besides the different proportions of institutional deliveries between rural and urban women, also the use of private facilities differs:
16 percent of urban women have their births in private facilities against 8 percent of rural women.
The present igure of 40 percent skilled delivery assistance indicates a large improvement from the 24 percent recorded in the NRVA 2007-08. This improvement its in the general trend of rapidly improving maternal health care provision
observed in successive surveys in Afghanistan since 2003 see Figure 9.5. The trends for ante-natal care coverage and
institutional delivery follow similar paths of rapid improvement.
