Factors associated with antenatal care visits in Afghanistan: secondary analysis of Afghanistan Demographic and Health Survey 2015

Abstract

Afghanistan is one of the countries with the poorest maternal mortality ratio in the world. Inadequate utilization of antenatal care (ANC) services increases the risk of maternal mortality. This study aimed to identify the factors associated with ANC visits in Afghanistan. The dataset of the Afghanistan Demographic and Health Survey (AfDHS) 2015 were used for taking the socio-demographic factors, cultural factors, and the number of ANC visits. The subjects of this study were 18,790 women who had at least one live birth in the last five years, and 10,554 women (56.2%) had availed of at least one ANC visit. Most women were 20-29 years old (53.3%), poor (41.7%), had 2-4 children (43.9%), lived in rural areas (76.1%), and had no education (85.0%) or no job (86.7%). Most women answered that husbands made a decision about their healthcare and that getting permission from their husbands was a major challenge. Multivariate analysis showed that age, ethnicity, area of residence, parity, women's education, husband's education, literacy, having a job, wealth, the decision maker for healthcare, and difficulty in getting permission from the husband were significantly correlated with availing of the ANC visits. This study showed that not only the socio-demographic factors but also the cultural factors were associated with ANC visits. The Afghanistan government should improve the education programs at schools and healthcare facilities, for both men and women. To augment women's propensity to take a decision, the programs for women's empowerment need to be supported and extended across the country.

Keywords: Afghanistan; Afghanistan Demographic and Health Survey; antenatal care; women.

Fig. 1. Number of antenatal care visits during last pregnancy (N=18,790)

8,236 women (43.8%) did not use any antenatal care (ANC) service. Among 10,554 women (56.2%) who undertook ANC visits, two ANC visits were most frequent (17.0%). Women who undertook four visits or more and eight visits or more were 16.5% and 1.8%, respectively.

Fig. 2. Distribution of parity in age groups

In the youngest age group (15–19 years), the majority was one parity. However, 2,781 women with one parity were distributed across all age groups and most of them were 20–29 years old. There were 6 women of 40–49 years (0.03%) who had one parity.