Afghanistan Mortality Survey 2010 - Measure DHS

4.5 CONCLUSIONMaternal and child health are strongly associated with the care received by women duringpregnancy and delivery. When compared with previously conducted surveys in the country, data from theAMS 2010 show a marked increase in key maternal health indicators. For example, more than six in tenwomen in Afghanistan are now receiving ANC, which is more than three times the proportion of womenreported to have had ANC at the time of the 2003 MICS. Around one-third of births are now beingassisted at delivery by a SBA, which is more than double the level found in 2003. Over one-quarter ofwomen received care from an SBA in the postnatal period.Despite these gains, it is evident that substantial gaps in maternal care remain. For example, lessthan 16 percent of women reported having at least 4 visits, the minimum necessary to provide adequatescreening for pregnancy complications. Moreover, except for blood pressure measurement, only aminority of women who had ANC—40 percent or less—report they received other components of goodANC screening. Only 38 percent took iron tablets or syrup during her pregnancy. Tetanus toxoidcoverage is more widespread, but half of women did not receive two injections during pregnancy for thelast birth. With regard to delivery care, access to care still represents a very considerable challenge for themajority of women, particularly rural women, with two-thirds of births taking place at home. Mostpostnatal care is limited to women who delivered in a health facility.Large differentials are also evident between population subgroups. Rural women are less likely toreceive care during pregnancy, at delivery or in the postnatal period than urban women. Women with noeducation and women in the lowest wealth quintile are the least likely to receive maternal care. The latterdifferentials are particularly large. For example, around nine in ten women with a secondary educationsaw an SBA for ANC compared with 57 percent of women with no education. Women in the highestwealth quintile are nearly six times as likely to deliver in a health facility as women in the lowest quintile.What are the major barriers to getting maternal care? Around seven in ten women giving birth inthe five-year period before the survey said that lack of money and distance to facilities pose seriousproblems in accessing any health care. These were also the reasons for not seeking care cited most oftenby women who did not get ANC, delivery care, or postnatal care during pregnancy. There also is thecontinuing need to educate women about the importance of seeking care; four in ten women who did notreceive ANC felt it was not necessary to seek such care. Similarly, 35 percent of women who did notdeliver the most recent birth in a facility said that a facility delivery was not necessary.88 | Maternal Health