Afghanistan Mortality Survey 2010 - Measure DHS

overall. The median year of birth of respondents (1986, which is roughly equivalent to the year 1365 inthe Afghan calendar) is the same as the median year of birth of their siblings, indicating that there is noperceptible bias in the years of birth of siblings (Table C.11).A final measure of data quality is the mean number of siblings, or the mean sibship size. Sibshipsize is expected to stay fairly constant when fertility is not changing and to decline as fertility declinesover time. Unexpectedly, sibship size in the AMS 2010 was found to increase over time as discussed inChapter 6 (Table 6.7). This suggests that there may be omission in the reporting of siblings of olderwomen. In addition, the particularly high sex ratios at birth for siblings of older women suggest thatsisters are more likely to be underreported than brothers.If the omission occurred only among sisters who died before age 12, the pregnancy-relatedmortality estimates would not be biased because information about deaths of women under 12 years ofage is not used in the estimation of pregnancy-related mortality. When siblings under 12 years old areexcluded (second panel of Table 6.7), the mean sibship size increased from 5.6 for women born before1966 (1345 in the Afghan calendar) to 6.0 for women born in 1976-1985 and then declined steadily to alow of 5.0 for women born in 1991-1995 (1370-1374 in the Afghan calendar). The overall sex ratio atbirth decreased from 115.1 to 113.9 when siblings under 12 years old were excluded, indicating that thereis some underreporting of sisters that is likely to affect the pregnancy-related mortality estimates.7.2 PREGNANCY-RELATED MORTALITY BASED ON INFORMATION ABOUT SIBLINGSIn the sibling history, female respondents were asked to list, in chronological order starting withthe first born, all the brothers and sisters born to their natural mother. Information was then obtained onthe survivorship of each of the siblings, the ages of surviving siblings, the year of death or years sincedeath of deceased siblings, and the age at death of deceased siblings. For each sister who died at age 12 orlater in life, the respondent was asked additional questions to determine whether the death was pregnancyrelated; that is (1) whether the sister was pregnant when she died; (2) if not, whether the sister died duringchildbirth; and (3) if not, whether the sister died within two months of the termination of a pregnancy orchildbirth. Listing all siblings (female and male) in chronological order of their birth is believed to resultin better reporting of events than would be the case if only information on sisters was obtained. Moreover,the information collected also allows direct estimates of adult male and female mortality.To obtain the pregnancy-related mortality estimates from the sibling history data, age-specificmortality rates for sisters are calculated by dividing the number of deaths by the number of years ofexposure. To remove the effect of truncation bias (caused by the fact that the upper boundary foreligibility in the AMS 2010 is 49 years), the overall rate for women age 15-49 is standardized by the agedistribution of the survey respondents. Pregnancy-related deaths are defined as deaths that occurredduring pregnancy, during childbirth, or within two months after the birth or termination of a pregnancy.The sample for the AMS 2010 was designed to provide acceptable estimates of pregnancyrelatedmortality for the country as a whole, for urban and rural areas separately, and for three geographiczones—North, Central, and South. Nevertheless, because of the statistical rarity of the event, estimates ofpregnancy-related mortality from the sibling history are subject to wide confidence intervals (CI) andhave to be interpreted with caution.The level of pregnancy-related mortality in Afghanistan in the seven years preceding the AMS2010 is moderately high (Table 7.1). Respondents reported 256 pregnancy-related deaths in the sevenyears preceding the survey. The pregnancy-related mortality rate, which is the annual number ofpregnancy-related deaths per 1,000 women-years of exposure, was 0.59, and pregnancy-related deathsaccounted for 41 percent of all deaths to women age 15-49 in the seven years preceding the survey. InMaternal Mortality | 127