Afghanistan Mortality Survey 2010 - Measure DHS

Another frequently used approach to assessing trends in fertility is to compare the results from themost recent survey to findings from other data sources, including censuses and other surveys. Caution hasto be exercised in making such comparisons since differences in the populations surveyed, themethodology used for obtaining the fertility estimates, and data quality can affect the interpretation whenmultiple data sources are used to examine changes over time in fertility levels. The situation is furthercomplicated in Afghanistan by the relative lack of national level surveys.The NRVA 2007/08 is the survey that is most similar in coverage and methodology to the AMS2010, although the two surveys varied in the methodology used to obtain fertility estimates. 1 The declinein fertility in recent times in Afghanistan as seen in the AMS 2010 is consistent with the pattern reportedin the NRVA 2007/8 (ICON-INSTITUTE, 2009), which estimated the TFR for the three-year periodimmediately before the survey at 5.3 births per woman (including Kuchi women). 2The 2003 MICS produced an indirect estimate of TFR from information collected on the numberof children ever born to women age 15-49. The estimated TFR from the MICS 2003 for Afghanistan was6.3 (CSO and UNICEF, 2004). However, there were several data quality issues associated with theimplementation and analysis of the MICS 2003 that may render this estimate less reliable.Other sources of TFR estimates for Afghanistan typically have used various demographicestimation techniques to derive the rates they report. The TFR estimates vary substantially. For example,data from the World Population Data Sheet for 2010 produced by the Population Reference Bureauestimates the TFR for Afghanistan for 2010 at 5.7 children per woman (PRB, 2011). The United NationsPopulation Division estimated the TFR for the period 2005-2010 at 6.6 children per woman (UnitedNations, 2011).3.2.4 Pregnancy OutcomesAs discussed earlier, the AMS 2010 included the collection of a complete pregnancy history fromeach respondent. Thus, the survey provides information not only on the live births the women had, butalso information on the miscarriages or stillbirths they experienced. Collecting information on pregnancyhistories is more difficult than collecting birth histories retrospectively, particularly in the case ofpregnancies that miscarry within the first few months after conception. Therefore, the total number ofpregnancies and abortions may be underestimated, and caution should be exercised in interpreting thesedata. Abortion is illegal in Afghanistan, and there is also social stigma associated with it. Consequently,women may report an induced abortion as a spontaneous abortion or a stillbirth, or omit mentioning italtogether.Data on pregnancy outcomes among ever-married women in the 10 years preceding the survey byage at the end of pregnancy are presented in Table 3.4. Overall, 98 percent of pregnancies resulted in alive birth and only 2 percent ended as a stillbirth or miscarriage. Women are less likely to report havinghad a miscarriage (0.7 percent) than a stillbirth (1.8 percent). There is not much variation in pregnancyoutcomes across age groups, except for age group 45-49, where 6 percent of pregnancies ended in astillbirth and 3 percent in a miscarriage.1 The estimate of TFR from the NRVA 2007/8 was derived from a partial birth history of recent deliveries, adjustedfor under-reporting of children who later died. In contrast, as discussed above, the AMS 2010 collected a completebirth history with dates of birth of all children whether living or dead at the time of the survey, in addition to age atdeath of children who had died.2 The NRVA 2007/8 also produced an indirect estimate of fertility of 6.3 based on the assumption that fertilityestimates from censuses and surveys tend to be underestimated. The Brass approach and an estimation equationbased on the Coale-Trussell Fertility Model was used in calculating the indirect estimate of TFR (ICON-INSTITUTE, 2009).44 | Fertility, Marriage, and Family Planning