Afghanistan Mortality Survey 2010 - Measure DHS

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There are substantial differences in the use of contraceptive methods among subgroups ofcurrently married women. Urban women are twice as likely to use a method of family planning as arerural women (36 percent and 18 percent, respectively), probably reflecting wider availability and easieraccess to methods in urban areas than in rural areas. The contraceptive prevalence rate for modernmethods is 31 percent in urban areas, compared with 17 percent in rural areas.Contraceptive use is more than twice as high in the Central zone as in the North and South zones.Use is lowest in the South Eastern region (10 percent) and highest in the Central Highland region (36percent), with use higher than the national average in four of the eight regions (Western, CentralHighland, Capital, and Southern regions). The low use in the South Eastern region may be due not only tothe limited availability of contraceptives but also difficulty in gaining access to methods and lowerawareness and educational level, coupled with the prevailing cultural and traditional barriers in thisregion.The relationship between education and contraceptive use is strong. Use increases rapidly from20 percent among married women with no education to 45 percent among women with higher education.Even a small amount of schooling can make a difference. One-third of women with some primaryeducation use contraception. The most popular methods among women who have no education areinjectables (7 percent) and pills (5 percent). As women’s level of education increases they are more likelyto use IUDs and condoms.Wealth has a positive relationship with women’s contraceptive use. Contraceptive use increasesmarkedly with household wealth, from 17 percent among currently married women in the lowest wealthquintile to 34 percent among those in the highest wealth quintile.There is a direct association between use of family planning methods and the number of childrenthat women have. Less than 1 percent of married women with no living children use contraception; thispercentage increases to 29 percent among women with five or more children. Use of female sterilizationincreases somewhat with the number of living children a woman has, but pills and injectables remain themost popular methods for women with three or more children.Not surprisingly, remoteness has a negative effect on women’s contraceptive use. Contraceptiveuse decreases markedly as remoteness increases, from 29 percent among currently married women in theleast remote quintile to 18 percent among those in the most remote quintile.3.4.4 Trend in Current Use of ContraceptionInformation on contraceptive prevalence from the AMS 2010 can be compared with similar datafrom earlier surveys conducted in Afghanistan (Figure 3.5). However, these comparisons have to beinterpreted carefully because of coverage differences and differences in the way the questions oncontraceptive knowledge and use were asked between these surveys. In addition, when reviewing thechanges in the use of modern versus traditional methods between surveys, consideration must be given tothe fact that in the AMS 2010 LAM is tabulated as a modern method in contrast to the NRVA 2007/8 andthe AHS 2006 in which LAM is treated as a traditional method. There has been a marked increase in theuse of a contraceptive method among currently married women in the past 7 years with the increase morerapid between 2003 and 2006 than in the more recent years. The AHS 2006 survey found 16 percent ofcurrently married rural women using a modern method of contraception (JHUBSPH and IIHMR, 2008), athree-fold increase in use of modern methods in rural Afghanistan since 2003 (CSO and UNICEF, 2004).However, since 2006, the use of modern methods among currently married rural women appears to have58 | Fertility, Marriage, and Family Planning
stagnated. The NRVA 2007/8 showed that 15 percent of currently married women (including Kuchiwomen) were using a modern method of family planning (ICON-INSTITUTE, 2009) compared with 20percent in the AMS 2010. Use of a modern method in urban areas (28 percent) is more than twice as highas in rural areas (13 percent) in the NRVA 2007/8 with similar proportions seen in the AMS 2010 (31percent of urban women and 17 percent of rural women). The MICS 2003 did not provide information bytype of method.Figure 3.5 Trends in Modern Contraceptive Use in Afghanistan3530Percent2831252015102110101613151720550MICS 2003 NRVA 2005 AHS 2006 NRVA 2007/8 AMS 2010Urban Rural TotalNote: MICS 2003 urban and total refers to all methods.AMS 20103.5 CONSISTENCY BETWEEN THE TFR AND PROXIMATE DETERMINANTS OF FERTILITYThe level of fertility is principally determined by three proximate determinants, age at firstmarriage, contraceptive use, and postpartum infecundability (which is mostly influenced by the durationand intensity of breastfeeding). 6 Bongaarts proposed a model where the total fertility rate of a populationcan be calculated from four indices of proximate determinants and the total fecundity (TF): the index ofmarriage (Cm), the index of contraception (Cc), the index of induced abortion (Ca) and the index ofpostpartum infecundability (Ci) (Bongaarts, 1978). These indices range from 0 to 1. The higher eachindex, the higher the TFR will be. The proximate determinants of fertility model can be applied to theAMS 2010 data to indicate whether the TFR in Afghanistan is consistent with the measures of theproximate determinants. The TFR predicted by the model for Afghanistan is only slightly higher than themeasured TFR, indicating compatibility between the level of fertility and the level of proximatedeterminants, and internal consistency in the data collected from the AMS 2010 (Table 3.17). 7 The TFRand implied fertility are exactly the same (5.0) in Afghanistan excluding the South zone.6 Because the AMS 2010 did not collect information on breastfeeding status, the index of postpartum infecundabilitywas calculated by assuming that children were breastfeeding if the time since birth of the child was less than 7months and the child was currently living with the mother at the time of the survey.7 There is a fourth proximate determinant in the Bongaarts model, induced abortion, which is not included here(assumed to be 1.0). However, even in countries with very high levels of induced abortion, such as those of theformer Soviet Union, the effect on fertility is quite small, due to the relatively short time that an abortion protects awoman from becoming pregnant again.Fertility, Marriage, and Family Planning | 59
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AfghanistanMortality Survey 2010
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CONTENTSTABLES AND FIGURES ........
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4.3 Postnatal Care.................
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TABLES AND FIGURESCHAPTER 1INTRODUC
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Table 5.2 Early childhood mortality
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APPENDIX CDATA QUALITY TABLESTable
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AMS 2010 TECHNICAL ADVISORY GROUP M
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AMS 2010 CONTRIBUTORS TO THE REPORT
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INTRODUCTION 11.1 GEOGRAPHY, HISTOR
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After the fall of the communist reg
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Afghanistan, in cooperation with th
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Page 33 and 34: 1.7 QUESTIONNAIRESFour questionnair
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Page 37 and 38: 1.10 RESPONSE RATESTable 1.2 shows
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Page 44 and 45: Table 2.3 Children’s orphanhood s
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Page 58 and 59: 2.10 CONCLUSIONThe AMS 2010 enumera
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Page 64 and 65: Table 3.2 Fertility by background c
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Page 68 and 69: 3.2.6 Birth IntervalsA birth interv
Page 70 and 71: 3.2.7 Age at First BirthThe onset o
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Page 82 and 83: Table 3.17 Total fertility rate and
Page 85 and 86: MATERNAL HEALTH 4Afghanistan is com
Page 87 and 88: Table 4.1 Antenatal carePercent dis
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Page 95 and 96: About one-third (32 percent) of mot
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Page 109 and 110: Table 4.13 Problems in accessing he
Page 111 and 112: INFANT AND CHILD MORTALITY 5Early c
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Page 121 and 122: Table 5.4 Early childhood mortality
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fallen from 118 deaths to 71 deaths
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Table 6.4 shows adult mortality rat
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mortality levels. The procedures us
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Table 6.6 Female and male life tabl
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Table 6.7 Mean sibship size and sex
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6.4.2 Household ReportingIn the Hou
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The unexpectedly low crude death ra
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Figure 6.8.2 Estimates of Female Ad
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The third panel estimates life expe
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Maternal mortality in Afghanistan i
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other words, about two in five deat
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It is useful to compare the seven-y
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50PercentFigure 7.1Timing of Pregna
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ased on the sibling history (270).
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The VA interview started by checkin
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Figure 8.1 Causes of Female and Mal
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Table 8.4 Causes of deaths among ch
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Global Agricultural Information Net
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Streatfield, P.K., S.E. Arifeen, A.
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• The Cluster Level Questionnaire
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A.3 STRUCTURE OF THE SAMPLE AND THE
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ased on sampling probabilities sepa
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ESTIMATES OF SAMPLING ERRORSAppendi
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For the total sample, the value of
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Table B.3 Sampling errors for Urban
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Table B.5 Sampling errors for North
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Table B.7 Sampling errors for South
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Table B.9 Sampling errors for North
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Table B.11 Sampling errors for Cent
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Table B.13 Sampling errors for East
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Table B.15 Sampling errors for Sout
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Table C.2 Myers’ Blended IndexPre
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Table C.5 Births by calendar years
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Table C.6 Reporting of age at death
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Table C.9 Sex ratio of live birthsS
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mother and the household. The morta
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The estimated infant mortality rate
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D.3.1 Evidence of Underreporting of
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Given the apparent omission of livi
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totally consistent with the estimat
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Perhaps a more sensitive indicator
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Figure D.6 Neonatal and Postneonata
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PERSONS INVOLVED IN AMS 2010Appendi
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Office EditorsMaleMohammad NaseemFe
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AshiqullahAssadullah JavedAtiqullah
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QUESTIONNAIRESAppendix FAppendix F
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Introduction and ConsentHello. My n
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SECTION 2. MIGRATION FROM HOUSEHOLD
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SECTION 4. INPATIENT HEALTH EXPENDI
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SECTION 5. OUTPATIENT HEALTH EXPEND
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SECTION 6. HOUSEHOLD CHARACTERISTIC
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NO. QUESTIONS AND FILTERS CODING CA
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SECTION 2. MARITAL STATUSNO.201QUES
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Now I would like to record the name
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SECTION 4. ANTENATAL, DELIVERY AND
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SECTION 6. MATERNAL MORTALITYNO. QU
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COMMENTS ABOUT RESPONDENT:INTERVIEW
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DEATH OF A CHILD AGED 0-28 DAYSSECT
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SECTION 6. DELIVERY HISTORYNO. QUES
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AFGHANISTAN MORTALITY SURVEYVERBAL
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DEATH OF A CHILD AGED 29 DAYS TO 11
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401 Could you tell me about the ill
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DEATH OF A PERSON AGED 12 YEARS AND
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