Afghanistan Mortality Survey 2010 - Measure DHS

As with other maternal health indicators, tetanus toxoid coverage appears to have risen rapidly.The AHS 2006 found that 24 percent of women in rural Afghanistan had received at least 2 doses oftetanus toxoid (JHUBSPH and IIHMR, 2008). This compares to a rate of 50 percent among the ruralwomen interviewed in the AMS. 44.2 DELIVERY CAREProper medical attention and hygienic conditions during delivery can reduce the risk ofcomplications and infections that may cause the death or serious illness of the mother, the baby, or both.Hence, an important component in the effort to reduce the health risks of mothers and children is toincrease the proportion of babies delivered in a safe, clean environment and under the supervision ofhealth professionals. Afghanistan is promoting safe motherhood through various activities, especiallydelivery by skilled birth attendants (SBA). Data on delivery care were collected for all births thatoccurred in the five years preceding the survey.4.2.1 Delivery in a Health FacilityTable 4.7 presents the percent distribution of women’s most recent live births in the five yearspreceding the survey by place of delivery, according to background characteristics. Nearly one in threebirths (32 percent) takes place in a health facility: 27 percent are delivered in a public sector healthfacility, and 5 percent are delivered in a private facility. With regard to facility deliveries, theoverwhelming majority of deliveries occurring in public facilities took place in hospitals or CHCs (datanot shown in table).More than two out of three births (67 percent) take place at home. Delivery in a health facility ismore common among mothers whose age at birth is less than 20 years (35 percent), mothers of first-orderbirths (44 percent), and mothers who have had at least four antenatal visits (62 percent). Two out of threechildren (66 percent) in urban areas are born in a health facility, compared with 25 percent in rural areas.Delivery in a health facility also varies by zones, being lowest in the North zone (24 percent), highest inthe Central zone (39 percent), and moderate (34 percent) in the South zone. Delivery in a health facility ismost common in the Capital region (56 percent).There is a strong association between health facility delivery, mother’s education, wealth andremoteness quintiles. The proportion of deliveries in a health facility is only 28 percent among births touneducated mothers, compared with 76 percent among births to mothers with higher education. A similarpattern is seen in terms of wealth quintiles: delivery at a health facility is significantly less commonamong births to mothers in the lowest wealth quintile (11 percent) compared with 63 percent of births tomothers in the highest quintile. Similary, 21 percent of births in the most remote households are deliveredin a facility compared with 57 percent of births in the least remote households.4 Some caution should be used in interpreting these results since information on TT coverage was obtaineddifferently in the AHS 2006 and in the AMS 2010. In the AHS 2006, information on TT coverage was obtainedfrom all women who had a birth in the two years before the survey who had a TT card to show, but for those whodid not have a card, recall questions were only asked of women who had received ANC from an SBA. TT coveragedid not include women who received TT during campaigns. This could have resulted in an underestimate of truecoverage (JHUBSPH and IIHMR, 2008). In the AMS 2010, TT coverage was obtained from recall for the mostrecent live birth in the five years before the survey. In addition, these women were also asked about TT received atany time before the pregnancy, the number of times TT was received and the month and year the last TT wasreceived.Maternal Health | 75