Availability and quality of emergency obstetric and neonatal care services in Afghanistan

Int J Gynaecol Obstet. 2012 Mar;116(3):192-6. doi: 10.1016/j.ijgo.2011.10.017. Epub 2011 Dec 22.


Objective: To assess the availability and utilization of emergency obstetric and neonatal care (EmONC) facilities in Afghanistan, as defined by UN indicators.

Methods: In a cross-sectional study of 78 first-line referral facilities located in secure areas of Afghanistan, EmONC service delivery was evaluated by using Averting Maternal Deaths and Disabilities (AMDD) Program assessment tools.

Results: Forty-two percent of peripheral facilities did not perform all 9 signal functions required of comprehensive EmONC facilities. The study facilities delivered 17% of all neonates expected in their target populations and treated 20% of women expected to experience direct complications. The population-based rate of cesarean delivery was 1%. Most maternal deaths (96%) were due to direct causes. The direct and indirect obstetric case fatality rates were 0.8% and 0.2%, respectively.

Conclusion: Notable progress has been made in Afghanistan over the past 8 years in improving the quality, coverage, and utilization of EmONC services, but gaps remain. Re-examination of the criteria for selecting and positioning EmONC facilities is recommended, as is the provision of high-quality, essential maternal and neonatal health services at all levels of the healthcare system, linked by appropriate communication and functional referral systems.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Afghanistan
  • Cross-Sectional Studies
  • Delivery, Obstetric / standards
  • Delivery, Obstetric / statistics & numerical data
  • Emergency Medical Services* / standards
  • Emergency Medical Services* / statistics & numerical data
  • Female
  • Health Care Surveys
  • Health Services Accessibility* / standards
  • Health Services Accessibility* / statistics & numerical data
  • Humans
  • Infant, Newborn
  • Maternal Mortality
  • Obstetric Labor Complications / mortality
  • Outcome and Process Assessment, Health Care
  • Perinatal Care* / standards
  • Perinatal Care* / statistics & numerical data
  • Pregnancy
  • Quality Indicators, Health Care