Current status and determinants of maternal healthcare utilization in Afghanistan: Analysis from Afghanistan Demographic and Health Survey 2015

PLoS One. 2019 Jun 11;14(6):e0217827. doi: 10.1371/journal.pone.0217827. eCollection 2019.


Background: Advancing maternal health is central to global health policy-making; therefore, considerable efforts have been made to improve maternal health. Still, in many developing countries, particularly in Sub-Saharan Africa and South Asia, including Afghanistan, the maternal mortality ratio (MMR) remains high. The objective of this study was to examine the determinants and current status of the utilization of maternal healthcare in Afghanistan.

Methods: This study used the most recent data from the Afghanistan Demographic and Health Survey 2015. The unit of analysis for this study was women who had a live birth in the five years preceding the survey. The outcome variables were four or more antenatal care (ANC) visits, delivery assistance by a skilled birth attendant (SBA), and delivery by cesarean section (CS). The explanatory variables were basic sociodemographic characteristics of the mothers. We examined the sociodemographic characteristics of women utilizing ANC, SBA, and CS using descriptive statistics and estimated usage of ANC, SBA and CS after adjusting for maternal age and parity groups via direct standardization. Multivariable logistic regression models were employed to investigate the determinants of maternal healthcare variables.

Results: Overall, 17.8% of women attended four or more ANC visits, 53.6% utilized an SBA, and 3.4% of women gave birth through CS. Women's education, wealth status, urbanity, autonomy, and availability of their own transport were found to be the major determinants of service utilization.

Conclusions: This study underscores low utilization of maternal healthcare services with wide disparities in Afghanistan and highlighted the need for an adequate health strategy and policy implementation to improve maternal healthcare uptake.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Afghanistan / epidemiology
  • Female
  • Health Surveys*
  • Humans
  • Maternal Health Services*
  • Maternal Mortality*
  • Middle Aged
  • Parity*
  • Patient Acceptance of Health Care*
  • Pregnancy
  • Prenatal Care*

Grants and funding

This study was supported by the Mid-career Researcher Program of the National Research Foundation (NRF) funded by the Ministry of Science & ICT (No. NRF-2014R1A2A1A11051392 and No. NRF-2017R1A2A2A05069746) and a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea [grant number: HI18C0446] to YHK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.