Determinants of Skilled Birth Attendant Utilization in Afghanistan: A Cross-Sectional Study

Abstract

Objectives. We sought to identify characteristics associated with use of skilled birth attendants where health services exist in Afghanistan. Methods. We conducted a cross-sectional study in all 33 provinces in 2004, yielding data from 617 health facilities and 9917 women who lived near the facilities and had given birth in the past 2 years. Results. Only 13% of respondents had used skilled birth attendants. Women from the wealthiest quintile (vs the poorest quintile) had higher odds of use (odds ratio [OR] = 6.3; 95% confidence interval [CI] = 4.4, 8.9). Literacy was strongly associated with use (OR = 2.5; 95% CI = 2.0, 3.2), as was living less than 60 minutes from the facility (OR = 1.5; 95% CI = 1.1, 2.0) and residing near a facility with a female midwife or doctor (OR = 1.4; 95% CI = 1.1, 1.8). Women living near facilities that charged user fees (OR = 0.8; 95% CI = 0.6, 1.0) and that had male community health workers (OR = 0.6; 95% CI = 0.5, 0.9) had lower odds of use. Conclusions. In Afghanistan, the rate of use of safe delivery care must be improved. The financial barriers of poor and uneducated women should be reduced and culturally acceptable alternatives must be considered.

Social Determinants of Maternal Health in Afghanistan: A Review

“…10 Mayhew et al found that wealth was the strongest determinant of skilled birth attendant use. 16 Women in the poorest quantile had lower odds of skilled birth attendant use compared to women in each of the other quintiles; the strength of the association increased with each wealth quintile. 16 While the health system is designed to accomodate the low income population, even a small fee for health care or drugs can prevent the low income population segment from accessing health care specialists.…”

“…13 Lack of human and technical resources were the major reported reasons associated with adverse maternal and infant health outcomes in the poor-resource setting of Afghanistan. [14][15][16] The findings of the studies conducted between 2001 and 2011 that there is a need to improve health facilities, and to increase the number of professionals in both urban and rural areas in order to improve maternal health. [17][18][19][20][21][22][23][24][25][26] Published research suggests that the provision of expanded health services alone would not lead to the increased utilization of Bartlett et al found that 93% of women who died due to maternity-related causes were illiterate.…”

“…34 spacing, family planning, and their overall health. 10,16,29,34,35 Studies found that educated women recognize emergency obstetric complications and seek medical care immediately 34 , receive antenatal care, use skilled birth attendants, use contraceptives 10,16,35 , and have lower rates of adolescent pregnancies. 10 Women's education, irrespective of other socioeconomic factors, had positive contribution to improved reproductive health.…”

“…9,10,16,31,43 In a study in western Afghanistan in 2002, protected water sources and appropriate control of feces were lacking in districts under investigation. 9 Latrines were used by 85.1% of households in Karokh and 28.4% in Chesht-eSharif.…”

“…Quantitative and qualitative studies have established that health care services, although increased in numbers, lack quality. 9,10,16 There are buildings for clinics, but no doctors or midwives; there are ambulances, but no fuel; there is hightechnology equipment, but not the skills to operate them. 49 forgotten prerequisites for success in such a challenging environment".…”