Descriptive Analysis
Table 1 shows the overall percentages of births that took place in a health facility versus at home, along with confidence intervals. Overall, 66.3% of the women delivered at a health facility, while 33.7% delivered at home (Table 1).
Table 1
Coverage of Institutional Delivery in Afghanistan 2022/23:This table shows the overall percentages of births that took place in a health facility versus at home, along with confidence intervals.
Delivery Type | Proportion | Confidence Interval |
Lower Bound | Upper Bound |
Institutional Delivery Home Delivery | 66.33% | 64.51% | 68.09% |
33.67% | 31.91% | 35.49% |
The sample size for this analysis included 12,587 women of childbearing age who had given birth in the past two years. Of these, 15.4% were from urban areas (N = 1,934), while 84.6% were from rural areas (N = 10,644). The average age of the women was 28.6 years. In terms of language, 34.66% were Dari-speaking (N = 4,360), 50.29% were Pashto-speaking (N = 6,326), 7% were Uzbeki-speaking (N = 884), 1.56% were Turkmani-speaking (N = 196), 2.67% were Nuristani-speaking (N = 336), 0.72% were Balochi-speaking (N = 91), and 2.59% were Pashaie-speaking (N = 326), while 0.47% spoke other languages (N = 59). Regarding education among the heads of households, 64.56% had pre-primary education (N = 8,120), 10.93% had primary education (N = 1,375), 6.15% had lower secondary education (N = 774), and 5.02% had upper secondary education (N = 322). Additionally, 7.8% had higher education (N = 981). Among the women, 80.39% had pre-primary education (N = 10,111), 8.42% had primary education (N = 1,059), 3.62% had lower secondary education (N = 455), and 5.02% had upper secondary education, while 2.56% had higher education (N = 322). In terms of the wealth index, 22.21% were in the poorest quintile (N = 2,793), 23.26% were in the second quintile (N = 2,926), 22.75% were in the middle quintile (N = 2,861), 18.73% were in the fourth quintile (N = 2,356), and 13.02% were in the richest quintile (N = 1,642).
Table 2 provides a detailed breakdown of the demographic and socioeconomic characteristics of the households and women included in the MICS 2023 survey in Afghanistan.
Table 2
Characteristics of households and women in MICS 2023 (N = 12587), Afghanistan
Characteristics of households, mothers | n | % (Sample) | % (Population)* |
Head of Household Language | | | |
Dari | 4,360 | 34.66 | 40.2 |
Pashto | 6,326 | 50.29 | 48.2 |
Uzbeki | 884 | 7.03 | 7.6 |
Turkmani | 196 | 1.56 | 1.5 |
Nooristani | 336 | 2.67 | 0.5 |
Balochi | 91 | 0.72 | 0.4 |
Pashaie | 326 | 2.59 | 1.3 |
Other Languages | 59 | 0.47 | 0.3 |
Education of household head | | | |
Pre-primary/ECE or none | 8,120 | 64.56 | 61.9 |
Primary | 1,375 | 10.93 | 12.9 |
Lower Secondary | 774 | 6.15 | 6.9 |
Upper Secondary | 1,303 | 10.36 | 10.3 |
Higher | 981 | 7.8 | 7.8 |
Don't know/Missing | 25 | 0.2 | 0.2 |
Mother's Education | | | |
Pre-primary/ECE or none | 10,111 | 80.39 | 76.2 |
Primary | 1,059 | 8.42 | 10.3 |
Lower Secondary | 455 | 3.62 | 4.6 |
Upper Secondary | 631 | 5.02 | 5.8 |
Higher | 322 | 2.56 | 3.2 |
Mean number of members in a household | 12,578 | 10.85 | 10.39 |
Wealth index quintile | | | |
Poorest | 2,793 | 22.21 | 20.9 |
Second | 2,926 | 23.26 | 20.8 |
Middle | 2,861 | 22.75 | 20.5 |
Fourth | 2,356 | 18.73 | 19.7 |
Richest | 1,642 | 13.05 | 18.2 |
Living area | | | |
Urban | 1,934 | 15.4 | 23.1 |
Rural | 10,644 | 84.6 | 76.9 |
Mean women age | 12,578 | 28.6 | 28.4 |
%* Weighted percentage | | | |
The logistic regression analysis results provide important insights into the determinants of institutional delivery in Afghanistan.
Language of the Household Head
The language spoken by the household head was significantly associated with the likelihood of institutional delivery, as indicated by the Odds Ratios (ORs). For example, Nooristani-speaking households had significantly higher odds of not having institutional deliveries, with an adjusted OR of 7.54 (95% CI: 3.03, 18.74; p < 0.001), compared to women from Dari-speaking households. Conversely, Pashto-speaking households were associated with a higher likelihood of institutional deliveries, as shown by an adjusted OR of 0.79 (95% CI: 0.65, 0.95; p = 0.014). (Tables 3 and 4)
Economic and Rural/Urban Status
Economic status also played a critical role. Women from the richest households were 0.09 times less likely (95% CI: 0.07, 0.13; p < 0.001) to have a home delivery compared to those from the poorest households. Conversely, those in rural areas were 1.89 times more likely (95% CI: 1.40, 2.55; p < 0.001) to have a home delivery compared to urban residents. (Tables 3 and 4)
Table 3
presents the cross-tabulation of sociodemographic variables with institutional delivery among Afghan women aged 15–49 years based on a sample size of 12,578 This table cross-tabulates different sociodemographic variables with the place of delivery, helping to see the relationships between these factors and whether the birth took place in a health facility or at home. The p-values are derived from chi-square tests applied to all categories.
Variables | Category | Institutional Delivery (N) | Institutional Delivery (%) | 95% CI | Home Delivery (N) | Home Delivery (%) | 95% CI | P-value |
Head of the Household Language | Dari | 3,444 | 68.5 | [65.32, 71.58] | 1,582 | 31.5 | [28.42, 34.68] | < 0.001 |
Pashto | 3,929 | 65.2 | [62.64, 67.67] | 2,097 | 34.8 | [32.33, 37.36] |
Uzbeki | 661 | 69.2 | [62.75, 74.97] | 294 | 30.8 | [25.03, 37.25] |
Turkmani | 146 | 76.8 | [64.84, 85.61] | 44 | 23.2 | [14.39, 35.16] |
Nooristani | 11 | 18.3 | [7.62, 37.83] | 51 | 81.7 | [62.17, 92.38] |
Balochi | 28 | 61.8 | [44.92, 76.17] | 17 | 38.3 | [23.83, 55.08] |
Pashaie | 45 | 28.2 | [19.07, 39.47] | 115 | 71.8 | [60.53, 80.93] |
Other Languages | 31 | 74.3 | [55.07, 87.20] | 11 | 25.7 | [12.80, 44.93] |
Area | Urban | 2,566 | 88.7 | [85.50, 91.19] | 326 | 11.4 | [8.81, 14.50] | < 0.001 |
Rural | 5,730 | 59.6 | [57.44, 61.74] | 3,883 | 40.4 | [38.26, 42.56] |
Women's Education | No Education | 5,829 | 61.2 | [59.15, 63.14] | 3,702 | 38.8 | [36.86, 40.85] | < 0.001 |
Primary | 972 | 75.5 | [71.13, 79.38] | 316 | 24.5 | [20.62, 28.87] |
Lower Secondary | 475 | 83.5 | [78.48, 87.54] | 94 | 16.5 | [12.46, 21.52] |
Upper Secondary | 639 | 88.0 | [84.05, 91.08] | 87 | 12.0 | [8.92, 15.95] |
Higher | 381 | 96.7 | [93.47, 98.32] | 13 | 3.3 | [1.68, 6.53] |
Economic Status | Poorest | 1,071 | 41.0 | [37.95, 44.19] | 1,539 | 59.0 | [55.81, 62.05] | < 0.001 |
Second | 1,438 | 55.3 | [52.11, 58.34] | 1,165 | 44.8 | [41.66, 47.89] |
Middle | 1,720 | 67.2 | [64.23, 70.05] | 839 | 32.8 | [29.95, 35.77] |
Fourth | 1,952 | 79.4 | [76.82, 81.78] | 506 | 20.6 | [18.22, 23.18] |
Richest | 2,115 | 92.9 | [90.70, 94.56] | 162 | 7.1 | [5.44, 9.30] |
Table 4
Multivariate analysis of determinants of Institutional Delivery Among Afghan Women Aged 15–49 (n = 12,578) This table provides both unadjusted and adjusted odds ratios with confidence intervals for each variable, summarizing the results of the univariate and multivariate logistic regression analyses.
Variable | Category | Unadjusted Odds Ratio | 95% CI Lower | 95% CI Upper | P-Value | Adjusted Odds Ratio | 95% CI Lower | 95% CI Upper | P-Value |
Head of the Household Language | Dari | 1 | - | - | - | 1 | - | - | - |
Pashto | 1.16 | 0.96 | 1.40 | 0.116 | 0.79 | 0.65 | 0.95 | 0.014 |
Uzbeki | 0.97 | 0.70 | 1.34 | 0.853 | 0.75 | 0.55 | 1.03 | 0.071 |
Turkmani | 0.66 | 0.36 | 1.20 | 0.173 | 0.58 | 0.31 | 1.08 | 0.087 |
Nooristani | 9.72 | 3.54 | 26.70 | < 0.001 | 7.54 | 3.03 | 18.74 | < 0.001 |
Balochi | 1.35 | 0.67 | 2.71 | 0.400 | 0.70 | 0.37 | 1.30 | 0.261 |
Pashaie | 5.56 | 3.26 | 9.46 | < 0.001 | 3.32 | 2.14 | 5.16 | < 0.001 |
Other Languages | 0.75 | 0.31 | 1.81 | 0.526 | 1.01 | 0.34 | 2.97 | 0.987 |
Number of Members in the Household | Number | 1.00 | 0.99 | 1.01 | 0.799 | 1.02 | 1.01 | 1.04 | < 0.001 |
Women's Education | No Education | 1 | - | - | - | 1 | - | - | - |
Primary | 0.51 | 0.41 | 0.64 | < 0.001 | 0.70 | 0.57 | 0.86 | 0.001 |
Lower Secondary | 0.31 | 0.22 | 0.43 | < 0.001 | 0.48 | 0.36 | 0.66 | < 0.001 |
Upper Secondary | 0.21 | 0.15 | 0.30 | < 0.001 | 0.40 | 0.28 | 0.58 | < 0.001 |
Higher | 0.05 | 0.03 | 0.11 | < 0.001 | 0.14 | 0.07 | 0.31 | < 0.001 |
Economic Status | Poorest | 1.00 | - | - | - | 1.00 | - | - | - |
Second | 0.56 | 0.48 | 0.67 | < 0.001 | 0.58 | 0.49 | 0.69 | < 0.001 |
Middle | 0.34 | 0.28 | 0.40 | < 0.001 | 0.36 | 0.31 | 0.44 | < 0.001 |
Fourth | 0.18 | 0.15 | 0.22 | < 0.001 | 0.22 | 0.18 | 0.27 | < 0.001 |
Richest | 0.05 | 0.04 | 0.07 | < 0.001 | 0.09 | 0.07 | 0.13 | < 0.001 |
Area | Urban | 1.00 | - | - | - | 1.00 | - | - | - |
Rural | 5.29 | 3.94 | 7.11 | < 0.001 | 1.89 | 1.40 | 2.55 | < 0.001 |