Impact of Antenatal Care on Maternal Mortality Among Women Aged 15-49 Years in Afghanistan

Abstract

Background: Afghanistan is one of the countries with the highest maternal mortality worldwide. The inadequate utilization of antenatal care (ANC) services increases the risk of maternal mortality in Afghanistan. Purpose: This study aimed to understand the key factors associated with antenatal care on maternal mortality in Afghanistan. Furthermore, this study elaborated on the impacts and utilization of antenatal care services among women in Afghanistan. Methods: Data were obtained from the Afghanistan Demographic Health Survey 2015. The participants of this study were 18139 reproductive-aged women. The relevant variable was chosen, and data were analyzed for descriptive statistics. In addition, a chi-squared test and logistic regression were performed. All analyses were conducted using JAMOVI version 2.2.5. Results: Overall, 10040 (55.4%) women had ANC visits, and 8099 women (44.6%) never had ANC visits. Of these, 11.2% and 17% visited the ANC services once and twice, which was the most frequent, respectively. Furthermore, 11.6%, 7.1%, and 4.3% of the women visited three, four, and more than four times, respectively. In this study, we examined the socio-economic and demographic backgrounds of 18139 reproductive-aged women who attended ANC clinics. The highest age group (30-39 years) represented 32.3% (OR=0.947, 95%CI: 0.885-1014), followed by those over 40, which was 25.1% (OR=0.919, 95%CI: 0854-0.990). According to residency, 77.2% and 22.8% were from urban and rural areas, respectively (OR=1.097, 95%CI: 1.023-1.177). Regarding education, 86%, 6.5% (OR=1.159, 95%CI: 1.020-1.316), 5.7% (OR=0.981, 95%CI: 0.828-1.163), and 1.8% (OR=0.917, 95%CI: 0.712-1.181) women had received no education, primary education, secondary education, and higher education, respectively. Regarding ethnic groups , Pashtuns had the most frequent ANC visits (38.8%), followed by Tajiks with 35.1%. (OR=0.192, 95%CI: 0.852-0.977), Uzbek with 10% (OR=1.224, 95%CI: 0.869-1.068), Hazara with 6.6% (OR=0.963, 95%CI: 0.869-1.068), Turkmen with 5.4% (OR=2.571, 95%CI: 2.208-2.924), Aimaq with 1.2% (OR=1.574, 95%CI: 1.196-2.072), Baloch with 0% (OR=1.917, 95%CI: 0.320-11.4812.072), and others with 2.6% (OR=0.910, 95%CI: 0.753-1.099). Regarding media exposure, 58.1% did not listen to the radio, followed by 16% (OR=0.974, 95%CI: 0.897-1.058), 25.8% (OR=0.854, 95%CI: 0.797-0.915), and 0.1% (OR=0.970, 95%CI: 0.402-2.343) who listened to the radio once, twice, or more than thrice a week, respectively. In addition, 56% did not watch TV, followed by 11% (OR=0.888, 95%CI: 0.807-0.977), 32.6% (OR=0.913, 95%CI: 0.856-0.974), and 0.2% 9 OR=1.188, 95%CI: 0.617-2.286) who watched TV once, twice, or more than thrice a week, respectively. Conclusion: The most important key factors associated with antenatal care were residency, education level, ethnic groups, and media exposure. We suggest that the Afghanistan government improve their health policy and increase accessibility to healthcare and equal distribution of health services in rural and urban areas. This can also be applied to the international community.