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Determinants of skilled birth attendant utilization in Afghanistan: a cross-sectional study
Maureen Mayhew1, Peter M Hansen, David H Peters
1Vancouver Coastal Health, and Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Ave, Vancouver, BC V6T 1Z3, Canada. mmayhew07@shaw.ca
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.