Changes in maternal health care utilization in Afghanistan, 2010-2011 to 2022-2023

Background: Maternal healthcare in Afghanistan remains a challenge as it has the highest maternal mortality rate around the globe. Over the last decade, political instability has affected Afghanistan's health system and utilization of healthcare services. Objectives: The study examines the utilization of maternal healthcare services in Afghanistan during 2010-2011 to 2022-2023 to determine the changes of maternal health over the time. Methodology: To achieve the study objective, data has been utilized from two rounds of Multiple Indicator Cluster Surveys (MICS4-2010-11 and MICS6-2022-23). Results: The findings revealed that antenatal care coverage increased significantly from 58% in 2010-2011 to 74% in 2022-23 (p < 0.001). The results also show a substantial growth in deliveries occurring at public health facilities (from 31.6% to 56.9%) and a 4-percentage-point decline in caesarean section deliveries during the study period. Furthermore, the findings indicate that women's education levels played an important role in shaping these outcomes. Conclusion: Maternal healthcare utilization may have increased between the two survey periods, the political transition during the survey period was not directly measured, limiting the ability to draw causal inferences. The study findings highlight that improvements in women's education and economic status are strongly associated with higher use of maternal healthcare services. Persistently low levels of educational attainment and poor economic conditions among women remain significant barriers to accessing essential maternal health services. Ensuring equitable access to education and healthcare is therefore critical for improving maternal health outcomes and advancing Afghanistan's progress toward achieving Sustainable Development Goals 3 and 4.