Factors associated with postnatal care utilization in Afghanistan | BMC Women’s Health

Study setting or area

The current study used secondary data from the 2015 (AfDHS), which was collected from all over Afghanistan.

Study design and population

A quantitative cross-sectional study was conducted among women age15-49 group who gave birth in the past two years preceding the survey. Mothers who did not have children and those who did not have a birth in the last two years preceding the survey were excluded.

Data Source, sampling method and sample size

This study used data from the 2015 Afghanistan Demographic and Health Survey 2015 [11]. The sampling frame for this was provided by the Central Statistics Organization (CSO). The sampling frame contained information on 25,974 enumeration areas (EAs). The 2015 AFDHS followed a stratified two-stage sample design and was intended to allow estimates of key indicators at the national level for urban and rural areas, and for each of the 34 provinces of Afghanistan. Zabul Province was excluded for security reasons, and data were collected only from seven urban EAs.

Data for this study were obtained from the individual recode file, which included data on women age 15–49. A total of 29,461 women age 15–49 completed the interviews. For this study, we used data only from married women who had children. Among all women who completed the interviews, 2863 did not have a child; therefore, we assumed that PNC use is nearly nonexistent among them and thus, they have no need for PNC use and excluded. Furthermore, if a woman has not delivered in last two years’ prior the survey, there is no reason to use PNC because we will find the women who have delivery in last two years prior the survey, so in the second step, in the analysis of PNC use we also excluded 14,836 women who were not have delivery in last two years’ prior the survey at the time of the interview. After exclusion, 11,762 women were selected who were currently married and had delivered in the last two years prior to the survey and after weighting it form 11,538.8 sample for analysis to check PNC use Figure 1.

Derivation of sample for analysis

Description of variables

Outcome variable

Postnatal care use

The Postnatal period begins immediately after the birth of the baby and extends up to six weeks (42 days) after birth. The DHS questionnaire asks about PNC use. Did anyone check your health while you were still in the facility? Did anyone check your health after leaving the facility? Did anyone check your health after you gave birth (NAME)? Possible responses were categorized as YES and No. Women who replied yes were classified as PNC use or PNC visit, and those who replied no were classified as non-visit PNC.

Independent variables

Parity or birth order

Parity is defined as women who have live children. Therefore, women who do not have a living child are considered to have no parity. There are four categories of women with children: women who have one child, women who have two to three children, women who have four to five children, and women who have more than five children.

Age at first marriage

The age at first marriage was divided into four categories: women who married before age 20, women who married at age 20–29; women who married at age 30–39; and women who married at age 40–49.

Number of household members

This refers to the total number of individuals living in the same house who shared meals. We divided this into four categories: households with five or fewer individuals, households with five to nine individuals, households with ten to 14 individuals, and households with more than 14 individuals.

Education attainment

Education is divided into four categories: women who have no formal or informal education and are unable to read and write, women who have completed primary-level education, women who have secondary-level education, and women with higher education.

Household wealth quintile

The five wealth quintiles are the poorest, poorer, middle, richer, and richest.

Women’s employment status

Women’s employment status was classified into two categories: yes or no. Women who did not have a current job or a job in the last year are classified in the “no” category, while women who were currently working and who have a job but were on leave in the last seven days are classified in the “yes” category.

Exposure to media

Women who responded that they have heard about postnatal care in the last few months from radio, television, or newspapers or magazines are categorized as having exposure to media; if they have not heard about postnatal care from any media source, they categorized as having no media exposure.

Husband education level

Education is divided into four categories: husband who has no formal or informal education and is not able to read and write, husband who has completed primary-level education, husband who has secondary-level education, and husband with higher education.

Husband occupation

This was divided into clerical, professional, agriculture, services, skilled manual, and unskilled manual.

Type of place of residence: this divided into urban and rural.

Regions: divided into central, eastern, northern, northeastern, southern, southeastern, and western regions.

Women autonomy: means women who have their own decisions regarding their healthcare services utilization divided into categories such as No, Some yes.

Place of delivery: Women who gave birth in a health facility or at home.

Number of antenatal care visits: To reduce maternal mortality, the World Health Organization (WHO) recommends eight ANC visits to detect disorders and complications through frequent communication with healthcare providers, the first visit during the first trimester, and two and five visits during the second and third trimesters, respectively [12]. Thus, we divided them into categories of no visit 0, 2–3 and more than 4 visits.

Statistical analysis

First, we ran the frequency distribution for all sociodemographic variables. Next, we used Pearson’s chi-square test for associations between the outcome and each independent variable. To identify the magnitude and strength of association between PNC use and the independent variables, a binary logistic regression was used. Odds ratios (OR) and 95% CI considering P-values are reported.

All statistical analysis was conducted with STATA version 15.