The impacts of antenatal care on maternal mortality among women aged 15-49 years old in Afghanistan

Background: Afghanistan is among the countries which have the highest maternal mortality in the world. The inadequate utilization of antenatal care (ANC) services increased the risk of maternal mortality in Afghanistan. The goal of this study is to understand key associated factors with antenatal care and its impact on maternal mortality in Afghanistan. It also elaborates on the impacts and utilization of antenatal care services among women in Afghanistan. Methods: For this research, data from the Afghanistan Demographic Health Survey 2015 has been used, the study participants were 18139 reproductive-aged women. The relevant variable was chosen, and data was analyzed for general descriptive, Chi-square, and logistic regression tests. Analysis was carried out using JAMOVI 2.2.5. Results: The overall number of ANC visits among women was 10040 (55.4%) and 8099 women (44.6%) never used ANC visits. The utilization of one ANC visit was 11.2% and two ANC visits were most frequent among women with 17%. Women who undertook three or four and more than four were 11.6%, 7.1%, and 4.3% respectively. In this study, we examined the socio-economic and demographic backgrounds of 18139 reproductive-aged women attending ANC clinics. The highest age group (30-39 years) represented 32.3% (OR=0.947, 95%CI: 0.885-1014), followed by the age group of over 40 which was 25.1% (OR=0.919, 95%CI: 0854-0.990) compared to age group under 29 among women. According to residency, urban areas represented 77.2% of the total (18139) women, and 22.8% were from rural areas (OR=1.097, 95%CI: 1.023-1.177) compared to urban areas. In terms of education, 86% of women had received no education, 6.5% received primary education (OR=1.159, 95%CI: 1.020-1.316), the number of secondary educations was 5.7% with (OR=0.981, 95%CI: 0.828-1.163) and higher education was 1.8%with (OR=0.917, 95%CI: 0.712-1.181) compared to not education women group in Afghanistan. ANC visits were used more frequently by Pashtuns, 38.8%, followed by Tajiks, 35.1%. (OR=0.192,95% CI:0.852-0.977), Uzbek was 10% (OR=1.224, 95% CI:0.869-1.068) followed by Hazara at 6.6% (OR=0.963, 95% CI:0.869-1.068) the Turkmen at 5.4% (OR=2.571, 95% CI:2.208-2.924), the percentage by Aimaq was 1.2% (OR=1.574, 95% CI:1.196-2.072) and for Baloch 0% (OR=1.917, 95% CI:0.320-11.4812.072) followed by others with 2.6% (OR=0.910, 95% CI:0.753-1.099) compared to Pashtun ethnic group. For media exposure the number of not listening to the radio per week was 58.1% and one time per week was 16% (OR=0.974, 95%CI: 0.897-1.058), for two times per week it was 25.8% (OR=0.854, 95%CI: 0.797-0.915) and more than three plus times per week was 0.1% (OR=0.970, 95%CI: 0.402-2.343) compared with the zero time of listening to radio per week. Also, for not watching TV was 56% and one time per week was 11.3% (OR=0.888, 95%CI: 0.807-0.977) also for two times per week it was 32.6% (OR=0.913, 95%CI: 0.856-0.974) and the number of three plus times of watching TV was 0.2% OR=1.188, 95%CI: 0.617-2.286) compared with zero time of watching the TV. Conclusion: The most important key associated factors were residency, education level, ethnic groups, and media exposure. We suggest that the Afghanistan government and with international community improve their health policy, increasing accessibility of health care and equal distribution of health services in rural and urban areas in Afghanistan.