Postnatal Care Service Utilization and Associated Factors Among Women in Rural Afghanistan: A Cross‐Sectional Analysis of the 2022–2023 Multiple Indicator Cluster Survey

Background and Aims: Although Afghanistan has achieved notable reductions in maternal and overall mortality over the past two decades, significant disparities remain between urban and rural populations. This study assessed the magnitude and determinants of postnatal care (PNC) service utilization among women in rural Afghanistan. Methods: This study used secondary data from a nationwide representative sample of the 2022-2023 Afghanistan Multiple Indicator Cluster Survey (MICS). The study included ever-married women aged 15-49 years living in rural areas who had at least one live birth in the 2 years preceding the survey. The outcome variable was defined as a binary variable on PNC service utilization (≥ 1 PNC visit equals 1, and zero otherwise). Bivariate and multivariable logistic regression models were fitted to identify factors associated with PNC service utilization. Results: Of 10,644 women, only 14.4% (95% CI 13.3-15.4%) of women had at least one PNC visit. PNC service utilization was significantly more likely among women who delivered in public (AOR = 2.73, 95%CI: 2.27-3.28) and private (AOR = 2.21, 95%CI: 1.63-2.98) health facilities, women living in the Southern East (AOR = 2.54, 95%CI: 1.84-3.52) and Central high (AOR = 1.71, 95%CI: 1.14-2.57) regions, those with ≥ 4 (AOR = 1.61, 95%CI: 1.28-2.02) and 1-3 (AOR = 1.26, 95%CI: 1.03-1.54) antenatal care (ANC) visits, and women belonging to households where the head had secondary/higher education (AOR = 1.23, 95%CI: 1.01-1.49). Conclusion: PNC utilization in rural Afghanistan is unacceptably low. It was significantly associated with place of delivery, region of residence, prior ANC attendance, and the household head's education. These findings highlight the importance of strengthening maternal health services by promoting ANC attendance, encouraging facility-based deliveries, and addressing regional disparities.