Factors associated with institutional delivery among married women aged 15–49 years in a remote district of Nooristan Province, Afghanistan: A cross-sectional household survey, 2021

Institutional delivery is a proven intervention for reducing maternal and neonatal deaths, yet rates remain low in remote provinces such as Nooristan. This study assessed the prevalence and factors associated with institutional delivery among married women in Paroon district, Nooristan Province. A cross-sectional household survey was conducted between October and November 2021 among 595 married women aged 15–49 years who had given birth in the past five years. A two-stage sampling approach was used, with all 11 villages included and households systematically selected within villages, and data were collected through structured interviews in local languages. Descriptive statistics and survey-based bivariate and multivariable Poisson regression were applied to estimate prevalence ratios (PRs) and adjusted prevalence ratios (APRs) for factors associated with institutional delivery. The prevalence of institutional delivery was only 19.3%, far below the national average of 56.3% reported in the Afghanistan Health Survey 2018. In adjusted analyses, women aged 45–49 years (APR = 4.13, 95% CI: 2.27–7.53), those who completed high school (APR = 3.35, 95% CI: 2.21–5.08), women from higher-income households (APR = 1.71, 95% CI: 1.01–2.87) and employed women (APR = 1.87, 95% CI: 1.11–3.16) were significantly more likely to report institutional delivery for the last child.