Prevalence and factors associated with institutional delivery in rural Afghanistan: secondary analysis of the 2022-2023 multiple indicator cluster survey

Abstract

<p><b>Background: </b>Institutional delivery rates among rural women appear to still be suboptimal, mainly in low and middle-income countries (LMICs). Despite that, there has been a lack of research addressing this issue among women in rural Afghanistan. Hence, this study aimed to assess the prevalence and factors associated with institutional delivery among women in rural Afghanistan.<br><br><b>Methods: </b>In this cross-sectional study, we used the 2022–2023 Afghanistan Multiple Indicator Cluster Survey (MICS) for analysis. A total of 10,644 ever-married women, aged 15–49 years, who gave birth to a live baby in the past 2 years and lived in rural areas of Afghanistan were included in this analysis. The outcome was institutional delivery and was defined as a live birth delivered by an ever-married woman at a public or private health facility in the past 2 years prior to the MICS. We applied a binary logistic regression model and provided adjusted odds ratios (AORs) and 95% confidence intervals (CIs) on the factors associated with institutional delivery.<br><br><b>Results: </b>Out of 10,644 women, 59.4% delivered at a health facility in their last pregnancy. We found that women in the age groups 30–39 years [AOR = 1.16, 95% CI (1.05–1.28)] and 40–49 years [1.28 (1.08–1.51)], women with formal education [1.56 (1.35–1.79)], women living in households with educated heads [1.19 (1.07–1.33)], women who had 1–3 antenatal care (ANC) visits [3.12 (2.81–3.47)] and ≥ 4 ANC visits [5.42 (4.78–6.15)], women who had access to mobile phones [1.26 (1.15–1.39)], women in the third [1.73 (1.51–1.98)], fourth [2.30 (1.98–2.66)], and highest [3.66 (3.05–4.39)] wealth households, and those with media access [1.24 (1.09–1.41)] were more likely to use institutional delivery. However, the likelihood was lower in multipara women [0.65 (0.57–0.74)].<br><br><b>Conclusion: </b>Just more than half of Afghan women opt for institutional deliveries in rural settings. There is a pressing need for concerted efforts aimed at enhancing access to maternal healthcare services, taking into account the associated factors identified in this context.<br></p>