Afghanistan - Demographic and Health Survey - 2017

Publication date: 2017

Afghanistan Demographic and Health Survey 2015 A fghanistan 2015 D em ographic and H ealth S urvey AFGHANISTAN DEMOGRAPHIC AND HEALTH SURVEY 2015 Central Statistics Organization Ansari Watt, Kabul, Afghanistan Ministry of Public Health Wazir Akbar Khan, Kabul, Afghanistan The DHS Program ICF Rockville, Maryland, USA January 2017 The 2015 Afghanistan Demographic and Health Survey (2015 AfDHS) was implemented by the Central Statistics Organization and the Ministry of Public Health from 15 June, 2015, to 23 February, 2016. The funding for the AfDHS was provided by the United States Agency for International Development (USAID). ICF provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2015 AfDHS may be obtained from the Central Statistics Organization, Ansari Watt, Kabul, Afghanistan; Telephone: (+93) 0202104338; Internet: http://cso.gov.af and the Ministry of Public Health, Great Masoud Road, Wazir Akbar Khan area, Kabul, Afghanistan; Internet: http://moph.gov.af. Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; E-mail: info@DHSprogram.com; Internet: www.DHSprogram.com. Cover photo ©2013 Sayed Saber Samim/CSO Afghanistan. Used with permission. ISBN: 978-9936-8050-03 Suggested citation: Central Statistics Organization (CSO), Ministry of Public Health (MoPH), and ICF. 2017. Afghanistan Demographic and Health Survey 2015. Kabul, Afghanistan: Central Statistics Organization. Contents • iii CONTENTS TABLES AND FIGURES . vii FOREWORD.xv CONTRIBUTORS TO THE REPORT . xvii READING AND UNDERSTANDING TABLES FROM THE 2015 AFDHS . xix ADDITIONAL DHS PROGRAM RESOURCES . xxvii ACRONYMS AND ABBREVIATIONS . xxix MAP OF AFGHANISTAN . xxxii 1 INTRODUCTION AND SURVEY METHODOLOGY .1 1.1 Survey Objectives .1 1.2 Sample Design .1 1.3 Questionnaires.2 1.4 Pretest .3 1.5 Training of Trainers .3 1.6 Training of Field Staff .3 1.7 Fieldwork .4 1.7.1 Fieldwork Challenges .4 1.8 Data Processing .4 1.9 Response Rates .5 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION .7 2.1 Drinking Water Sources and Treatment .7 2.2 Sanitation .8 2.3 Other Household Characteristics .9 2.4 Household Wealth .9 2.5 Hand Washing .10 2.6 Household Population and Composition .10 2.7 Birth Registration .11 2.8 Children’s Living Arrangements and Parental Survival .11 2.9 Education .12 2.9.1 Educational Attainment .12 2.9.2 School Attendance .12 2.9.3 Reasons for Not Attending School .13 3 CHARACTERISTICS OF RESPONDENTS .31 3.1 Basic Characteristics of Survey Respondents .31 3.2 Education and Literacy .31 3.3 Mass Media Exposure .33 3.4 Employment .34 3.5 Occupation .34 3.6 Tobacco and Drug Use.35 3.7 Knowledge of Tuberculosis .36 3.8 Knowledge of Hepatitis .36 3.9 Hepatitis Prevalence.36 iv • Contents 3.10 Cancer Prevalence and Deaths Related to Cancer .37 4 MARRIAGE AND SEXUAL ACTIVITY .61 4.1 Marital Status .61 4.2 Polygyny .62 4.3 Age at First Marriage .63 4.4 Age at First Sexual Intercourse .64 4.5 Recent Sexual Activity .65 5 FERTILITY.77 5.1 Current Fertility .77 5.2 Children Ever Born and Living.79 5.3 Birth Intervals .79 5.4 Insusceptibility to Pregnancy .80 5.5 Age at First Birth .80 5.6 Teenage Childbearing .81 6 FERTILITY PREFERENCES .91 6.1 Desire for Another Child .91 6.2 Ideal Family Size .92 6.3 Fertility Planning Status .93 6.4 Wanted Fertility Rates .94 7 FAMILY PLANNING .103 7.1 Contraceptive Knowledge and Use .104 7.2 Source of Modern Contraceptive Methods .106 7.3 Informed Choice .107 7.4 Discontinuation of Contraceptives .107 7.5 Demand for Family Planning .108 7.6 Contact of Nonusers with Family Planning Providers .110 8 INFANT AND CHILD MORTALITY .127 8.1 Early Childhood Mortality .128 8.2 Biodemographic Risk Factors .129 8.3 Perinatal Mortality .130 9 MATERNAL HEALTH CARE .135 9.1 Antenatal Care Coverage and Content .136 9.1.1 Skilled Providers .136 9.1.2 Timing and Number of ANC Visits .136 9.2 Components of ANC Visits .137 9.3 Protection against Neonatal Tetanus .137 9.4 Delivery Services .138 9.4.1 Institutional Deliveries .138 9.4.2 Skilled Assistance during Delivery .139 9.4.3 Delivery by Cesarean .140 9.5 Postnatal Care .140 9.5.1 Postnatal Health Check for Mothers .140 9.5.2 Postnatal Health Checks for Newborns .141 9.6 Problems in Accessing Health Care .142 Contents • v 10 CHILD HEALTH .159 10.1 Birth Weight.159 10.2 Vaccination of Children .160 10.3 Symptoms of Acute Respiratory Infection .162 10.4 Fever .162 10.5 Diarrheal Disease .163 10.5.1 Prevalence of Diarrhea .163 10.5.2 Treatment of Diarrhea .163 10.5.3 Feeding Practices .164 10.5.4 Knowledge of ORS Packets .165 10.6 Disposal of Children’s Stools .165 11 NUTRITION OF CHILDREN AND WOMEN .185 11.1 Infant and Young Child Feeding Practices .185 11.1.1 Breastfeeding .185 11.1.2 Exclusive Breastfeeding.186 11.1.3 Median Duration of Breastfeeding.187 11.1.4 Complementary Feeding .187 11.1.5 Minimum Acceptable Diet .188 11.2 Micronutrient Intake and Supplementation among Children.189 11.3 Presence of Iodized Salt in Households .190 11.4 Micronutrient Intake among Mothers .190 12 MALARIA .201 12.1 Ownership of Insecticide-Treated Nets .202 12.2 Household Access and Use of ITNs .203 12.3 Use of ITNs by Children and Pregnant Women .204 12.4 Case Management of Malaria in Children .204 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR .215 13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods .216 13.2 Knowledge about Mother-to-Child Transmission .218 13.3 HIV/AIDS Attitudes .218 13.3.1 Attitudes toward People Living with HIV/AIDS .218 13.3.2 Attitudes toward Negotiating Safer Sexual Relations with Husbands .219 13.3.3 Attitudes toward Condom Education for Young People .219 13.4 Coverage of HIV Testing Services .220 13.5 Male Circumcision .220 13.6 Self-reporting of Sexually Transmitted Infections .220 13.7 Injections .221 13.8 HIV/AIDS-Related Knowledge and Behavior among Young People .221 13.8.1 Knowledge .221 13.8.2 First Sex .222 13.8.3 Coverage of HIV Testing Services .222 14 ADULT AND MATERNAL MORTALITY .245 14.1 Data .245 14.2 Direct Estimates of Adult Mortality .246 14.3 Direct Estimates of Pregnancy-related Mortality .247 vi • Contents 15 WOMEN’S EMPOWERMENT .251 15.1 Married Women’s and Men’s Employment .251 15.2 Control over Women’s Earnings .252 15.3 Control over Men’s Earnings .253 15.4 Women’s and Men’s Ownership of Assets .253 15.5 Women’s Participation in Decision Making .254 15.6 Attitudes toward Wife Beating .255 16 DOMESTIC VIOLENCE .273 16.1 Measurement of Violence .274 16.2 Experience of Physical Violence from Anyone .274 16.2.1 Prevalence of Physical Violence .274 16.2.2 Perpetrators of Physical Violence .275 16.3 Marital Control.275 16.4 Spousal Violence .276 16.4.1 Prevalence of Spousal Violence.276 16.4.2 Onset of Spousal Violence .279 16.5 Injuries due to Spousal Violence .279 16.6 Violence Initiated by Women against Husbands .280 16.7 Response to Violence .280 16.7.1 Help Seeking Behavior to Stop the Violence .280 16.7.2 Sources for Help .280 17 FISTULA .299 17.1 Womens’ Knowledge of Fistula .299 17.2 Self-Reported Symptoms and Treatment .300 17.2.1 Self-reported Fistula Symptoms .300 17.2.2 Treatment Seeking for Fistula .300 REFERENCES .307 APPENDIX A SAMPLE DESIGN.309 APPENDIX B ESTIMATES OF SAMPLING ERRORS .319 APPENDIX C DATA QUALITY TABLES .359 APPENDIX D QUESTIONNAIRES .365 Tables and Figures • vii TABLES AND FIGURES INTRODUCTION AND SURVEY METHODOLOGY .1 Table 1.1 Results of the household and individual interviews . 5 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION .7 Table 2.1 Household drinking water . 15 Table 2.2 Household sanitation facilities . 16 Table 2.3 Household characteristics . 17 Table 2.4 Household possessions . 18 Table 2.5 Wealth quintiles . 19 Table 2.6 Hand washing . 20 Table 2.7 Household population by age, sex, and residence . 21 Table 2.8 Household composition . 21 Table 2.9 Birth registration of children under age 5 . 22 Table 2.10 Children’s living arrangements and orphanhood . 23 Table 2.11 School attendance by survivorship of parents . 24 Table 2.12.1 Educational attainment of the female household population . 25 Table 2.12.2 Educational attainment of the male household population . 26 Table 2.13 School attendance ratios . 27 Table 2.14 Reasons for children never attending school . 28 Table 2.15 Reasons for children dropping out of school . 29 Figure 2.1 Households with improved water sources . 8 Figure 2.2 Household drinking water by residence . 8 Figure 2.3 Household toilet facilities by residence . 9 Figure 2.4 Household wealth by residence . 10 Figure 2.5 Population pyramid . 11 Figure 2.6 Birth registration by wealth . 11 Figure 2.7 Orphanhood by age . 12 Figure 2.8 Secondary school attendance by wealth . 13 CHARACTERISTICS OF RESPONDENTS .31 Table 3.1 Background characteristics of respondents . 39 Table 3.2.1 Educational attainment: Women . 40 Table 3.2.2 Educational attainment: Men . 41 Table 3.3.1 Literacy: Women . 42 Table 3.3.2 Literacy: Men . 43 Table 3.4.1 Exposure to mass media: Women. 44 Table 3.4.2 Exposure to mass media: Men . 45 Table 3.5.1 Employment status: Women . 46 Table 3.5.2 Employment status: Men . 47 Table 3.6.1 Occupation: Women . 48 Table 3.6.2 Occupation: Men . 49 Table 3.7 Type of employment: Women . 50 Table 3.8.1 Use of tobacco: Women . 51 Table 3.8.2 Use of tobacco: Men . 52 Table 3.9 Use of drugs . 53 Table 3.10.1 Knowledge concerning tuberculosis: Women . 54 viii • Tables and Figures Table 3.10.2 Knowledge concerning tuberculosis: Men . 55 Table 3.11.1 Knowledge concerning hepatitis: Women . 56 Table 3.11.2 Knowledge concerning hepatitis: Men . 57 Table 3.12.1 Reported prevalence of hepatitis: Women . 58 Table 3.12.2 Reported prevalence of hepatitis: Men . 59 Table 3.13 Households with members diagnosed with cancer . 60 Table 3.14 Deaths of household members diagnosed with cancer . 60 Figure 3.1 Education of survey respondents . 32 Figure 3.2 Women with more than a secondary education . 33 Figure 3.3 Exposure to mass media . 33 Figure 3.4. Employment by education . 34 Figure 3.5 Occupation . 35 Figure 3.6 Use of tobacco . 36 MARRIAGE AND SEXUAL ACTIVITY .61 Table 4.1 Current marital status. 66 Table 4.2.1 Number of women's co-wives . 67 Table 4.2.2 Number of men's wives . 68 Table 4.3 Age at first marriage . 69 Table 4.4 Median age at first marriage by background characteristics . 70 Table 4.5 Age at first sexual intercourse . 71 Table 4.6 Median age at first sexual intercourse by background characteristics . 72 Table 4.7.1 Recent sexual activity: Women . 73 Table 4.7.2 Recent sexual activity: Men . 75 Figure 4.1 Marital status . 62 Figure 4.2 Polygyny . 63 Figure 4.3 Median age at first marriage by education . 64 Figure 4.4 Median age at first sexual intercourse and first marriage among women and men . 64 FERTILITY.77 Table 5.1 Current fertility . 83 Table 5.2 Fertility by background characteristics . 84 Table 5.3 Trends in age-specific fertility rates . 85 Table 5.4 Children ever born and living . 85 Table 5.5 Birth intervals . 86 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility . 87 Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 87 Table 5.8 Menopause . 88 Table 5.9 Age at first birth . 88 Table 5.10 Median age at first birth. 89 Table 5.11 Teenage pregnancy and motherhood . 90 Figure 5.1 Age-specific fertility rates by residence . 78 Figure 5.2 Total fertility by education . 78 Figure 5.3 Fertility by province . 78 Figure 5.4 Birth intervals . 79 Figure 5.5 Median age at first birth by education . 81 Tables and Figures • ix FERTILITY PREFERENCES .91 Table 6.1 Fertility preferences by number of living children . 95 Table 6.2.1 Desire to limit childbearing: Women . 96 Table 6.2.2 Desire to limit childbearing: Men . 97 Table 6.3 Ideal number of children by number of living children . 98 Table 6.4 Mean ideal number of children by background characteristics . 99 Table 6.5 Fertility planning status . 100 Table 6.6 Wanted fertility rates . 101 Figure 6.1 Desire to limit childbearing . 92 Figure 6.2 Ideal family size . 92 Figure 6.3 Ideal family size by number of living children . 93 Figure 6.4 Fertility planning status . 93 Figure 6.5 Wanted and Actual Fertility . 94 FAMILY PLANNING .103 Table 7.1 Knowledge of contraceptive methods . 112 Table 7.2 Knowledge of contraceptive methods by background characteristics . 113 Table 7.3 Current use of contraception by age . 114 Table 7.4 Current use of contraception by background characteristics . 115 Table 7.5 Timing of sterilization . 116 Table 7.6 Source of modern contraception methods . 116 Table 7.7 Use of social marketing brand pills and condoms . 117 Table 7.8 Informed choice . 118 Table 7.9 Twelve-month contraceptive discontinuation rates . 118 Table 7.10 Reasons for discontinuation . 119 Table 7.11 Knowledge of fertile period . 119 Table 7.12.1 Need and demand for family planning among currently married women . 120 Table 7.12.2 Need and demand for family planning among ever-married women . 121 Table 7.13 Future use of contraception . 122 Table 7.14.1 Exposure to family planning messages: Women . 123 Table 7.14.2 Exposure to family planning messages: Men . 124 Table 7.15 Contact of nonusers with family planning providers . 125 Figure 7.1 Knowledge of contraceptive methods . 104 Figure 7.2 Contraceptive use . 104 Figure 7.3 Use of modern methods by education . 105 Figure 7.4 Modern contraceptive use by province . 106 Figure 7.5 Source of modern contraceptive methods . 106 Figure 7.6 Demand for family planning . 108 Figure 7.7 Unmet need for family planning by province . 109 INFANT AND CHILD MORTALITY .127 Table 8.1 Early childhood mortality rates . 131 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 131 Table 8.3 Early childhood mortality rates by demographic characteristics . 132 Table 8.4 Perinatal mortality . 133 Table 8.5 High-risk fertility behavior . 134 Figure 8.1 Under-5 mortality by mother’s education . 129 Figure 8.2 Under-5 mortality by birth interval. 129 x • Tables and Figures MATERNAL HEALTH CARE .135 Table 9.1 Antenatal care . 144 Table 9.2 Number of antenatal care visits and timing of first visit . 145 Table 9.3 Components of antenatal care . 146 Table 9.4 Knowledge of symptoms of pregnancy complications . 147 Table 9.5 Men's participation during ANC visits . 148 Table 9.6 Tetanus toxoid injections . 149 Table 9.7 Place of delivery . 150 Table 9.8 Assistance during delivery . 151 Table 9.9 Timing of first postnatal checkup for the mother . 153 Table 9.10 Type of provider of first postnatal checkup for the mother . 154 Table 9.11 Timing of first postnatal checkup for the newborn . 155 Table 9.12 Type of provider of first postnatal checkup for the newborn . 156 Table 9.13 Problems in accessing health care . 157 Figure 9.1 Antenatal care coverage . 136 Figure 9.2 Components of antenatal care . 137 Figure 9.3 Institutional deliveries by education . 138 Figure 9.4 Institutional deliveries by province . 139 Figure 9.5 Delivery assistance . 139 Figure 9.6 Delivery assistance by wealth . 140 Figure 9.7 Postnatal care by place of delivery . 141 Figure 9.8 Women with at least one problem in accessing health care by education . 142 CHILD HEALTH .159 Table 10.1 Child’s size and weight at birth . 167 Table 10.2 Vaccinations by source of information . 168 Table 10.3 Vaccinations by background characteristics . 169 Table 10.4 Vaccinations in first year of life . 171 Table 10.5 Prevalence and treatment of symptoms of ARI . 172 Table 10.6 Prevalence and treatment of fever . 174 Table 10.7 Prevalence of diarrhea . 175 Table 10.8 Diarrhea treatment . 177 Table 10.9 Feeding practices during diarrhea . 179 Table 10.10 Knowledge of ORS packets or ORS pre-packaged liquids . 181 Table 10.11 Disposal of children’s stools . 182 Table 10.12 Knowledge of childhood illness . 183 Figure 10.1 Childhood vaccinations . 160 Figure 10.2 Vaccination coverage by province . 161 Figure 10.3 Vaccinations in first year of life . 162 Figure 10.4 Diarrhea prevalence by age . 163 Figure 10.5 Treatment of diarrhea . 164 Figure 10.6 Feeding practices during diarrhea . 165 Figure 10.7 Prevalence and treatment of childhood illnesses . 165 NUTRITION OF CHILDREN AND WOMEN .185 Table 11.1 Initial breastfeeding . 190 Table 11.2 Breastfeeding status by age . 192 Table 11.3 Median duration of breastfeeding . 193 Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview . 194 Table 11.5 Infant and young child feeding (IYCF) practices . 195 Table 11.6 Micronutrient intake among children . 197 Tables and Figures • xi Table 11.7 Presence of iodized salt in household . 199 Table 11.8 Micronutrient intake among mothers. 200 Figure 11.1 Breastfeeding practices by age . 186 Figure 11.2 IYCF breastfeeding indicators . 187 Figure 11.3 IYCF indicators on minimum acceptable diet . 189 MALARIA .201 Table 12.1 Household possession of mosquito nets . 206 Table 12.2 Access to an insecticide-treated net (ITN) . 207 Table 12.3 Use of mosquito nets by persons in the household . 208 Table 12.4 Use of existing ITNs . 209 Table 12.5 Use of mosquito nets by children . 210 Table 12.6 Use of mosquito nets by pregnant women . 211 Table 12.7 Prevalence, diagnosis, and prompt treatment of children with fever . 212 Table 12.8 Source of advice or treatment for children with fever . 213 Table 12.9 Type of antimalarial drugs used . 214 Figure 12.1 Household Ownership of ITNs . 202 Figure 12.2 ITN Ownership by household wealth . 203 Figure 12.3 Access to ITNs . 203 Figure 12.4 Use of ITNs . 204 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR .215 Table 13.1 Knowledge of AIDS . 224 Table 13.2.1 Source of knowledge on HIV/AIDS: Women . 225 Table 13.2.2 Source of knowledge on HIV/AIDS: Men . 226 Table 13.3 Knowledge of HIV prevention methods . 227 Table 13.4.1 Comprehensive knowledge about HIV/AIDS: Women . 228 Table 13.4.2 Comprehensive knowledge about HIV/AIDS: Men . 229 Table 13.5 Knowledge of prevention of mother to child transmission of HIV . 230 Table 13.6.1 Accepting attitudes toward those living with HIV/AIDS: Women . 231 Table 13.6.2 Accepting attitudes toward those living with HIV/AIDS: Men . 232 Table 13.7 Attitudes toward negotiating safer sexual relations with husband . 233 Table 13.8 Adult support of education about condom use to prevent AIDS . 234 Table 13.9.1 Coverage of prior HIV testing: Women . 235 Table 13.9.2 Coverage of prior HIV testing: Men . 236 Table 13.10 Male circumcision . 237 Table 13.11 Place of circumcision. 238 Table 13.12 Age at circumcision . 239 Table 13.13 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms . 240 Table 13.14 Prevalence of medical injections . 241 Table 13.15 Comprehensive knowledge about AIDS and of a source of condoms among young people . 242 Table 13.16 Age at first sexual intercourse among young people . 243 Table 13.17 Recent HIV tests among youth . 244 Figure 13.1 Knowledge of AIDS by wealth status . 216 Figure 13.2 Comprehensive knowledge of HIV . 216 Figure 13.3 Knowledge of HIV prevention methods . 217 Figure 13.4 HIV knowledge by education . 218 Figure 13.5 Knowledge of Mother-to- Child Transmission of HIV . 218 Figure 13.6 Women and men seeking treatment for STIs. 221 xii • Tables and Figures Figure 13.7 Early Sexual Initiation . 222 ADULT AND MATERNAL MORTALITY .245 Table 14.1 Completeness of information on siblings . 249 Table 14.2 Adult mortality rates . 249 Table 14.3 Adult mortality probabilities . 249 Table 14.4 Pregnancy-related mortality rates . 250 WOMEN’S EMPOWERMENT .251 Table 15.1 Employment and cash earnings of currently married women and men . 257 Table 15.2.1 Control over women's cash earnings and relative magnitude of women's cash earnings 258 Table 15.2.2 Control over men's cash earnings . 259 Table 15.3 Women's control over their own earnings and over those of their husbands . 260 Table 15.4.1 Ownership of assets: Women . 261 Table 15.4.2 Ownership of assets: Men . 262 Table 15.5 Participation in decision making . 263 Table 15.6.1 Women's participation in decision making by background characteristics . 264 Table 15.6.2 Men's participation in decision making by background characteristics . 265 Table 15.7.1 Attitude toward wife beating: Women . 266 Table 15.7.2 Attitude toward wife beating: Men . 268 Table 15.8 Indicators of women's empowerment . 269 Table 15.9 Current use of contraception by women's empowerment . 270 Table 15.10 Ideal number of children and unmet need for family planning by women's empowerment . 270 Table 15.11 Reproductive health care by women's empowerment. 271 Table 15.12 Early childhood mortality rates by women's status . 271 Figure 15.1 Women's and men's employment by age . 252 Figure 15.2 Control over women's earnings . 252 Figure 15.3 Ownership of assets . 253 Figure 15.4 Women's participation in decision making . 254 Figure 15.5 Attitudes towards wife beating . 255 DOMESTIC VIOLENCE .273 Table 16.1 Experience of physical violence . 282 Table 16.2 Experience of violence during pregnancy . 284 Table 16.3 Persons committing physical violence . 285 Table 16.4 Marital control exercised by husbands . 286 Table 16.5 Forms of spousal violence . 287 Table 16.6 Spousal violence by background characteristics . 288 Table 16.7 Spousal violence by husband's characteristics and empowerment indicators. 290 Table 16.8 Physical or sexual violence in the past 12 months by any husband . 291 Table 16.9 Experience of spousal violence by duration of marriage . 292 Table 16.10 Injuries to women due to spousal violence . 293 Table 16.11 Women's violence against their spouse by background characteristics . 294 Table 16.12 Women's violence against their spouse by husband’s characteristics and empowerment indicators . 295 Table 16.13 Help seeking to stop violence . 296 Table 16.14 Sources for help to stop the violence . 297 Figure 16.1 Violence during pregnancy by number of living children . 275 Figure 16.2 Types of Spousal violence . 277 Figure 16.3 Spousal violence by subnational unit . 278 Tables and Figures • xiii Figure 16.4 Spousal violence by subnational unit . 279 Figure 16.5 Help seeking by type of violence experienced . 280 FISTULA .299 Table 17.1 Fistula . 302 Table 17.2 Characteristics of labor reported as cause of fistula symptoms . 303 Table 17.3 Type of provider for treatment of fistula . 304 Table 17.4 Outcome of treatment of fistula . 304 Table 17.5 Reasons for not seeking treatment for fistula symptoms . 305 Figure 17.1 Knowledge of fistula by age . 299 Figure 17.2 Reported cause of fistula . 300 Figure 17.3 Outcome of fistula treatment . 301 Figure 17.4 Reason for not seeking treatment . 301 Foreword • xv FOREWORD he Afghanistan Demographic and Health Survey (AfDHS) 2015 is the first survey of its kind to be implemented in the country as part of the worldwide Demographic and Health Surveys (DHS) Program. It was implemented by the joint effort of the Central Statistical Organization (CSO) and the Ministry of Public Health (MoPH), with the objective of providing reliable, accurate, and up-to- date data for the country. We hope that information contained in this report will assist policymakers and program managers in monitoring and designing programs and strategies for improving maternal and child health and family planning services in Afghanistan. This report presents comprehensive, final outcomes of the findings of the survey. Users will find the information useful for program planning and evaluation. The 2015 AfDHS is a national sample survey that provides up-to-date information on fertility levels; marriage; fertility preferences; awareness and use of family planning methods; child feeding practices; nutrition, adult, and childhood mortality; awareness and attitudes regarding HIV/AIDS; women’s empowerment; and domestic violence. The target groups were women and men age 15-49 in randomly selected households across Afghanistan. In addition to presenting national estimates, the report provides estimates of key indicators for both the urban and rural areas in Afghanistan and the provinces. The success of the 2015 AfDHS was made possible by a number of organizations and individuals. In this regard, we appreciate the support of the United States Agency for International Development in Afghanistan (USAID) for funding the survey. We would like to extend our gratitude to the United Nations Children’s Fund (UNICEF) for providing technical support during the training. We also appreciate the valuable technical input provided by the Technical Committee and the Steering Committee during the different phases of the survey; these contributed to its successful implementation. Furthermore, the support and collaboration witnessed from the national and provincial administration, nongovernmental and international development organizations, and other major stakeholders is highly acknowledged. We are grateful to the 2015 AfDHS core team for managing technical, administrative, and logistical aspects of the survey; the master trainers, for their support in training and monitoring the fieldwork; the field staff, for data collection; the data processing team; and, in particular, the survey respondents. Similarly, we wish to express our appreciation to ICF for its technical assistance in all stages of the survey. We wish to also acknowledge Avais Hyder Liaquat Nauman (AHLN) Chartered Accountants for providing accounting and disbursement services that allowed for the timely and efficient transfer of project funds throughout the survey period. T Contributors to the Report • xvii CONTRIBUTORS TO THE REPORT Dr. Sayed Ataullah Saeedzai, General Director, Evaluation and Health Information System General Directorate, MoPH Dr. Said Iftekhar Sadaat, EHIS Advisor, Evaluation and Health Information System General Directorate, MoPH Sayed Ali Aqa Hashimi, Deputy Director of Field Operation, CSO Dr. Edris Ayazi, DHS Survey Manager, MoPH Ataullah Serajy, Health Statistics Manager, Demography Department, CSO Dr. Abdul Nasir Ikram, Project Management Specialist-Health, Office of Health and Nutrition, USAID Dr. Hafez Rasooli, National Influenza & Zoonotic Surveillance Manager, Surveillance Department, MoPH Dr Roqia Naser, Training officer, National EPI, MoPH Dr. Zohra Shamszai, MNH Manager, Reproductive Health Directorate, MoPH Dr. Samim Soroush, M&E and Research Coordinator, Reproductive Health Directorate, MoPH Dr. Nezamuddin Jalil, Learning & Coordination Manager, Reproductive Health Directorate, MoPH Dr. Rangina Aziz, RH Morbidity Officer, Reproductive Health Directorate, MoPH Dr. Naziha Ahmadi, FP Public Officer, Reproductive Health Directorate, MoPH Dr. Muhammad Naeem Habib, Malaria program coordinator, National Malaria & Leishmaniosis Control Program (NMLCP), MoPH Ahmad Fahim Haidari, Member of Population Research, Demography Department, CSO Dr. Abdul Baseer Sardar Qureshi, National Nutrition Surveillance Coordinator, Public Nutrition Department Dr. Younas Bargami, Program technical coordinator, National AIDS Control Program, MoPH Bahar Rasoly, EHIS officer, Evaluation and Health Information System General Directorate, MoPH Fatima Arifi, EHIS officer, Evaluation and Health Information System General Directorate, MoPH Abida Jafari, M&E Officer, Gender Directorate, MoPH Reading and Understanding Tables from the 2015 AFDHS • xix READING AND UNDERSTANDING THE 2015 AFDHS In 2016, The DHS Program began producing final reports with a new format and style. The new style features about 90 figures to highlight trends, subnational patterns, and background characteristics. The text has been simplified to highlight key points in bullets and to clearly identify indicator definitions in boxes. All of the standard tables that have historically been included in the DHS continue to be included in this new style. They are located at the end of each chapter. Each DHS final report is based on approximately 200 tables of data. While the text and figures featured in each chapter highlight some of the most important findings from the tables, not every finding can be discussed or displayed graphically. For this reason, DHS data users should be comfortable reading and interpreting tables. The following pages provide an introduction to the organization of DHS tables, the presentation of background characteristics, and a brief summary of sampling and understanding denominators. In addition, this section provides some exercises for users as they practice their new skills in interpreting DHS tables. xx • Reading and Understanding Tables from the 2015 AFDHS Example 1: Exposure to Mass Media A Question Asked of All Survey Respondents Table 3.4.1 Exposure to mass media: Women Percentage of ever-married women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Afghanistan 2015 Background characteristic Reads a news- paper at least once a week Watches tele- vision at least once a week Listens to radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 4.3 36.7 23.5 1.5 47.9 1,825 20-24 3.5 37.6 27.0 1.1 46.4 6,089 25-29 2.7 38.8 25.3 1.2 46.2 6,299 30-34 1.4 40.3 23.1 0.4 47.2 4,302 35-39 2.7 41.8 21.4 1.5 47.5 4,463 40-44 1.7 38.5 23.2 0.9 47.6 3,113 45-49 1.4 40.2 21.3 0.9 48.5 3,369 Residence Urban 7.6 71.1 26.3 3.2 20.7 6,870 Rural 1.0 29.6 23.2 0.4 55.1 22,591 Province1 Kabul 9.2 70.4 27.1 4.0 21.2 3,658 Kapisa 6.5 41.6 47.0 4.2 37.9 205 Parwan 1.8 20.5 36.0 0.2 50.9 625 Wardak 0.0 16.9 10.1 0.0 76.1 382 Logar 5.9 15.1 52.1 1.6 41.9 472 Nangarhar 2.3 31.2 18.6 1.0 59.0 794 Laghman 1.4 14.2 36.5 0.4 59.9 583 Panjsher 4.8 52.3 10.4 0.6 42.9 54 Baghlan 3.8 51.3 11.1 1.2 43.0 839 Bamyan 1.8 38.6 10.8 0.6 56.0 303 Ghazni 1.8 31.8 34.1 0.5 48.1 1,328 Paktika 0.0 7.2 40.4 0.0 55.5 792 Paktya 0.1 20.6 60.4 0.1 37.4 542 Khost 0.2 33.6 55.6 0.1 38.8 851 Kunarha 1.5 6.1 13.7 0.7 83.2 559 Nooristan 0.6 0.1 2.0 0.0 97.9 222 Badakhshan 1.0 12.8 5.5 0.8 85.7 1,004 Takhar 0.5 22.3 19.7 0.2 70.4 1,105 Kunduz 1.9 49.1 23.9 1.2 46.0 1,232 Samangan 1.3 20.3 6.8 0.8 77.4 330 Balkh 2.1 53.2 7.2 0.7 44.0 1,781 Sar-E-Pul 1.2 26.6 2.1 0.4 72.5 654 Ghor 0.5 39.3 16.5 0.3 55.9 715 Daykundi 0.3 11.9 1.2 0.2 87.2 329 Urozgan 0.0 5.7 20.8 0.0 77.4 230 Kandahar 0.8 16.2 55.8 0.2 40.0 2,227 Jawzjan 5.1 54.0 22.8 3.3 42.5 614 Faryab 2.5 76.8 5.9 1.3 20.9 2,114 Helmand 0.8 23.2 40.8 0.4 46.7 875 Badghis 0.3 6.8 2.4 0.2 92.1 650 Herat 1.9 55.6 12.5 0.7 37.7 2,316 Farah 0.2 38.6 28.9 0.1 46.6 777 Nimroz 1.4 57.3 1.1 0.0 42.3 278 Education No education 0.2 33.2 24.1 0.0 51.8 24,604 Primary 3.8 64.7 20.5 1.9 28.0 2,330 Secondary 18.4 70.2 22.0 6.3 21.7 1,971 More than secondary 43.4 89.1 40.4 24.9 6.1 556 Wealth quintile Lowest 0.3 22.1 10.9 0.1 71.0 5,904 Second 0.5 24.1 22.3 0.2 59.5 6,001 Middle 0.7 26.4 27.2 0.3 53.3 5,888 Fourth 1.9 48.2 30.7 0.6 34.8 6,010 Highest 9.6 77.0 28.8 4.3 15.4 5,657 Total 2.5 39.2 24.0 1.1 47.1 29,461 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 1 3 2 4 5 Reading and Understanding Tables from the 2015 AFDHS • xxi Step 1: Read the title and subtitle. They tell you the topic and the specific population group being described. In this case, the table is about ever-married women age 15-49 and their exposure to different types of media. All eligible ever-married female respondents age 15-49 were asked these questions. Step 2: Scan the column headings—highlighted in green in Example 1.They describe how the information is categorized. In this table, the first three columns of data show different types of media that ever-married women access at least once a week. The fourth column shows ever-married women who access all three media, while the fifth column is ever-married women who do not access any of the three types of media at least once a week. The last column lists the number of ever-married women interviewed in the survey. Step 3: Scan the row headings—the first vertical column highlighted in blue in Example 1. These show the different ways the data are divided into categories based on population characteristics. In this case, the table presents ever-married women’s exposure to media by age, urban-rural residence, province, educational level, and wealth quintile. Most of the tables in the AfDHS report will be divided into these same categories. Step 4: Look at the row at the bottom of the table highlighted in red. These percentages represent the totals of all ever-married women age 15-49 and their access to different types of media. In this case, 2.5%* of ever-married women age 15-49 read a newspaper at least once a week, 39.2% watch television weekly, and 24.0% listen to the radio weekly. Step 5: To find out what percentage of ever-married women with more than secondary education access all three media weekly, draw two imaginary lines, as shown on the table. This shows that 24.9% of ever- married women age 15-49 with more than secondary education access all three types of media weekly. Step 6: By looking at patterns by background characteristics, we can see how exposure to mass media varies across Afghanistan. Mass media are often used to communicate health messages. Knowing how mass media exposure varies among different groups can help program planners and policy makers determine how to most effectively reach their target populations. *For the purpose of this document data are presented exactly as they appear in the table including decimal places. However, the text in the remainder of this report rounds data to the nearest whole percentage point. Practice: Use the table in Example 1 to answer the following questions: a) What percentage of ever-married women in Afghanistan do not access any of the three media at least once a week? b) What age group of ever-married women are most likely to watch television weekly? c) Compare ever-married women in urban areas to ever-married women in rural areas—which group is more likely to read the newspaper weekly? d) What are the lowest and highest percentages (range) of ever-married women who do not access any of the three media at least once a week by province? e) Is there a clear pattern in exposure to television on a weekly basis by education level? f) Is there a clear pattern in exposure to radio on a weekly basis by wealth quintile? Answers: a) 47.1% b) Ever-married women age 35-39: 41.8% of ever-married women in this age group watch television weekly c) Ever-married women in urban areas, 7.6% listen to the radio weekly, compared to 1.0% of ever-married women in rural areas d) 20.9% of ever-married women in the Faryab province do not access any of the three media at least once a week, compared to 97.9% of ever-married women in Nooristan. e) Exposure to television on a weekly basis increases as a woman’s level of education increases; 33.2% of ever-married women with no education watch television weekly, compared to 89.1% of ever-married women with more than secondary education. f) There is no clear pattern in exposure to radio on a weekly basis by wealth quintile. Ever-married women in the lowest wealth quintile are least likely to listen to the radio on a weekly basis (10.9%) and ever-married women in the fourth wealth quintile are most likely to listen to the radio on a weekly basis (30.7%). xxii • Reading and Understanding Tables from the 2015 AFDHS Example 2 Prevalence and Treatment of Symptoms of ARI A Question Asked of a Subgroup of Survey Respondents Table 10.5 Prevalence and treatment of symptoms of ARI Among children under age 5, the percentage who had symptoms of acute respiratory infection (ARI) in the 2 weeks preceding the survey and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider and the percentage who received antibiotics as treatment, according to background characteristics, Afghanistan 2015 Among children under age 5 Among children under age 5 with symptoms of ARI: Background characteristic Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Age in months <6 10.0 3,095 71.1 49.8 308 6-11 14.7 2,720 64.0 60.7 400 12-23 13.9 5,708 67.3 61.5 792 24-35 14.8 6,598 54.5 52.1 977 36-47 11.3 6,282 61.4 53.5 708 48-59 10.7 5,902 58.5 48.1 631 Sex Male 12.9 15,605 62.4 55.2 2,017 Female 12.2 14,699 60.4 53.4 1,800 Mother’s smoking status Smokes cigarettes/tobacco 13.2 769 61.2 60.3 101 Does not smoke 12.6 29,460 61.5 54.2 3,715 Missing 0.3 75 * * 0 Cooking fuel Electricity or gas 9.9 9,089 70.7 55.8 904 Kerosene * 1 * * 0 Coal/lignite 14.5 99 * * 14 Charcoal 4.5 176 * * 8 Wood/straw3 13.7 15,015 60.2 50.9 2,052 Animal dung 14.1 5,751 55.4 61.7 814 Other fuel 17.9 130 (41.9) (68.9) 23 No food cooked in household (4.0) 20 * * 1 Missing (1.0) 22 * * 0 Residence Urban 11.8 7,040 65.1 50.7 834 Rural 12.8 23,264 60.4 55.4 2,983 Province4 Kabul 6.9 3,677 52.8 47.4 252 Kapisa 15.8 211 50.7 54.2 33 Parwan 2.6 688 * * 18 Wardak 17.3 329 57.1 50.8 57 Logar 1.4 417 * * 6 Nangarhar 18.2 972 68.6 56.8 177 Laghman 16.0 770 76.3 58.5 124 Panjsher 0.9 39 * * 0 Baghlan 26.3 700 37.8 36.2 184 Bamyan 9.3 314 51.3 57.3 29 Ghazni 0.4 778 * * 3 Paktika 2.5 856 (93.0) (86.2) 21 Paktya 7.7 578 75.5 30.0 44 Khost 7.8 991 46.8 93.4 78 Kunarha 4.3 704 (49.4) (70.0) 31 Nooristan 9.1 303 47.1 49.0 28 Badakhshan 17.6 870 22.9 26.0 153 Takhar 9.2 1,187 34.2 65.9 110 Kunduz 9.4 1,177 60.8 75.5 111 Samangan 5.7 345 (74.7) (48.5) 20 Balkh 15.2 1,874 63.8 67.3 285 Sar-E-Pul 3.6 596 * * 21 Ghor 28.3 846 58.2 56.6 239 Daykundi 7.5 308 (12.2) (23.8) 23 Urozgan 6.7 385 93.5 66.5 26 Kandahar 24.0 2,751 60.1 50.4 660 Jawzjan 18.4 569 50.4 56.9 105 Faryab 10.0 2,281 66.7 96.8 229 Helmand 7.7 893 87.2 66.7 69 Badghis 13.5 723 61.6 75.4 97 Herat 27.3 2,046 85.6 33.1 558 Farah 2.4 810 (62.6) (49.6) 19 Nimroz 2.4 290 * * 7 (Continued…) 1 2 a b 4 Reading and Understanding Tables from the 2015 AFDHS • xxiii Table 10.5—Continued Background characteristic Among children under age five: Among children under age five with symptoms of ARI: Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Mother’s education No education 12.9 25,261 61.1 54.0 3,256 Primary 13.1 2,429 62.1 53.0 319 Secondary 9.5 2,130 63.9 64.1 203 More than secondary 7.9 484 (77.7) (47.6) 38 Wealth quintile Lowest 16.2 5,795 52.9 51.0 939 Second 11.9 6,185 65.6 56.4 737 Middle 12.8 6,398 56.3 51.2 821 Fourth 11.3 6,312 67.1 57.2 714 Highest 10.8 5,614 70.0 58.2 606 Total 12.6 30,304 61.5 54.4 3,817 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Symptoms of ARI consist of cough accompanied by short, rapid breathing that was chest-related and/or by difficult breathing that was chest-related. 2 Excludes pharmacy, shop, market, and traditional practitioner 3 Includes grass, shrubs, and crop residues 4 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Step 1: Read the title and subtitle. In this case, the table is about two separate groups of children: all children under age five (a) and children under age five who had symptoms of acute respiratory infection (ARI) in the two weeks before the survey (b). Step 2: Identify the two panels. First, identify the columns that refer to all children under age five (a), and then isolate the columns that refer only to those children under age five who had symptoms of ARI in the two weeks before the survey (b). Step 3: Look at the first panel. What percentage of children under age five had symptoms of ARI in the two weeks before the survey? It’s 12.6%. Now look at the second panel. How many children under age five are there who had symptoms of ARI in the two weeks before the survey? It’s 3,817 children or 12.6% of the 30,304 children under age five (with rounding). The second panel is a subset of the first panel. Step 4: Only 12.6% of children under age five had symptoms of ARI in the two weeks before the survey. Once these children are further divided into the background characteristic categories, there may be too few cases for the percentages to be reliable.  What percentage of children under age five in Kunarha province who had symptoms of ARI in the two weeks before the survey received antibiotics? 70.0%. This percentage is in parentheses because there are between 25 and 49 children (unweighted) in this category. Readers should use this number with caution—it may not be reliable. (For more information on weighted and unweighted numbers, see Example 4.)  What percentage of children under age five in Nimroz province who had symptoms of ARI in the two weeks before the survey received antibiotics? There is no number in this cell—only an asterisk. This is because fewer than 25 children under age five in Nimroz province had symptoms of ARI in the two weeks before the survey. Results for this group are not reported. The subgroup is too small, and therefore the data are not reliable. Note: When parentheses or asterisks are used in a table, the explanation will be noted under the table. If there are no parentheses or asterisks in a table, you can proceed with confidence that enough cases were included in all categories that the data are reliable. 3 3 xxiv • Reading and Understanding Tables from the 2015 AFDHS Example 3: Understanding Sampling Weights in AfDHS Tables A sample is a group of people who have been selected for a survey. In the AfDHS, the sample is designed to represent the national population age 15-49. In addition to national data, most countries want to collect and report data on smaller geographical or administrative areas. However, doing so requires a minimum sample size per area. For the 2015 AfDHS, the survey sample is representative at the national and provincial levels, and for urban and rural areas. To generate statistics that are representative of the country as a whole and the 33 provinces, the number of women surveyed in each province should contribute to the size of the total (national) sample in proportion to size of the province. However, if some provinces have small populations, then a sample allocated in proportion to each province’s population may not include sufficient women from each province for analysis. To solve this problem, provinces with small populations are oversampled. For example, let’s say that you have enough money to interview 29,461 women and want to produce results that are representative of Afghanistan as a whole and its provinces (as in Table 3.1). However, the total population of Afghanistan is not evenly distributed among the provinces: some provinces, such as Kabul, are heavily populated while others, such as Panjsher are not. Thus, Panjsher must be oversampled. A sampling statistician determines how many women should be interviewed in each province in order to get reliable statistics. The blue column (1) in the table at the right shows the actual number of women interviewed in each province. Within the provinces, the number of women interviewed ranges from 652 in Bamyan to 1,398 in Nooristan province. The number of interviews is sufficient to get reliable results in each province. With this distribution of interviews, some provinces are overrepresented and some provinces are underrepresented. For example, the population in Kabul is about 12% of the population in Afghanistan, while Panjsher’s population contributes only 0.2% of the population in Afghanistan. But as the blue column shows, the number of women interviewed in Kabul accounts for only about 2.5% of the total sample of women interviewed (755/29,461) and the number of women interviewed in Panjsher accounts for almost the same percentage of the total sample of women interviewed (2.3%, or 681/29,461). This unweighted distribution of women does not accurately represent the population. In order to get statistics that are representative of Afghanistan, the distribution of the women in the sample needs to be weighted (or mathematically adjusted) such that it resembles the true distribution in the country. Women from a small province, Panjsher, should only contribute a small amount to the national Table 3.1 Background characteristics of respondents Percent distribution of ever-married women age 15-49 by selected background characteristics, Afghanistan 2015 Women Background characteristic Weighted percent Weighted number Unweighted number Province1 Kabul 12.4 3,658 755 Kapisa 0.7 205 874 Parwan 2.1 625 744 Wardak 1.3 382 870 Logar 1.6 472 915 Nangarhar 2.7 794 1,023 Laghman 2.0 583 800 Panjsher 0.2 54 681 Baghlan 2.8 839 740 Bamyan 1.0 303 652 Ghazni 4.5 1,328 1,146 Paktika 2.7 792 1,110 Paktya 1.8 542 1,174 Khost 2.9 851 1,338 Kunarha 1.9 559 734 Nooristan 0.8 222 1,398 Badakhshan 3.4 1,004 835 Takhar 3.8 1,105 819 Kunduz 4.2 1,232 839 Samangan 1.1 330 682 Balkh 6.0 1,781 909 Sar-E-Pul 2.2 654 812 Ghor 2.4 715 886 Daykundi 1.1 329 669 Urozgan 0.8 230 805 Kandahar 7.6 2,227 952 Jawzjan 2.1 614 865 Faryab 7.2 2,114 742 Helmand 3.0 875 843 Badghis 2.2 650 875 Herat 7.9 2,316 989 Farah 2.6 777 1,133 Nimroz 0.9 278 680 Total 100.0 29,461 29,461 Note: Education categories refer to the highest level of education attended. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 3 2 1 Reading and Understanding Tables from the 2015 AFDHS • xxv total. Women from a large province, like Kabul, should contribute much more. Therefore, DHS statisticians mathematically calculate a “weight” which is used to adjust the number of women from each province so that each province’s contribution to the total is proportional to the actual population of the province. The numbers in the purple column (2) represent the “weighted” values. The weighted values can be smaller or larger than the unweighted values at provincial level. The total national sample size of 29,461 women has not changed after weighting, but the distribution of the women in the provinces has been changed to represent their contribution to the total population size. How do statisticians weight each category? They take into account the probability that a woman was selected in the sample. If you were to compare the red column (3) to the actual population distribution of Afghanistan, you would see that women in each province are contributing to the total sample with the same weight that they contribute to the population of the country. The weighted number of women in the survey now accurately represents the proportion of women who live in Kabul and the proportion of women who live in Panjsher. With sampling and weighting, it is possible to interview enough women to provide reliable statistics at national and provincial levels. In general, only the weighted numbers are shown in each of the AfDHS tables, so don’t be surprised if these numbers seem low: they may actually represent a larger number of women interviewed. Additional DHS Program Resources • xxvii ADDITIONAL DHS PROGRAM RESOURCES The DHS Program Website – Download free DHS reports, standard documentation, key indicator data, and training tools, and view announcements. DHSprogram.com STATcompiler – Build custom tables, graphs, and maps with data from 90 countries and thousands of indicators. Statcompiler.com DHS Program Mobile App – Access key DHS indicators for 90 countries on your mobile device (Apple, Android, or Windows). Search DHS Program in your iTunes or Google Play store DHS Program User Forum – Post questions about DHS data, and search our archive of FAQs. userforum.DHSprogram.com Tutorial Videos – Watch interviews with experts and learn DHS basics, such as sampling and weighting, downloading datasets, and How to Read DHS Tables. www.youtube.com/DHSProgram Datasets – Download DHS datasets for analysis. DHSprogram.com/Data Spatial Data Repository – Download geographically linked health and demographic data for mapping in a geographic information system (GIS). spatialdata.DHSprogram.com Social Media – Follow The DHS Program and join the conversation. Stay up to date through: Facebook www.facebook.com/DHSprogram Twitter www.twitter.com/ DHSprogram Pinterest www.pinterest.com/ DHSprogram LinkedIn www.linkedin.com/ company/dhs-program YouTube www.youtube.com/DHSprogram Blog Blog.DHSprogram.com Acronyms and Abbreviations • xxix ACRONYMS AND ABBREVIATIONS ACT artemisinin-based combination therapy AfDHS Afghanistan Demographic and Health Survey AFGA Afghan Family Guidance Association AIDS acquired immunodeficiency syndrome ANC antenatal care ANDS Afghanistan National Development Strategy ARI acute respiratory infection ART antiretroviral therapy ASFR age-specific fertility rate BCG Bacille-Calmette-Guerin vaccine against tuberculosis BPHS basic package of health services BMI body mass index CBMM community based management of malaria CHC comprehensive health center CPR contraceptive prevalence rate CSO Central Statistics Organization DHS Demographic and Health Survey DPT Diphtheria, pertussis, and tetanus vaccine EA enumeration area EPI Expanded Program on Immunization EVAW elimination of violence against women GAR gross attendance ratio GFR general fertility rate GPI gender parity index HIV human immunodeficiency virus HMIS health management information system ICPD International Conference on Population and Development IRB institutional review board ITN insecticide-treated net IUD intrauterine device IYCF infant and young child feeding LAM lactational amenorrhea method LLIN long-lasting insecticide-treated bed net LPG liquid petroleum gas MAD minimum acceptable diet MDGs Millennium Development Goals MMR maternal mortality ratio MoPH Ministry of Public Health xxx • Acronyms and Abbreviations MTCT mother-to-child transmission NAPWA National Action Plan for Women of the Afghanistan NAR net attendance ratio NGO nongovernmental organization NMLCP National Malaria and Leishmaniosis Control Program NN neonatal mortality NNS national nutrition survey NTG national treatment guideline OPV oral polio vaccine ORS oral rehydration salts ORT oral rehydration therapy PAHO Pan American Health Organization PCV Pneumococcal conjugate vaccine PHD provincial health directorate PNN postneonatal mortality PSOs provincial statistical officers PSU primary sampling unit RHF recommended homemade fluids RMNCA reproductive, maternal, neonatal, child, and adolescent SP sulfadoxine/pyrimethamine STI sexually transmitted infection TB tuberculosis TFR total fertility rate TWFR total wanted fertility rate UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNDP United Nations Development Program UNICEF United Nations Children’s Fund USAID United States Agency for International Development VAD vitamin A deficiency VIP ventilated improved pit WHO World Health Organization xxxii • Map of Afghanistan Introduction and Survey Methodology • 1 INTRODUCTION AND SURVEY METHODOLOGY 1 he 2015 Afghanistan Demographic and Health Survey (AfDHS) was implemented by the Central Statistics Organization (CSO) and the Ministry of Public Health (MoPH). Data collection took place from June 15, 2015, to February 23, 2016. ICF provided technical assistance through the DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. The United Nations Children’s Fund (UNICEF) facilitated the successful implementation of the survey through its technical support. 1.1 SURVEY OBJECTIVES The primary objective of the 2015 AfDHS project is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the AfDHS collected information on knowledge and practice of family planning, fertility levels, marriage, fertility preferences, child feeding practices, nutritional status of children and women, childhood mortality, maternal and child health, awareness and attitudes regarding HIV/AIDS, knowledge about other illnesses (e.g., tuberculosis, hepatitis B and C), and domestic violence. The information collected through the AfDHS is intended to assist policymakers and program managers in evaluating and designing programs and strategies for improving the health of the country’s population. 1.2 SAMPLE DESIGN The sampling frame used for the 2015 AfDHS is an updated version of the Household Listing Frame, prepared in 2003-04 and updated in 2009, provided by the Central Statistics Organization (CSO). The sampling frame had information on 25,974 enumeration areas (EAs). An EA is a geographic area consisting of a convenient number of dwelling units that serve as counting units for the census. The sampling frame contained information about the location (province, district, and control area), the type of residence (urban or rural), and the estimated number of residential households for each of the 25,974 EAs. Satellite maps were also available for each EA, which delimited the geographic boundaries of the area. The sampling frame excluded institutional populations such as persons in hotels, barracks, and prisons. The 2015 AfDHS followed a stratified two-stage sample design and was intended to allow estimates of key indicators at the national level, in urban and rural areas, and for each of the 34 provinces of Afghanistan. The first stage involved selecting sample points (clusters) consisting of EAs. A total of 950 clusters were selected, 260 in urban areas and 690 in rural areas. It was recognized that some areas of the country might be difficult to reach because of ongoing security issues. Therefore, to mitigate the situation, reserve clusters were selected in all of the provinces to replace the inaccessible clusters. The 101 reserve clusters that were preselected did not exceed 10% of the selected clusters in the province. The second stage involved systematic sampling of households. A household listing operation was undertaken in all of the selected clusters, and a fixed number of 27 households per cluster were selected through an equal probability systematic selection process, for a total sample size of 25,650 households. Because of the approximately equal sample size in each province, the sample is not self-weighting at the national level, and weighting factors have been calculated, added to the data file, and applied so that results are representative at the national level. All ever-married women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. In half of the households, all ever-married men age 15-49 who were either residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. T 2 • Introduction and Survey Methodology During the household listing operation, more than 70 selected clusters were identified as insecure. Therefore, a decision was made to carry out the household listing operation in all of the 101 preselected reserve clusters, which also accounted for the possibility of identifying more insecure clusters during data collection. Household listing was successfully completed in 976 of 1,051 clusters. Overall, the survey was successfully carried out in 956 clusters.1 1.3 QUESTIONNAIRES Three questionnaires were used for the 2015 AfDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires, based on the DHS Program’s standard Demographic and Health Survey questionnaires, were adapted to reflect the population and health issues relevant to Afghanistan. Input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and international donors. After all questionnaires were finalized in English, the questionnaires were translated into Dari and Pashto. The survey protocol and the questionnaires were approved by the ICF Institutional Review Board (IRB) and the Ministry of Public Health of Afghanistan. The Household Questionnaire listed all household members and visitors; basic information was collected on their age, sex, education, relationship to the head of the household, marital status, and, for children under age 18, parents’ survival status. Data on age and sex were used to identify women and men who were eligible for individual interviews. The Household Questionnaire also collected information on the characteristics of the household’s dwelling unit, such as water source, toilet facilities, fuel use, and flooring materials, as well as on possessions such as durable goods and mosquito nets. In addition, a small sample of salt was requested from each household, and the sample was tested for iodine content using a rapid test kit. The Woman’s Questionnaire was administered to all ever-married women age 15-49 in the selected households. These women were asked questions on the following topics:  Background characteristics (including age, education, and media exposure)  Birth history and child mortality  Knowledge and use of family planning methods  Fertility preferences  Antenatal, delivery, and postnatal care  Breastfeeding and infant feeding practices  Vaccinations and childhood illnesses  Marriage  Women’s work and husbands’ background characteristics  Awareness and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs)  Adult and maternal mortality  Knowledge, attitudes, and behavior related to other health issues (e.g., tuberculosis, hepatitis, fistula)  Domestic violence (questions asked of one woman per household) The Man’s Questionnaire was administered to all ever-married men age 15-49 in the subsample of households selected for the male survey. The Man’s Questionnaire collected much of the same information found in the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health. 1 Because of extreme security issues in rural areas of Zabul, only seven urban clusters could be covered. Consequently, it is not possible to provide provincial-level estimates for Zabul; however, the information collected from this province is included in national-level estimates. Introduction and Survey Methodology • 3 1.4 PRETEST Eleven women and 16 men participated in training to pretest the AfDHS survey protocol over a three-week period in March 2015. The participants were staff of CSO and MoPH from various departments, including CSO Field Operations, Database, Census, Sampling, Cartography, and Demography and MoPH Monitoring and Evaluation. Twelve days of classroom training was provided. The training was led by The DHS Program staff, supported by the in-country AfDHS core team that translated the sessions into Dari and Pashto. Furthermore, resource persons from MoPH and UNICEF attended the sessions to provide technical background on topics such as family planning, reproductive health, child health, and salt testing for iodine. The fieldwork for the pretest was carried out in four locations in and around Kabul. There were four teams deployed: two teams for testing the Dari language questionnaires and two teams for testing the Pashto language questionnaires. Following the field practice, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. 1.5 TRAINING OF TRAINERS The training of trainers was conducted from May 9-13, 2015, for the master trainers, who had earlier participated in the pretest training in March 2015. The purpose of the training was to prepare the master trainers for the main training. Seventeen master trainers were selected, based on their performance, from among the individuals who participated in the pretest. The DHS Program survey manager facilitated the session, highlighting the concept of adult learning principles and guidelines on conducting effective training. As the participants had gone through the pretest training and fieldwork, they were well versed in the components of the AfDHS. The training focused on key components such as interview techniques and procedures for completing the AfDHS questionnaires; birth history, family planning, and contraceptive calendar; and completing the vaccination section. The participants worked in groups to develop teach- backs on these topics using various training techniques. They were encouraged to develop participatory methods for the training. Several tests were carried out, which also helped them design test questions for the main training. 1.6 TRAINING OF FIELD STAFF The CSO recruited and trained 300 people for the main fieldwork to serve as supervisors, field editors, interviewers, and reserve interviewers. Additionally, five staff from MoPH joined the training to serve as fieldwork monitors and secondary editors. The field staff main training took place from May 21 to June 13, 2015, at Rana University in Kabul. The training course consisted of instruction regarding interviewing techniques and field procedures, a detailed review of questionnaire content, instruction on how to administer the paper questionnaires, mock interviews between participants in the classroom, and practice interviews with real respondents in areas outside the sample points selected for the survey. The main fieldwork training was led by the master trainers and backstopped by The DHS Program trainers. The sessions included discussing concepts, procedures, and methodology of conducting the survey. Participants were guided through the questionnaires. Furthermore, resource persons from the MoPH and UNICEF attended the sessions to provide technical input. The master trainers used various techniques they had learned to facilitate the training sessions. These techniques included presentations, lectures, hands-on exercises, mock interviews, role plays, group work, and quizzes. In-class exercises included probing for age, checking age consistencies, filling out vaccination cards, completing the reproductive calendar, and practicing interviews. The trainees were taken for field practice twice in the nonsampled areas of Kabul district, where they had an opportunity to implement the survey in a real-world situation. Participants were evaluated through in-class exercises, quizzes, and observations made during field practice. Ultimately, 33 supervisors and 33 field editors were identified based on their performance. Similarly, 198 participants were selected to serve as interviewers while the rest were kept as reserves. The 4 • Introduction and Survey Methodology supervisors and field editors received additional training in data quality control procedures, fieldwork coordination, and management. 1.7 FIELDWORK Data collection was carried out by 33 field teams, each consisting of one team supervisor, one field editor, three female interviewers, and three male interviewers. However, the team composition had to be adjusted during the different phases of the fieldwork operation because of security challenges (see below). Data collection took place from June 15, 2015, through February 23, 2016, although most of the teams completed the fieldwork by November 2015. The extension of fieldwork in some provinces was due to the ongoing unrest and insurgency in the provinces of Kunduz, Helmand, Faryab, Badghis, and Ghazni. In the case of Badakhshan, the team had to pass through Tajikistan to access the clusters; this entailed getting visa approval, which took more than 3 months. Despite substantial challenges in the field, the AfDHS field teams successfully completed the fieldwork. Fieldwork monitoring was an integral part of the AfDHS, and five rounds of monitoring were carried out by the AfDHS core team and the 17 master trainers. Two levels of monitoring strategies were identified: technical monitoring and coverage monitoring. The technical monitoring was carried out by the AfDHS core team and the master trainers, while the coverage monitoring was carried out by provincial statistical officers (PSOs) and the Provincial Health Directorate (PHD) of MoPH. The monitors were provided with guidelines for overseeing the fieldwork. 1.7.1 Fieldwork Challenges A number of challenges were faced by the field teams during data collection, especially in provinces under the control of the insurgents. There was a need to get support from security officers and local civil elders to obtain access to the selected clusters. This process delayed the fieldwork schedule. Due to security concerns, in some areas the teams could not collect data as a group but had to split into smaller groups, which hindered efficient management of the fieldwork. One such case was Zabul, where complete data were gathered for only seven urban clusters. Consultative meetings with security officers, civil agencies, and the Zabul local government were arranged, as most of the districts in this province were under the control of the insurgents, making data collection impossible. Thus, this survey cannot provide provincial estimates for Zabul. In provinces such as Kunduz, Helmand, Badakhshan, Ghazni, Faryab, Nooristan, Baghlan, and Kunarha, the household listing operation was delayed as a result of security challenges, which impacted data collection. In addition, the teams faced mobility problems due to security issues and tough terrain. Consequently, the fieldwork in these areas was prolonged, but the data collection was completed. There were unique problems in Badakhshan as, due to security concerns and weather conditions, four clusters could not be accessed through Afghanistan. The household listing team and the data collection team had to move together to access these clusters through Tajikistan. It was very difficult to find suitable candidates for data collection in Helmand, Zabul, and Urozgan. These provinces had to be covered by interviewers from the nearby provinces. 1.8 DATA PROCESSING The processing of the 2015 AfDHS data began simultaneously with the fieldwork. All completed questionnaires were edited immediately while in the field by the field editors and checked by the supervisors before being dispatched to the data processing center at the CSO central office in Kabul. These completed questionnaires were edited and entered by 23 data processing personnel specially trained for this task. All data were entered twice for 100% verification. Data were entered using the CSPro computer Introduction and Survey Methodology • 5 package. The concurrent processing of the data offered a distinct advantage, because it maximized the likelihood of the data being error-free and authentic. Moreover, the double entry of data enabled easy comparison and identification of errors and inconsistencies. Inconsistencies were resolved by tallying with the paper questionnaire entries. The secondary editing of the data was completed in the first week of March 2016. The final cleaning of the data set was carried out by The DHS Program data processing specialist and was completed by mid-April 2016. 1.9 RESPONSE RATES A total of 25,741 households were selected for the sample, of which 24,941 were occupied during the survey fieldwork (Table 1.1). Of the occupied households, 24,395 were successfully interviewed, yielding a response rate of 98%. In the interviewed households, 30,434 ever-married women age 15-49 were identified for individual interviews; interviews were completed with 29,461 of these women, yielding a response rate of 97%. In the subsample of households selected for the male survey, 11,778 ever-married men age 15-49 were identified and 10,760 were successfully interviewed, yielding a response rate of 91%. The lower response rate for men was likely due to their more frequent and longer absences from the household. The response rates are lower in urban areas than in rural areas. The difference is more prominent for men than women, as men in the urban areas are often away from their households for work. Moreover, given the security situation in the country, the field teams could not carry out interviews in the late evenings when more men are at home. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Afghanistan 2015 Residence Total Result Urban Rural Household interviews Households selected 6,977 18,764 25,741 Households occupied 6,663 18,278 24,941 Households interviewed 6,391 18,004 24,395 Household response rate1 95.9 98.5 97.8 Interviews with women age 15-49 Number of eligible women 7,396 23,038 30,434 Number of eligible women interviewed 7,025 22,436 29,461 Eligible women response rate2 95.0 97.4 96.8 Interviews with men age 15-49 Number of eligible men 2,771 9,007 11,778 Number of eligible men interviewed 2,333 8,427 10,760 Eligible men response rate2 84.2 93.6 91.4 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 7 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 Key Findings  Drinking water: Sixty-five percent of household in Afghanistan have access to an improved source of drinking water.  Sanitation: Twenty-five percent of households in Afghanistan have improved toilet facilities.  Household population and composition: The population of Afghanistan remains young, with 47% under age 15 (male 48% and female 46%).  Birth registration: About two in five children under age 5 (42%) had their births registered with the government.  Orphans: Among children under age 18, 4% are orphans (that is, one or both parents are dead).  School attendance: The net attendance ratio falls from 60% in primary school to 38% in secondary school. Boys are much more likely to attend both primary and secondary school than girls. nformation on the socioeconomic characteristics of the household population in the 2015 AfDHS provides a context to interpret demographic and health indicators and can furnish an approximate indication of the representativeness of the survey. In addition, this information sheds light on the living conditions of the population. This chapter presents information on source of drinking water, sanitation, exposure to smoke inside the home, relative wealth, hand washing, household population and composition, educational attainment, school attendance, birth registration, and family living arrangements. 2.1 DRINKING WATER SOURCES AND TREATMENT Improved sources of drinking water Include piped water, public taps, standpipes, tube wells, boreholes, protected dug wells and springs, rainwater, and bottled water. Sample: Households Improved drinking water sources protect against outside contamination so that water is more likely to be safe to drink. Overall, 65% of households in Afghanistan have access to an improved source of drinking water. Eighty-six percent of urban households have access to an improved drinking water source, in contrast to only 58% of rural households (Table 2.1). Access to an improved water source varies by province (Figure 2.1). I 8 • Housing Characteristics and Household Population Figure 2.1 Households with improved water sources Percentage of households Urban and rural households rely on different sources of drinking water. Twenty-one percent of urban households have piped water in their dwelling or yard, while 11% use public taps and 29% use tube wells or boreholes (Figure 2.2). In contrast, only 2% of rural households have piped water in their dwelling or yard. Rural households mainly rely on tube wells or boreholes and protected dug wells (17% each). Only 35% of rural households have a water source on the premises, as compared with 77% of urban households. Seventeen percent of rural residents travel 30 minutes or longer roundtrip to fetch drinking water. Clean water is a basic need for human life. Most households (90%) report that they do not treat their water prior to drinking. Twelve percent of urban households and 4% of rural households treat their drinking water. Appropriate treatment methods include boiling, adding bleach/chlorine, filtering, and solar disinfecting (Table 2.1). 2.2 SANITATION Improved toilet facilities Include any non-shared toilet of the following types: flush/pour flush toilets to piped sewer systems, septic tanks, and pit latrines; ventilated improved pit (VIP) latrines; pit latrines with slabs; and composting toilets. Sample: Households Figure 2.2 Household drinking water by residence 21 2 7 11 15 14 29 17 20 25 23 23 12 40 33 Urban Rural All Unimproved source Protected well or spring Tubewell or borehole Public tap/standpipe Piped water into dwelling/yard/plot Percent distribution of households by source of drinking water Housing Characteristics and Household Population • 9 One-fourth of households in Afghanistan have access to improved toilet facilities. More than half of the households in urban areas (52%) have access to improved toilet facilities, as compared with only 16% of rural households (Figure 2.3). Thirteen percent of households do not have any toilet facility. In urban areas, improved toilet facilities generally consist of some kind of flush or pour flush toilet. In rural areas, they are mostly VIP pit latrines or pit latrines with slabs or composting toilets (Table 2.2). Three-fourths of rural households (75%) have unimproved toilet facilities or no toilet facilities at all, which increases the risk of disease transmission. Traditional dry vault toilets are the most common non-improved facility, used by half of rural households. 2.3 OTHER HOUSEHOLD CHARACTERISTICS Exposure to smoke inside the home, either from cooking with solid fuels or from smoking tobacco, has potentially harmful health effects. Sixty-seven percent of households in Afghanistan use some type of solid fuel for cooking. The majority of households in urban areas use liquefied petroleum gas (LPG) or natural gas (83%), but in rural areas most households use solid fuel (84%) such as wood, animal dung, or straw/shrubs/grass (Table 2.3). Exposure to cooking smoke is greater when cooking takes place inside the house rather than in a separate building or outdoors. In Afghanistan, cooking is done inside the home in more than half (55%) of households. Additionally, in 19% of households someone smokes inside the house daily. The survey also collected data on access to electricity, flooring materials, and the number of rooms used for sleeping. Seventy-two percent of households in Afghanistan have electricity, with a large urban-rural divide; 93% of urban households and 64% of rural households have electricity. Carpet is the most common material for flooring (56%). Overall, 48% of households reported having three or more rooms for sleeping (Table 2.3). 2.4 HOUSEHOLD WEALTH Wealth index Households are given scores based on the number and kinds of consumer goods they own, ranging from a television to a bicycle or car, in addition to housing characteristics such as source of drinking water, toilet facilities, and flooring materials. These scores are derived using principal component analysis. National wealth quintiles are compiled by assigning the household score to each usual (de jure) household member, ranking each person in the household population by his or her score, and then dividing the distribution into five equal categories, each comprising 20% of the population. Sample: Households In Afghanistan, the wealthiest households are concentrated in urban areas. Almost all of the urban population falls in the fourth and highest wealth quintiles, while most of the rural population is in the three lowest wealth quintiles (Figure 2.4). Figure 2.3 Household toilet facilities by residence 52 16 25 17 5 8 29 58 50 2 17 13 4 3 Urban Rural All Other No facility/bush/field Unimproved facility Shared facility Improved facility Percent distribution of households by type of toilet facilities 10 • Housing Characteristics and Household Population There are large provincial variations in wealth. In Kabul, 67% of the population is concentrated in the highest wealth quintile, while a large majority of the population in Ghor (76%), Bamyan (69%), and Daykundi (65%) is concentrated in the lowest wealth quintile (Table 2.5). Household Durable Goods The survey also collected information on household effects, means of transportation, agricultural land, farm animals, and bank accounts. Urban households are more likely than rural households to own a television (84% versus 39%), a mobile telephone (94% versus 85%), a refrigerator (51% versus 8%), and a computer (28% versus 5%). In contrast, 78% of rural households own farm animals. For complete information on household possessions, see Table 2.4. 2.5 HAND WASHING To obtain hand washing information, interviewers asked to see the place where members of the household most often washed their hands. Soap and water—the ideal hand washing agents—were observed in 36% of households; another 28% had water only (Table 2.6). Some 28% of households did not have water, soap, or any other cleaning agent. These results probably overstate the availability of cleaning agents because they exclude 15% of urban and 28% of rural households where interviewers were unable to observe the place where household members usually wash their hands. The most common reason for this was that there was no designated place for hand washing. Urban households were almost three times as likely as rural households to have soap and water at the usual place for hand washing. The availability of soap and water increased with increasing wealth. Households in the highest wealth quintile were almost seven times as likely as those in the lowest quintile to have soap and water. 2.6 HOUSEHOLD POPULATION AND COMPOSITION Household A person or group of related or unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult male or female as the head of the household, who share the same housekeeping arrangements, and who are considered a single unit. De facto population All persons who stayed in the selected households the night before the interview (whether usual residents or visitors). De jure population All persons who are usual residents of the selected households, whether or not they stayed in the household the night before the interview. Figure 2.4 Household wealth by residence 3 26 2 26 4 25 18 21 73 3 Urban Rural Percent distribution of de jure population by wealth quintiles Wealthiest Fourth Middle Second Poorest Housing Characteristics and Household Population • 11 A total of 192,389 individuals stayed overnight in the 24,395 interviewed households in the 2015 AfDHS. Forty-nine percent of them (93,963) were female, and 51% (98,426) were male (Table 2.7). The population pyramid in Figure 2.5 shows their distribution by five-year age groups and sex. The broad base of the pyramid indicates that Afghanistan’s population is young, which is typical of countries with high fertility rates. Forty-seven percent of the population is under age 15, while 3% of residents are age 65 or older (Table 2.7). The average size of households in Afghanistan is 8.0 persons (Table 2.8). Urban households are slightly smaller than rural households (7.7 persons versus 8.2 persons). Men head most of Afghan households (98%), with only 2% of households headed by women. 2.7 BIRTH REGISTRATION Registered birth Child has a birth certificate or his or her birth has been registered with the civil authority. Sample: De jure children under age 5 Forty-two percent of children under age 5 had their births registered with the civil authority at the time of the survey, and 20% had a birth certificate (Table 2.9). Boys and girls are equally likely to have their births registered and to have a birth certificate. There is evidence that registration may have improved recently: half of children under age 2 were registered, as compared with 38% of those age 2-4. Registration of births varies widely across provinces. Children are most likely to have their births registered in Badghis (78%) and least likely in Nooristan (less than 1%). Birth registration increases with increasing household wealth (Figure 2.6). 2.8 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Orphan A child with one or both parents dead Sample: Children under age 18 Figure 2.5 Population pyramid Figure 2.6 Birth registration by wealth 10 6 2 2 6 10 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Age Percent distribution of the household population Male Female 261210 30 31 35 48 70 42 Lowest Second Middle Fourth Highest Total Percentage of children under age 5 whose births are registered with the civil authorities WealthiestPoorest 12 • Housing Characteristics and Household Population Four percent of Afghan children under age 18 are orphaned, meaning that one or both of their parents are dead (Table 2.10). The proportion of orphaned children increases rapidly with age, rising from 1% among children under age 2 to 10% among children age 15-17 (Figure 2.7). Nine in 10 children under age 18 live with both of their parents (94%). Children age 10-14 whose parents are alive and who are living with at least one parent are more likely to attend school than those whose parents are deceased (67% versus 55%) (Table 2.11). 2.9 EDUCATION 2.9.1 Educational Attainment Median educational attainment Number of years of schooling completed by half of the population. Sample: De facto household population age 6 and older In Afghanistan, 57% of males age 6 and over have ever attended school, almost double the 31% of females (Tables 2.12.1 and 2.12.2). Only 4% of women and 10% of men have completed secondary school or gone beyond secondary school. The median number of years of schooling completed for women and men is 0.0 and 1.6 years, respectively. Patterns by background characteristics  Urban residents are much more likely to have completed secondary school than rural residents. Among women in urban households, 10% have completed secondary school, as compared with 2% of women in rural households. Similarly, 19% of men in urban areas have completed secondary school, compared with 8% of men in rural areas.  Educational attainment increases with increasing household wealth among both women and men. Thirteen percent of women in the wealthiest households have completed secondary school, as compared with 1% of women in the poorest households.  Educational attainment varies by province. Urozgan has the lowest level of educational attainment, with 96% of women and 79% of men having no education. For more details, see Table 2.12.1 and Table 2.12.2. 2.9.2 School Attendance Net attendance ratio (NAR) Percentage of the school age population that attends primary or secondary school. Sample: Children age 7-12 for primary school NAR and children age 13-18 for secondary school NAR Gross attendance ratio (GAR) The total number of primary and secondary school students expressed as a percentage of the official primary and secondary school age population. Sample: Children age 7-12 for primary school GAR and children age 13-18 for secondary school GAR Figure 2.7 Orphanhood by age 1 2 3 6 10 4 <2 2-4 5-9 10-14 15-17 0-17 Percentage of children under age 18 with one or both parents dead, by age of child Age in years Housing Characteristics and Household Population • 13 Sixty-nine percent of boys and 50% of girls age 7-12 attend primary school (Table 2.13). The net attendance ratio drops in secondary school: only 50% of boys and 25% of girls age 13-18 attend secondary school. Patterns by background characteristics  Urban children are considerably more likely than rural children to attend both primary and secondary school (Table 2.13).  There are large differences in secondary school attendance by province. Attendance ranges from 16% for boys in Urozgan and 2% for girls in Paktika to 76% for boys and 51% for girls in Panjsher (Table 2.13).  Children in the highest wealth quintile are more likely than those in the lowest quintile to attend primary school (76% versus 57%) (Table 2.13).  The net attendance ratio for secondary school increases with increasing wealth among both girls and boys, from 16% in the lowest quintile to 44% in the highest quintile for girls and from 38% in the lowest quintile to 64% in the highest quintile for boys (Figure 2.8). Other Measures of School Attendance The survey also collected data on two other indicators. The gross attendance ratio (GAR), which measures participation at each level of schooling among all persons age 5-24, is 78% at the primary school level and 49% at the secondary school level. This indicates that children outside the official school age population for a given level are attending school. The gender parity index (GPI), which is the ratio of female to male attendance rates, is 0.7 for primary school and 0.5 for secondary school. That is, there are about two girls per three boys in primary school and one girl per two boys in secondary school. For complete information on these indicators, see Table 2.13. 2.9.3 Reasons for Not Attending School The survey included questions on why children had never attended school and why those who had attended school but were not attending at the time of the survey had stopped attending. Among de facto household members age 5-24 who had never attended school, the most common reason given was that their parents simply did not send them to school (48% of females and 19% of males). Distance to school was also a common reason. The need to work or earn money was more often cited as a reason for boys never attending school than for girls (Table 2.14). Table 2.15 shows the percent distribution of the de facto population age 5-24 who dropped out of school by reasons for dropping out, according to sex and place of residence. The main reasons for males dropping out of school are the need to work (44%) and the need to help at home (15%). Among females, 30% dropped out because their parents did not send them to school, while 19% dropped out because they got married. Figure 2.8 Secondary school attendance by wealth 16 17 17 29 44 25 38 46 44 55 64 50 Lowest Second Middle Fourth Highest Total Girls Boys WealthiestPoorest Net attendance ratio for secondary school among children age 13-18 14 • Housing Characteristics and Household Population LIST OF TABLES For more information on household population and housing characteristics, see the following tables:  Table 2.1 Household drinking water  Table 2.2 Household sanitation facilities  Table 2.3 Household characteristics  Table 2.4 Household possessions  Table 2.5 Wealth quintiles  Table 2.6 Hand washing  Table 2.7 Household population by age, sex, and residence  Table 2.8 Household composition  Table 2.9 Birth registration of children under age 5  Table 2.10 Children’s living arrangements and orphanhood  Table 2.11 School attendance by survivorship of parents  Table 2.12.1 Educational attainment of the female household population  Table 2.12.2 Educational attainment of the male household population  Table 2.13 School attendance ratios  Table 2.14 Reasons for children never attending school  Table 2.15 Reasons for children dropping out of school Housing Characteristics and Household Population • 15 Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Afghanistan 2015 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 86.3 58.0 65.3 86.4 59.9 66.4 Piped into dwelling/yard/plot 21.0 2.4 7.2 19.4 2.5 6.6 Public tap/standpipe 10.6 15.4 14.2 11.0 16.7 15.3 Tube well or borehole 28.8 17.1 20.1 29.9 17.1 20.3 Protected dug well 23.9 16.7 18.5 24.1 17.2 18.9 Protected spring 1.4 5.8 4.7 1.4 5.9 4.8 Rain water 0.0 0.5 0.4 0.0 0.5 0.4 Bottled water 0.6 0.0 0.2 0.6 0.0 0.2 Non-improved source 11.9 40.3 33.0 11.9 38.6 32.1 Unprotected dug well 4.4 13.5 11.1 4.3 13.2 11.0 Unprotected spring 1.4 11.2 8.6 1.1 10.5 8.2 Tanker truck/cart with drum 5.2 6.2 5.9 5.7 5.8 5.8 Surface water 0.9 9.5 7.3 0.9 9.1 7.0 Other source 1.7 1.7 1.7 1.6 1.4 1.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 76.7 34.5 45.3 77.4 36.5 46.6 Less than 30 minutes 17.3 47.8 39.9 16.3 46.4 39.0 30 minutes or longer 4.6 16.6 13.5 4.9 16.1 13.3 Don’t know 1.4 1.2 1.2 1.4 1.1 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 8.5 2.4 3.9 8.3 2.3 3.8 Bleach/chlorine added 3.8 1.0 1.7 3.8 1.1 1.8 Strained through cloth 0.7 0.3 0.4 0.8 0.3 0.4 Ceramic, sand, or other filter 1.0 0.7 0.8 1.1 0.7 0.8 Solar disinfection 0.2 0.0 0.1 0.1 0.0 0.0 Other 1.7 1.1 1.2 2.0 1.1 1.3 No treatment 85.3 91.9 90.2 85.0 92.1 90.4 Percentage using an appropriate treatment method2 12.4 3.8 6.0 12.5 3.9 6.0 Number 6,269 18,126 24,395 48,246 147,802 196,048 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100%. 2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. 16 • Housing Characteristics and Household Population Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Afghanistan 2015 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility 52.1 16.2 25.4 54.6 16.9 26.2 Flush/pour flush to piped sewer system 7.6 0.3 2.2 8.0 0.3 2.2 Flush/pour flush to septic tank 26.4 2.0 8.3 28.2 2.4 8.7 Flush/pour flush to pit latrine 4.5 1.7 2.4 4.6 1.8 2.5 Ventilated improved pit (VIP) latrine 7.5 4.9 5.6 7.9 5.2 5.9 Pit latrine with slab 4.2 3.8 3.9 4.1 3.8 3.9 Composting toilet 1.9 3.5 3.1 1.9 3.4 3.0 Shared facility1 16.5 5.4 8.2 13.3 4.3 6.5 Flush/pour flush to piped sewer system 2.3 0.0 0.6 1.9 0.0 0.5 Flush/pour flush to septic tank 8.2 0.8 2.7 6.7 0.6 2.1 Flush/pour flush to pit latrine 1.5 0.3 0.7 1.2 0.3 0.5 Ventilated improved pit (VIP) latrine 2.1 1.2 1.4 1.6 1.1 1.2 Pit latrine with slab 1.8 1.3 1.4 1.2 1.2 1.2 Composting toilet 0.7 1.6 1.4 0.6 1.2 1.0 Non-improved facility 31.1 74.9 63.6 31.8 74.5 64.1 Flush/pour flush not to sewer/septic tank/pit latrine 3.0 0.4 1.1 3.3 0.4 1.1 Pit latrine without slab/open pit 2.2 5.7 4.8 2.4 5.2 4.5 Bucket 0.1 0.4 0.4 0.1 0.5 0.4 Traditional dry vault toilet 23.7 50.7 43.7 24.4 51.9 45.2 Eco sanitation 0.2 0.5 0.4 0.2 0.4 0.4 No facility/bush/field 1.9 17.2 13.2 1.4 16.1 12.5 Other 0.2 3.5 2.7 0.1 4.2 3.2 Missing 0.1 0.0 0.1 0.1 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 6,269 18,126 24,395 48,246 147,802 196,048 1 Facilities that would be considered improved if they were not shared by two or more households Housing Characteristics and Household Population • 17 Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Afghanistan 2015 Residence Housing characteristic Urban Rural Total Electricity Yes 92.5 64.2 71.5 No 7.5 35.8 28.5 Total 100.0 100.0 100.0 Flooring material Earth/sand 3.7 2.2 2.6 Dung 0.2 0.1 0.1 Mud and hay 4.5 3.2 3.6 Wood planks 0.4 0.1 0.2 Parquet or polished wood 0.1 0.1 0.1 Ceramic tiles 1.8 0.1 0.5 Cement 15.4 1.2 4.8 Rugs/mat 23.9 26.6 25.9 Carpet 48.0 58.6 55.9 Other 2.0 7.7 6.2 Total 100.0 100.0 100.0 Rooms used for sleeping One 20.0 15.2 16.4 Two 33.3 34.0 33.8 Three or more 44.0 49.6 48.2 Missing 2.6 1.2 1.6 Total 100.0 100.0 100.0 Place for cooking In the house 62.9 52.7 55.3 In a separate building 22.8 25.8 25.0 Outdoors 12.2 19.2 17.4 No food cooked in household 0.2 0.0 0.1 Other 1.9 2.2 2.1 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Cooking fuel Electricity 0.4 0.1 0.2 LPG/natural gas/biogas 83.1 15.1 32.6 Coal/lignite 0.1 0.6 0.5 Charcoal 0.3 0.9 0.7 Wood 9.3 28.0 23.2 Straw/shrubs/grass 2.7 21.8 16.9 Agricultural crop 0.9 8.0 6.2 Animal dung 2.8 24.8 19.2 Other fuel 0.1 0.5 0.4 No food cooked in household 0.2 0.0 0.1 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 16.0 84.2 66.7 Frequency of smoking in the home Daily 19.3 19.2 19.2 Weekly 2.3 2.7 2.6 Monthly 0.5 0.6 0.6 Less than monthly 0.4 0.5 0.4 Never 77.5 76.9 77.1 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Number 6,269 18,126 24,395 LPG = Liquefied petroleum gas 1 Includes coal/lignite, charcoal, wood, straw/shrubs/grass, agricultural crops, and animal dung 18 • Housing Characteristics and Household Population Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Afghanistan 2015 Residence Possession Urban Rural Total Household effects Radio 45.1 48.1 47.3 Television 84.2 39.1 50.7 Mobile telephone 93.5 85.1 87.3 Non-mobile telephone 6.0 0.7 2.1 Refrigerator 50.7 8.4 19.2 Table 20.4 6.7 10.2 Chair 17.6 5.5 8.6 Sofa 9.2 2.0 3.9 Bed 30.9 15.6 19.5 Cupboard 54.5 29.1 35.6 Stand fan 58.4 18.2 28.5 Generator 19.0 8.8 11.4 Sewing machine 62.3 58.8 59.7 Computer 28.4 5.3 11.3 Means of transport Bicycle 40.3 26.4 30.0 Animal-drawn cart 1.3 7.4 5.8 Rickshaw 2.6 4.1 3.7 Motorcycle/scooter 25.4 38.7 35.2 Car/truck/tractor 16.4 13.2 14.0 Ownership of agricultural land 18.9 64.4 52.7 Ownership of farm animals1 20.4 78.2 63.4 Number 6,269 18,126 24,395 1 Cattle, cows, bulls, horses, donkeys, goats, sheep, camels, ducks, or chickens Housing Characteristics and Household Population • 19 Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini coefficient, according to residence and province, Afghanistan 2015 Residence/province Wealth quintile Number of persons Gini coefficient Lowest Second Middle Fourth Highest Total Residence Urban 3.3 2.4 3.5 18.3 72.5 100.0 48,246 0.09 Rural 25.5 25.7 25.4 20.6 2.9 100.0 147,802 0.20 Province1 Kabul 0.3 1.7 6.3 24.3 67.4 100.0 25,119 0.15 Kapisa 7.2 40.4 28.6 21.3 2.4 100.0 1,413 0.11 Parwan 13.3 26.1 36.1 17.7 6.7 100.0 4,557 0.26 Wardak 36.3 16.8 26.0 20.7 0.2 100.0 2,597 0.22 Logar 2.8 29.0 33.1 31.6 3.6 100.0 3,360 0.24 Nangarhar 1.1 10.8 22.9 39.0 26.3 100.0 5,896 0.23 Laghman 2.5 26.8 38.4 29.0 3.3 100.0 4,138 0.24 Panjsher 37.2 35.2 18.0 9.2 0.4 100.0 429 0.32 Baghlan 44.8 23.3 12.2 7.1 12.6 100.0 5,630 0.22 Bamyan 68.7 15.4 8.6 6.3 1.1 100.0 2,370 0.15 Ghazni 10.9 30.3 24.6 31.5 2.7 100.0 7,265 0.24 Paktika 4.4 37.7 33.0 21.9 2.9 100.0 4,789 0.28 Paktya 3.7 26.5 42.2 23.8 3.9 100.0 3,566 0.19 Khost 4.2 17.8 24.4 41.9 11.7 100.0 5,478 0.19 Kunarha 9.4 27.4 34.7 22.8 5.7 100.0 4,560 0.16 Nooristan 6.5 42.6 30.6 20.1 0.2 100.0 1,257 0.27 Badakhshan 54.3 26.2 13.3 3.8 2.4 100.0 6,329 0.16 Takhar 33.3 28.8 17.8 12.3 7.8 100.0 7,664 0.22 Kunduz 25.1 31.5 17.2 14.9 11.3 100.0 8,583 0.24 Samangan 55.1 10.7 18.8 10.2 5.2 100.0 2,230 0.24 Balkh 29.3 18.6 11.6 16.0 24.5 100.0 12,078 0.33 Sar-E-Pul 46.2 21.9 21.6 7.9 2.4 100.0 4,291 0.16 Ghor 75.8 13.3 6.2 3.2 1.4 100.0 4,747 0.24 Daykundi 65.4 27.9 5.6 1.0 0.1 100.0 2,383 0.21 Urozgan 3.3 40.0 39.3 15.7 1.7 100.0 1,512 0.14 Kandahar 0.5 9.5 32.1 22.5 35.5 100.0 15,910 0.30 Jawzjan 20.1 26.5 14.6 24.1 14.7 100.0 4,738 0.24 Faryab 20.0 16.6 22.2 27.0 14.1 100.0 13,614 0.12 Helmand 4.1 33.7 28.9 18.0 15.3 100.0 6,171 0.25 Badghis 53.5 24.1 18.0 2.8 1.6 100.0 4,136 0.33 Herat 26.2 20.2 16.6 16.5 20.4 100.0 13,116 0.30 Farah 28.7 36.1 12.7 15.3 7.1 100.0 4,190 0.34 Nimroz 3.9 8.1 10.7 38.3 39.1 100.0 1,773 0.17 Total 20.0 20.0 20.0 20.0 20.0 100.0 196,048 0.14 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 20 • Housing Characteristics and Household Population Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, Afghanistan 2015 Background characteristic Percent- age of house- holds where place for washing hands was observed Number of house- holds Among households where place for hand washing was observed, percentage with: Number of house- holds with place for hand washing observed Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Missing Total Residence Urban 85.5 6,269 64.9 1.1 20.3 4.4 0.1 9.0 0.3 100.0 5,361 Rural 72.1 18,126 23.9 1.9 31.4 5.5 1.4 35.5 0.3 100.0 13,065 Province4 Kabul 86.5 3,369 72.9 1.4 16.7 5.0 0.1 3.6 0.3 100.0 2,913 Kapisa 97.0 179 58.1 1.0 23.6 6.7 0.1 10.5 0.0 100.0 173 Parwan 94.5 601 36.0 4.2 13.6 12.4 2.7 31.1 0.0 100.0 568 Wardak 82.1 351 27.9 3.2 38.1 9.7 0.5 20.4 0.1 100.0 289 Logar 72.4 398 60.1 7.4 5.3 4.3 0.9 21.6 0.4 100.0 288 Nangarhar 60.0 625 56.8 0.9 21.0 6.4 0.0 14.9 0.0 100.0 375 Laghman 77.3 446 26.2 0.6 8.8 3.6 0.8 59.9 0.0 100.0 345 Panjsher 96.7 54 65.5 0.4 2.0 27.5 0.0 3.9 0.7 100.0 52 Baghlan 75.5 776 13.6 1.0 30.5 1.6 0.6 51.9 0.7 100.0 586 Bamyan 98.8 300 17.2 0.6 21.4 7.2 0.8 52.1 0.5 100.0 296 Ghazni 41.0 864 25.9 3.3 40.3 0.8 2.6 26.9 0.3 100.0 354 Paktika 64.7 514 30.8 3.0 30.4 1.1 0.3 34.3 0.2 100.0 333 Paktya 83.4 353 59.9 4.1 14.1 4.8 2.7 14.2 0.2 100.0 294 Khost 49.9 457 35.8 9.8 54.3 0.0 0.0 0.1 0.0 100.0 228 Kunarha 70.2 507 23.1 8.1 16.4 2.4 5.6 44.3 0.1 100.0 356 Nooristan 52.2 127 15.8 1.4 25.0 22.2 5.7 29.9 0.0 100.0 66 Badakhshan 94.1 849 24.8 1.1 20.8 0.1 0.2 53.1 0.0 100.0 799 Takhar 78.1 1,027 16.1 0.4 53.2 0.3 0.2 29.4 0.6 100.0 803 Kunduz 97.6 1,070 12.6 1.6 12.4 18.2 4.2 50.5 0.5 100.0 1,044 Samangan 79.0 316 26.0 12.7 41.7 0.1 0.4 18.5 0.7 100.0 250 Balkh 98.2 1,510 40.6 1.8 23.2 5.8 2.1 26.5 0.0 100.0 1,482 Sar-E-Pul 88.6 644 23.0 1.3 60.0 1.4 0.1 14.2 0.0 100.0 571 Ghor 87.1 626 18.8 0.3 10.3 4.7 4.6 60.9 0.4 100.0 545 Daykundi 3.6 346 (10.7) (3.2) (62.9) (1.8) (0.0) (16.2) (5.2) 100.0 12 Urozgan 4.8 167 (62.0) (4.4) (25.4) (0.0) (0.0) (4.8) (3.4) 100.0 8 Kandahar 35.7 1,659 42.5 0.0 43.6 0.0 0.0 12.9 0.9 100.0 593 Jawzjan 89.4 563 28.6 2.4 7.8 37.7 2.3 21.1 0.1 100.0 503 Faryab 96.9 1,680 21.2 0.0 59.5 0.1 0.0 19.2 0.1 100.0 1,627 Helmand 29.6 718 48.2 0.5 19.0 0.0 0.0 29.5 2.7 100.0 213 Badghis 58.6 531 5.7 0.2 16.5 0.4 0.0 76.8 0.4 100.0 311 Herat 82.1 2,011 30.3 0.0 31.8 3.1 0.0 34.2 0.6 100.0 1,651 Farah 60.9 501 27.6 1.1 33.9 0.1 0.0 37.3 0.0 100.0 305 Nimroz 76.7 238 48.2 0.5 31.4 0.0 0.0 19.8 0.1 100.0 183 Wealth quintile Lowest 79.2 4,852 11.4 1.0 32.6 5.2 1.8 47.6 0.3 100.0 3,841 Second 70.8 4,838 17.1 2.0 32.8 5.6 1.3 40.9 0.4 100.0 3,424 Middle 67.5 4,871 25.8 2.9 31.4 4.8 1.5 33.0 0.5 100.0 3,286 Fourth 72.7 4,859 43.3 1.6 29.5 6.7 0.5 18.1 0.3 100.0 3,534 Highest 87.2 4,976 73.7 1.2 17.0 3.8 0.1 4.0 0.2 100.0 4,340 Total 75.5 24,395 35.8 1.7 28.2 5.2 1.0 27.8 0.3 100.0 18,426 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent 4 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Housing Characteristics and Household Population • 21 Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by 5-year age groups, according to sex and residence, Afghanistan 2015 Urban Rural Age Male Female Total Male Female Total Male Female Total <5 15.2 14.9 15.1 16.5 16.5 16.5 16.2 16.1 16.1 5-9 14.9 14.8 14.8 17.6 16.8 17.2 17.0 16.3 16.6 10-14 14.3 14.2 14.2 15.0 13.7 14.4 14.8 13.8 14.3 15-19 12.5 13.2 12.8 11.4 11.3 11.4 11.7 11.8 11.7 20-24 9.2 11.1 10.1 8.3 9.5 8.8 8.5 9.9 9.2 25-29 7.8 7.1 7.4 6.6 7.7 7.1 6.9 7.6 7.2 30-34 4.6 4.6 4.6 4.9 4.7 4.8 4.8 4.7 4.8 35-39 4.8 5.0 4.9 4.0 4.7 4.3 4.2 4.7 4.5 40-44 3.1 3.2 3.2 3.1 3.4 3.3 3.1 3.4 3.2 45-49 3.3 3.2 3.2 3.7 3.8 3.7 3.6 3.6 3.6 50-54 2.6 2.9 2.7 1.8 2.4 2.1 2.0 2.5 2.3 55-59 2.2 2.1 2.2 1.9 2.3 2.1 2.0 2.3 2.1 60-64 1.8 1.5 1.7 2.0 1.5 1.7 1.9 1.5 1.7 65-69 1.2 0.8 1.0 1.1 0.8 1.0 1.1 0.8 1.0 70-74 1.2 0.7 0.9 1.0 0.5 0.8 1.1 0.5 0.8 75-79 0.8 0.3 0.5 0.5 0.2 0.3 0.6 0.2 0.4 80+ 0.7 0.4 0.6 0.5 0.2 0.4 0.5 0.3 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 23,788 23,406 47,194 74,638 70,557 145,195 98,426 93,963 192,389 Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size, mean size of household, and percentage of households with orphans and foster children under age 18, according to residence, Afghanistan 2015 Residence Characteristic Urban Rural Total Household headship Male 97.2 98.7 98.3 Female 2.8 1.3 1.7 Total 100.0 100.0 100.0 Number of usual members 1 0.4 0.1 0.2 2 2.2 2.2 2.2 3 5.1 4.0 4.3 4 8.1 7.0 7.3 5 11.1 9.1 9.6 6 13.3 12.2 12.5 7 14.5 13.4 13.7 8 12.4 12.7 12.6 9+ 32.9 39.4 37.7 Total 100.0 100.0 100.0 Mean size of households 7.7 8.2 8.0 Percentage of households with orphans and foster children under age 18 Foster children1 3.5 4.3 4.1 Double orphans 1.2 1.3 1.2 Single orphans2 5.7 6.2 6.0 Foster and/or orphan children 8.3 9.6 9.3 Number of households 6,269 18,126 24,395 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent 22 • Housing Characteristics and Household Population Table 2.9 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Afghanistan 2015 Children whose births are registered Background characteristic Percentage who had a birth certificate Percentage who did not have a birth certificate Percentage registered Number of children Age <2 25.0 24.5 49.6 11,615 2-4 16.8 21.3 38.0 19,785 Sex Male 19.9 22.8 42.7 16,068 Female 19.8 22.1 41.9 15,332 Residence Urban 36.1 27.4 63.5 7,222 Rural 15.0 21.0 36.0 24,178 Province1 Kabul 45.5 25.1 70.6 3,755 Kapisa 30.2 37.3 67.4 212 Parwan 25.2 32.7 57.9 698 Wardak 42.4 6.2 48.6 355 Logar 15.7 11.5 27.2 424 Nangarhar 13.9 30.0 43.8 1,024 Laghman 3.0 2.0 5.0 782 Panjsher 40.2 18.7 58.9 41 Baghlan 13.7 2.7 16.4 752 Bamyan 14.5 47.6 62.1 344 Ghazni 18.7 6.3 25.0 785 Paktika 5.6 19.4 25.0 858 Paktya 0.8 69.8 70.6 613 Khost 11.0 25.6 36.6 1,008 Kunarha 14.7 19.9 34.6 809 Nooristan 0.0 0.1 0.1 299 Badakhshan 16.4 15.8 32.2 898 Takhar 6.2 21.2 27.4 1,227 Kunduz 16.9 8.9 25.8 1,201 Samangan 10.6 7.9 18.5 350 Balkh 19.7 21.0 40.6 1,951 Sar-E-Pul 33.4 18.7 52.1 614 Ghor 9.0 24.2 33.2 873 Daykundi 1.5 25.1 26.6 332 Urozgan 1.3 3.6 4.9 392 Kandahar 5.1 36.3 41.4 2,909 Jawzjan 31.6 5.5 37.1 604 Faryab 10.1 41.8 51.9 2,412 Helmand 16.0 1.3 17.3 949 Badghis 50.2 27.8 78.1 765 Herat 36.9 10.0 46.9 2,014 Farah 10.2 30.7 41.0 825 Nimroz 67.3 3.9 71.2 300 Wealth quintile Lowest 13.3 16.6 29.8 6,060 Second 12.7 18.3 30.9 6,385 Middle 13.7 21.3 34.9 6,708 Fourth 22.8 25.3 48.2 6,453 Highest 38.4 31.5 69.9 5,794 Total 19.8 22.5 42.3 31,400 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Housing Characteristics and Household Population • 23 Table 2.10 Children’s living arrangements and orphanhood Percent distribution of de jure children under 18 years of age by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Afghanistan 2015 Background characteristic Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percent- age not living with a biolo- gical parent Percent- age with one or both parents dead1 Number of children Father alive Father dead Mother alive Mother dead Both alive Only mother alive Only father alive Both dead Missing infor- mation on father/ mother Age 0-4 97.2 1.3 0.7 0.0 0.4 0.2 0.0 0.0 0.1 0.1 100.0 0.3 1.2 31,400 <2 97.9 1.2 0.5 0.0 0.0 0.1 0.0 0.0 0.1 0.0 100.0 0.2 0.6 11,615 2-4 96.8 1.4 0.8 0.1 0.6 0.2 0.0 0.0 0.1 0.1 100.0 0.3 1.6 19,785 5-9 95.8 1.3 1.6 0.0 0.7 0.2 0.2 0.0 0.1 0.1 100.0 0.5 2.6 32,226 10-14 92.8 1.1 3.2 0.1 1.3 0.3 0.4 0.0 0.6 0.1 100.0 1.3 5.5 27,801 15-17 86.4 0.9 5.3 0.1 2.0 2.3 0.2 0.2 1.7 0.9 100.0 4.4 9.5 13,748 Sex Male 94.7 1.2 2.2 0.1 0.8 0.3 0.2 0.0 0.4 0.1 100.0 0.9 3.7 54,602 Female 93.7 1.2 2.2 0.1 1.1 0.7 0.2 0.1 0.5 0.3 100.0 1.4 4.1 50,573 Residence Urban 94.6 1.0 2.3 0.1 0.8 0.5 0.1 0.1 0.4 0.1 100.0 1.1 3.7 24,787 Rural 94.1 1.3 2.2 0.1 1.0 0.5 0.2 0.0 0.5 0.2 100.0 1.2 3.9 80,389 Province2 Kabul 95.4 1.3 1.6 0.4 0.6 0.4 0.0 0.2 0.2 0.1 100.0 0.7 2.6 12,607 Kapisa 93.5 1.6 3.1 0.1 0.8 0.1 0.1 0.0 0.3 0.3 100.0 0.6 4.3 731 Parwan 91.2 0.8 4.3 0.1 2.6 0.3 0.1 0.1 0.3 0.3 100.0 0.7 7.3 2,362 Wardak 95.1 0.4 2.4 0.0 0.5 0.4 0.0 0.0 0.7 0.4 100.0 1.1 3.6 1,269 Logar 98.2 0.0 0.9 0.0 0.3 0.1 0.0 0.0 0.4 0.1 100.0 0.5 1.7 1,949 Nangarhar 94.0 1.3 3.4 0.0 0.4 0.4 0.1 0.1 0.2 0.2 100.0 0.7 4.1 3,228 Laghman 95.4 0.0 2.9 0.1 0.5 0.4 0.1 0.0 0.2 0.4 100.0 0.7 3.6 2,422 Panjsher 96.5 0.1 2.4 0.0 0.0 0.6 0.0 0.0 0.2 0.1 100.0 0.8 2.7 211 Baghlan 96.2 0.7 1.5 0.0 0.3 0.9 0.0 0.0 0.2 0.2 100.0 1.1 2.0 2,923 Bamyan 90.5 2.2 2.9 0.3 2.1 0.7 0.3 0.1 0.6 0.3 100.0 1.7 6.0 1,233 Ghazni 96.4 0.1 0.6 0.0 0.5 0.6 0.0 0.0 1.4 0.3 100.0 2.0 2.5 3,664 Paktika 93.9 1.2 1.8 0.1 2.4 0.1 0.0 0.0 0.3 0.2 100.0 0.4 4.5 2,541 Paktya 93.2 0.8 2.3 0.1 1.6 0.1 0.0 0.0 1.7 0.2 100.0 1.9 5.6 1,950 Khost 93.4 2.9 2.0 0.0 0.5 0.3 0.1 0.0 0.5 0.1 100.0 0.9 3.2 3,207 Kunarha 94.5 1.7 2.6 0.0 0.7 0.2 0.0 0.0 0.2 0.1 100.0 0.4 3.6 2,741 Nooristan 92.0 0.3 4.3 0.2 2.3 0.2 0.0 0.1 0.2 0.2 100.0 0.6 7.0 723 Badakhshan 93.0 1.3 3.1 0.0 1.2 0.5 0.4 0.1 0.1 0.1 100.0 1.1 5.0 3,354 Takhar 91.2 1.8 3.4 0.0 1.7 0.6 0.1 0.0 0.8 0.4 100.0 1.4 6.1 4,032 Kunduz 95.3 1.0 1.6 0.0 0.8 0.1 0.0 0.0 0.9 0.2 100.0 1.0 3.4 4,569 Samangan 93.6 0.8 2.8 0.0 0.6 0.7 0.2 0.1 1.1 0.1 100.0 2.1 4.8 1,172 Balkh 94.9 0.3 2.0 0.0 1.3 0.8 0.4 0.0 0.2 0.1 100.0 1.3 3.9 6,135 Sar-E-Pul 92.8 1.0 3.4 0.0 0.6 0.6 0.1 0.1 1.1 0.2 100.0 1.9 5.3 2,194 Ghor 94.5 0.7 1.0 0.0 2.5 0.8 0.1 0.0 0.4 0.1 100.0 1.3 3.9 2,734 Daykundi 86.7 7.0 2.8 0.0 0.8 1.7 0.2 0.4 0.1 0.2 100.0 2.3 4.3 1,293 Urozgan 98.4 0.0 1.0 0.0 0.4 0.0 0.0 0.0 0.1 0.2 100.0 0.1 1.4 947 Kandahar 96.7 0.4 1.3 0.0 1.0 0.1 0.0 0.0 0.4 0.1 100.0 0.6 2.7 9,101 Jawzjan 97.5 0.5 1.2 0.0 0.2 0.3 0.0 0.0 0.3 0.1 100.0 0.6 1.7 2,508 Faryab 87.6 4.9 3.7 0.0 1.1 0.8 1.6 0.0 0.3 0.1 100.0 2.7 6.6 6,967 Helmand 97.8 0.0 0.3 0.0 0.6 0.3 0.0 0.1 0.5 0.4 100.0 0.9 1.6 3,621 Badghis 94.0 0.1 2.5 0.0 1.3 1.2 0.1 0.0 0.4 0.4 100.0 1.8 4.3 2,321 Herat 93.9 1.0 3.3 0.0 0.8 0.3 0.1 0.0 0.4 0.2 100.0 0.9 4.6 6,947 Farah 93.3 0.1 4.0 0.0 0.3 1.2 0.0 0.0 0.7 0.4 100.0 1.9 4.9 2,405 Nimroz 92.5 0.4 3.4 0.0 0.7 1.6 0.0 0.3 0.9 0.2 100.0 2.8 5.4 1,019 Wealth quintile Lowest 94.2 0.8 2.1 0.1 1.3 0.5 0.1 0.1 0.4 0.2 100.0 1.1 4.1 21,194 Second 94.8 0.7 2.2 0.0 0.9 0.6 0.0 0.0 0.5 0.2 100.0 1.1 3.6 21,387 Middle 93.1 1.9 2.5 0.1 0.9 0.5 0.2 0.0 0.6 0.3 100.0 1.3 4.3 21,585 Fourth 93.9 1.6 2.3 0.0 0.8 0.4 0.5 0.0 0.4 0.2 100.0 1.3 4.0 21,374 Highest 95.0 0.9 2.1 0.2 0.8 0.5 0.1 0.1 0.3 0.1 100.0 1.0 3.4 19,634 Total <15 95.4 1.3 1.8 0.1 0.8 0.2 0.2 0.0 0.3 0.1 100.0 0.7 3.0 91,427 Total <18 94.2 1.2 2.2 0.1 0.9 0.5 0.2 0.0 0.4 0.2 100.0 1.2 3.9 105,175 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead and one parent dead but missing information on survival status of the other parent. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 24 • Housing Characteristics and Household Population Table 2.11 School attendance by survivorship of parents For de jure children age 10-14, the percentage attending school by parental survival and the ratio of the percentage attending, by parental survival, according to background characteristics, Afghanistan 2015 Percentage attending school by survivorship of parents Background characteristic Both parents deceased Number Both parents alive and living with at least one parent Number Ratio1 Sex Male 72.0 82 79.7 13,907 0.90 Female 36.2 74 52.9 12,247 0.68 Residence Urban (65.7) 28 84.2 6,400 0.78 Rural 52.6 127 61.6 19,754 0.85 Wealth quintile Lowest (69.4) 40 61.5 5,444 1.13 Second (39.0) 26 57.1 5,334 0.68 Middle 49.1 47 57.3 5,108 0.86 Fourth (51.2) 25 74.0 5,288 0.69 Highest * 18 87.0 4,980 0.76 Total 54.9 156 67.2 26,154 0.82 Note: Table is based only on children who usually live in the household. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Provincial-level disaggregation is not shown due to the small number of cases. 1 Ratio of the percentage with both parents deceased to the percentage with both parents alive and living with a parent Housing Characteristics and Household Population • 25 Table 2.12.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Afghanistan 2015 Background characteristic No edu- cation Some primary Com- pleted primary1 Some secon- dary Com- pleted secon- dary2 More than secon- dary Don’t know/ missing Total Number Median years com- pleted Age 6-9 69.8 29.1 0.0 0.0 0.0 0.0 1.1 100.0 12,649 0.0 10-14 40.8 45.1 6.5 7.2 0.0 0.0 0.4 100.0 13,004 1.6 15-19 48.7 12.1 5.9 26.3 5.5 1.1 0.4 100.0 11,094 1.6 20-24 64.9 7.3 3.1 9.7 8.8 5.8 0.4 100.0 9,272 0.0 25-29 80.5 6.3 2.1 3.9 3.6 3.3 0.3 100.0 7,095 0.0 30-34 88.0 4.5 1.5 2.9 1.4 1.5 0.2 100.0 4,416 0.0 35-39 89.4 3.8 0.9 2.6 1.4 1.5 0.4 100.0 4,462 0.0 40-44 89.0 4.6 1.2 1.8 0.9 2.1 0.4 100.0 3,159 0.0 45-49 91.2 3.7 0.8 1.3 1.7 1.0 0.3 100.0 3,412 0.0 50-54 94.1 2.0 0.9 0.9 0.6 0.9 0.6 100.0 2,394 0.0 55-59 94.2 2.2 0.7 0.9 0.5 0.4 1.1 100.0 2,116 0.0 60-64 94.5 2.8 0.2 0.3 0.5 0.4 1.3 100.0 1,404 0.0 65+ 96.9 0.8 0.6 0.9 0.0 0.2 0.6 100.0 1,713 0.0 Residence Urban 50.1 22.8 4.1 12.9 5.6 4.2 0.4 100.0 19,392 0.0 Rural 74.9 14.7 2.4 5.2 1.5 0.6 0.6 100.0 56,798 0.0 Province3 Kabul 49.1 23.2 4.1 13.1 6.2 4.0 0.4 100.0 10,061 0.2 Kapisa 55.0 22.5 4.6 11.0 3.5 2.9 0.6 100.0 577 0.0 Parwan 67.9 18.1 2.5 6.2 3.1 1.3 1.0 100.0 1,865 0.0 Wardak 84.4 11.2 1.4 2.1 0.2 0.0 0.7 100.0 1,017 0.0 Logar 66.6 17.1 2.9 9.5 2.8 0.6 0.4 100.0 1,308 0.0 Nangarhar 68.5 16.6 3.4 7.4 2.3 1.2 0.5 100.0 2,248 0.0 Laghman 72.7 18.8 1.6 4.7 1.2 0.4 0.5 100.0 1,503 0.0 Panjsher 51.4 21.1 5.4 16.2 4.0 1.0 1.0 100.0 182 0.0 Baghlan 70.6 14.6 4.5 5.4 2.4 1.3 1.3 100.0 2,246 0.0 Bamyan 60.2 21.6 5.2 9.7 2.0 0.8 0.5 100.0 936 0.0 Ghazni 68.1 16.9 2.8 8.5 1.8 0.5 1.4 100.0 3,091 0.0 Paktika 94.8 3.5 0.4 0.5 0.2 0.0 0.4 100.0 1,746 0.0 Paktya 84.4 11.3 0.9 1.9 0.6 0.1 0.7 100.0 1,235 0.0 Khost 88.6 6.7 1.6 1.5 0.7 0.1 0.8 100.0 1,972 0.0 Kunarha 66.5 21.9 4.4 4.6 0.9 0.3 1.4 100.0 1,681 0.0 Nooristan 91.7 5.5 0.8 1.3 0.2 0.0 0.5 100.0 445 0.0 Badakhshan 58.2 23.3 4.4 10.5 2.2 1.1 0.3 100.0 2,529 0.0 Takhar 68.1 17.1 3.3 7.6 1.9 1.8 0.3 100.0 3,025 0.0 Kunduz 80.3 9.8 1.1 5.1 1.7 1.0 1.1 100.0 3,346 0.0 Samangan 71.0 17.5 2.5 6.6 0.8 1.2 0.4 100.0 876 0.0 Balkh 59.3 20.7 3.7 10.0 4.5 1.7 0.2 100.0 4,761 0.0 Sar-E-Pul 70.5 16.7 4.8 5.5 1.2 0.7 0.6 100.0 1,748 0.0 Ghor 66.2 20.8 4.5 6.6 1.4 0.3 0.2 100.0 1,779 0.0 Daykundi 60.7 19.3 3.5 13.4 1.9 0.9 0.3 100.0 1,020 0.0 Urozgan 95.6 1.9 0.5 0.7 0.3 0.0 1.1 100.0 525 0.0 Kandahar 87.7 8.7 1.0 1.6 0.5 0.1 0.4 100.0 5,900 0.0 Jawzjan 62.8 17.2 2.7 9.1 4.5 2.7 0.9 100.0 1,839 0.0 Faryab 58.2 20.3 3.0 10.1 4.5 3.8 0.0 100.0 5,318 0.0 Helmand 84.1 9.8 1.5 2.9 0.8 0.4 0.6 100.0 2,259 0.0 Badghis 73.7 21.8 1.4 2.6 0.3 0.0 0.3 100.0 1,553 0.0 Herat 69.7 16.6 2.4 6.8 1.8 2.1 0.6 100.0 5,341 0.0 Farah 80.2 13.2 1.9 3.4 1.0 0.3 0.0 100.0 1,532 0.0 Nimroz 64.0 24.3 3.1 6.1 1.2 1.0 0.3 100.0 667 0.0 Wealth quintile Lowest 75.1 16.3 2.8 4.4 0.8 0.2 0.6 100.0 15,333 0.0 Second 77.8 13.5 2.0 4.8 1.0 0.3 0.6 100.0 15,297 0.0 Middle 78.6 13.0 2.0 4.3 1.2 0.4 0.5 100.0 14,779 0.0 Fourth 65.9 18.5 3.2 8.0 2.8 0.8 0.7 100.0 15,050 0.0 Highest 46.6 22.3 4.2 14.0 6.8 5.8 0.4 100.0 15,731 0.8 Total 68.6 16.8 2.8 7.1 2.5 1.5 0.5 100.0 76,190 0.0 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 26 • Housing Characteristics and Household Population Table 2.12.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Afghanistan 2015 Background characteristic No edu- cation Some primary Com- pleted primary1 Some secon- dary Com- pleted secon- dary2 More than secon- dary Don’t know/ missing Total Number Median years com- pleted Age 6-9 62.8 35.9 0.2 0.1 0.0 0.0 1.0 100.0 13,808 0.0 10-14 16.4 64.0 10.0 9.2 0.0 0.0 0.3 100.0 14,598 3.0 15-19 18.5 13.4 9.4 51.6 5.9 1.1 0.2 100.0 11,487 6.8 20-24 30.2 9.4 5.1 25.6 20.4 8.9 0.3 100.0 8,354 7.3 25-29 43.6 10.7 5.3 15.0 14.7 10.4 0.2 100.0 6,797 3.4 30-34 52.0 12.2 5.4 13.4 10.6 6.3 0.2 100.0 4,768 0.0 35-39 54.4 10.6 5.5 12.8 10.5 6.0 0.2 100.0 4,153 0.0 40-44 60.7 11.2 5.2 10.1 8.4 4.4 0.0 100.0 3,065 0.0 45-49 59.8 13.6 4.0 10.0 7.3 4.9 0.5 100.0 3,532 0.0 50-54 63.7 6.4 4.9 11.3 8.1 5.3 0.3 100.0 1,975 0.0 55-59 67.4 6.9 5.1 7.0 7.1 6.2 0.2 100.0 1,940 0.0 60-64 71.0 7.7 4.1 5.0 5.5 6.3 0.5 100.0 1,885 0.0 65+ 81.4 4.0 5.0 2.2 4.4 2.4 0.6 100.0 3,225 0.0 Residence Urban 28.7 24.9 6.2 20.8 11.5 7.6 0.3 100.0 19,490 4.3 Rural 47.1 24.7 5.6 14.6 5.2 2.3 0.4 100.0 60,099 0.6 Province3 Kabul 26.7 25.1 6.0 21.5 12.6 7.7 0.4 100.0 10,411 4.6 Kapisa 25.0 26.9 6.7 19.8 11.0 10.4 0.2 100.0 552 4.7 Parwan 31.3 26.4 4.9 21.1 10.1 5.5 0.7 100.0 1,786 3.2 Wardak 45.0 19.9 6.1 16.5 7.0 5.1 0.4 100.0 1,103 1.2 Logar 33.3 25.5 5.5 23.2 9.6 2.5 0.4 100.0 1,538 3.0 Nangarhar 35.2 24.9 5.5 19.1 8.7 6.2 0.4 100.0 2,335 2.8 Laghman 41.3 28.9 6.3 14.4 6.3 2.5 0.3 100.0 1,602 1.4 Panjsher 24.5 23.2 6.3 27.5 12.8 5.0 0.7 100.0 190 5.3 Baghlan 36.3 23.4 7.3 18.8 9.8 3.5 1.0 100.0 2,408 3.0 Bamyan 40.3 24.3 7.2 17.4 6.2 4.0 0.6 100.0 904 2.1 Ghazni 44.8 22.9 6.0 17.8 5.2 2.5 0.9 100.0 3,224 1.1 Paktika 44.8 24.1 5.7 13.4 9.9 1.7 0.3 100.0 2,031 0.8 Paktya 39.1 26.7 5.8 20.2 4.7 3.2 0.4 100.0 1,542 2.1 Khost 42.7 24.9 5.8 15.5 7.1 3.4 0.6 100.0 2,264 1.2 Kunarha 26.2 30.7 6.4 22.2 7.8 5.4 1.1 100.0 1,718 3.7 Nooristan 64.8 13.3 3.3 12.0 5.4 0.8 0.3 100.0 444 0.0 Badakhshan 41.7 27.9 6.7 15.8 4.4 3.2 0.3 100.0 2,624 1.9 Takhar 47.4 25.3 5.3 14.9 3.3 3.4 0.3 100.0 2,774 0.7 Kunduz 53.0 19.2 4.4 16.6 4.7 1.5 0.6 100.0 3,792 0.0 Samangan 49.9 22.8 6.5 13.2 4.7 2.8 0.1 100.0 907 0.0 Balkh 40.4 26.9 6.0 16.7 6.9 3.0 0.0 100.0 4,634 2.0 Sar-E-Pul 47.4 31.2 8.7 9.1 1.9 1.4 0.3 100.0 1,746 0.5 Ghor 42.1 24.9 5.5 16.7 6.4 4.0 0.3 100.0 1,992 1.5 Daykundi 47.9 26.2 5.2 15.4 3.0 2.1 0.3 100.0 881 0.4 Urozgan 79.0 9.9 2.0 4.9 2.3 0.4 1.4 100.0 515 0.0 Kandahar 63.9 17.5 3.2 10.2 3.9 1.0 0.3 100.0 6,398 0.0 Jawzjan 34.9 24.3 6.4 18.4 11.2 4.6 0.2 100.0 2,054 2.8 Faryab 37.5 27.9 7.8 16.7 6.7 3.3 0.1 100.0 5,043 2.3 Helmand 42.1 28.3 6.7 14.9 5.4 1.8 0.8 100.0 2,720 1.5 Badghis 55.5 29.9 3.9 7.6 2.3 0.6 0.2 100.0 1,627 0.0 Herat 51.5 25.1 5.2 11.0 3.1 3.9 0.4 100.0 5,446 0.0 Farah 51.9 24.5 5.7 11.0 5.2 1.5 0.2 100.0 1,620 0.0 Nimroz 49.1 31.9 4.2 9.9 3.3 1.2 0.4 100.0 699 0.1 Wealth quintile Lowest 51.6 24.8 5.8 12.7 3.2 1.4 0.5 100.0 16,141 0.0 Second 49.8 24.3 5.7 14.2 4.1 1.5 0.4 100.0 15,847 0.0 Middle 49.0 24.6 5.3 13.9 4.9 2.0 0.4 100.0 15,736 0.2 Fourth 38.3 26.5 5.8 17.5 7.8 3.7 0.5 100.0 15,875 2.3 Highest 24.5 23.7 6.1 22.2 13.9 9.4 0.3 100.0 15,990 5.3 Total 42.6 24.8 5.7 16.1 6.8 3.6 0.4 100.0 79,589 1.6 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Housing Characteristics and Household Population • 27 Table 2.13 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling, and the gender parity index (GPI), according to background characteristics, Afghanistan 2015 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender parity index3 Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 77.6 70.9 74.2 0.91 101.6 88.9 95.2 0.88 Rural 67.2 43.5 56.2 0.65 87.3 56.8 73.1 0.65 Province4 Kabul 79.7 74.5 77.1 0.94 107.9 93.6 100.6 0.87 Kapisa 83.3 69.5 76.8 0.83 104.9 90.5 98.1 0.86 Parwan 79.6 55.1 67.0 0.69 103.4 70.8 86.6 0.69 Wardak 75.5 31.0 54.2 0.41 94.8 42.4 69.7 0.45 Logar 72.2 53.0 63.9 0.73 95.2 67.2 83.0 0.71 Nangarhar 72.1 46.4 60.1 0.64 97.0 62.4 80.9 0.64 Laghman 72.0 40.3 57.2 0.56 95.1 55.8 76.8 0.59 Panjsher 79.8 72.4 76.1 0.91 105.7 98.6 102.2 0.93 Baghlan 70.2 41.9 57.4 0.60 95.6 63.1 80.9 0.66 Bamyan 76.2 64.5 70.4 0.85 94.6 83.6 89.1 0.88 Ghazni 72.0 54.9 63.4 0.76 89.8 67.4 78.5 0.75 Paktika 92.3 19.7 63.5 0.21 127.8 30.5 89.1 0.24 Paktya 85.1 39.5 65.6 0.46 119.3 56.3 92.4 0.47 Khost 80.8 23.8 55.7 0.29 112.9 35.3 78.7 0.31 Kunarha 78.1 42.1 60.3 0.54 103.7 55.1 79.7 0.53 Nooristan 37.4 20.2 29.7 0.54 44.2 27.1 36.5 0.61 Badakhshan 72.0 64.7 68.4 0.90 91.9 76.8 84.4 0.84 Takhar 67.0 51.9 59.7 0.77 83.2 69.3 76.5 0.83 Kunduz 48.7 28.3 39.1 0.58 61.7 36.7 50.0 0.59 Samangan 71.2 56.9 64.2 0.80 100.0 77.0 88.8 0.77 Balkh 76.2 67.9 71.9 0.89 98.2 84.3 91.1 0.86 Sar-E-Pul 71.4 50.6 62.4 0.71 88.1 64.4 77.8 0.73 Ghor 81.3 69.5 75.9 0.86 96.4 87.2 92.2 0.90 Daykundi 70.7 64.1 67.6 0.91 86.3 82.8 84.6 0.96 Urozgan 28.3 6.5 17.2 0.23 35.4 8.2 21.6 0.23 Kandahar 40.8 25.5 33.8 0.62 55.7 32.5 45.0 0.58 Jawzjan 68.4 48.4 59.5 0.71 83.3 56.5 71.3 0.68 Faryab 76.6 69.7 73.4 0.91 90.7 88.4 89.6 0.97 Helmand 66.4 23.0 47.2 0.35 86.3 32.9 62.7 0.38 Badghis 83.6 67.0 75.4 0.80 121.4 91.8 106.8 0.76 Herat 64.3 44.8 54.8 0.70 83.1 57.8 70.8 0.70 Farah 50.1 38.4 44.8 0.77 61.7 48.0 55.5 0.78 Nimroz 66.2 54.1 60.8 0.82 86.2 65.2 76.8 0.76 Wealth quintile Lowest 66.5 47.0 57.1 0.71 86.6 61.1 74.3 0.71 Second 63.6 38.9 51.9 0.61 83.6 49.3 67.3 0.59 Middle 66.1 37.8 53.4 0.57 86.4 51.2 70.6 0.59 Fourth 73.5 56.1 65.4 0.76 94.4 72.0 84.0 0.76 Highest 79.3 72.9 76.0 0.92 103.1 91.5 97.3 0.89 Total 69.4 50.4 60.4 0.73 90.4 64.8 78.3 0.72 SECONDARY SCHOOL Residence Urban 59.2 41.6 50.4 0.70 78.2 51.8 65.0 0.66 Rural 46.5 18.8 33.2 0.41 60.2 23.9 42.7 0.40 Province4 Kabul 58.2 39.6 49.0 0.68 77.9 50.0 64.1 0.64 Kapisa 64.5 33.8 48.2 0.52 80.7 42.2 60.3 0.52 Parwan 55.7 19.8 36.7 0.36 67.6 22.9 43.9 0.34 Wardak 51.9 4.4 29.8 0.09 66.9 6.1 38.6 0.09 Logar 63.2 29.2 48.5 0.46 81.8 35.8 61.9 0.44 Nangarhar 57.1 21.4 39.2 0.37 79.3 30.1 54.7 0.38 Laghman 47.2 9.4 29.7 0.20 60.9 13.9 39.2 0.23 Panjsher 76.3 50.6 64.2 0.66 109.3 69.7 90.7 0.64 Baghlan 50.4 17.0 34.0 0.34 68.3 20.9 45.0 0.31 Bamyan 57.3 33.2 44.0 0.58 76.3 41.9 57.3 0.55 Ghazni 62.4 39.2 50.5 0.63 82.9 49.3 65.6 0.59 Paktika 61.5 2.4 35.1 0.04 71.2 3.8 41.1 0.05 Paktya 60.0 9.1 41.7 0.15 74.8 10.8 51.7 0.14 Khost 58.7 9.5 37.1 0.16 73.5 13.0 46.9 0.18 Kunarha 59.4 17.6 41.8 0.30 71.8 21.6 50.7 0.30 Nooristan 39.3 5.1 23.1 0.13 46.8 6.2 27.5 0.13 (Continued…) 28 • Housing Characteristics and Household Population Table 2.13—Continued Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender parity index3 Male Female Total Gender parity index3 Badakhshan 45.9 36.4 41.5 0.79 61.1 43.8 53.1 0.72 Takhar 42.6 22.8 32.4 0.54 53.2 29.1 40.8 0.55 Kunduz 38.5 18.7 29.3 0.49 55.3 23.0 40.3 0.42 Samangan 42.5 22.7 33.5 0.53 54.3 27.8 42.3 0.51 Balkh 49.4 33.5 41.5 0.68 58.5 41.5 50.0 0.71 Sar-E-Pul 25.0 19.4 22.2 0.77 33.6 23.1 28.3 0.69 Ghor 66.5 31.7 50.4 0.48 90.6 38.7 66.6 0.43 Daykundi 59.4 45.2 51.2 0.76 77.7 56.6 65.5 0.73 Urozgan 15.5 3.2 9.2 0.21 20.7 3.7 11.9 0.18 Kandahar 34.3 5.1 19.8 0.15 45.2 7.3 26.4 0.16 Jawzjan 64.4 34.7 51.6 0.54 81.5 42.9 64.8 0.53 Faryab 55.3 38.0 46.5 0.69 75.7 47.3 61.2 0.62 Helmand 48.9 13.9 33.6 0.28 63.9 19.5 44.6 0.30 Badghis 20.2 10.5 15.4 0.52 30.2 13.9 22.1 0.46 Herat 34.0 23.4 28.7 0.69 41.6 28.5 35.1 0.68 Farah 40.9 12.3 25.6 0.30 52.8 16.2 33.2 0.31 Nimroz 30.7 16.4 23.0 0.53 38.8 20.6 29.0 0.53 Wealth quintile Lowest 38.4 15.9 27.6 0.41 50.9 20.3 36.2 0.40 Second 46.4 16.9 31.9 0.36 59.1 21.6 40.7 0.36 Middle 43.9 17.3 31.0 0.40 57.0 20.4 39.3 0.36 Fourth 55.4 28.9 42.7 0.52 70.4 36.0 53.8 0.51 Highest 64.1 44.0 54.1 0.69 85.4 56.3 71.0 0.66 Total 49.8 25.1 37.8 0.50 64.8 31.5 48.6 0.49 1 The NAR for primary school is the percentage of the primary school age (7-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school age (13-18 years) population that is attending secondary school. By definition, the NAR cannot exceed 100%. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary school age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary school age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100%. 3 The gender parity index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The gender parity index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. 4 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Table 2.14 Reasons for children never attending school Percent distribution of de facto household members age 5-24 who never attended school by the main reason for not attending school, according to sex and residence, Afghanistan 2015 Reasons for never attending Residence Total Urban Rural Male Female Male Female Male Female Too expensive 1.3 0.9 0.3 0.3 0.5 0.4 School too far 8.1 6.3 18.6 12.0 17.0 11.1 Insecure 1.8 4.1 7.2 8.4 6.4 7.7 Need to help at home 3.7 2.1 5.5 2.5 5.3 2.4 Parents did not send 22.4 54.2 18.1 47.3 18.7 48.4 Got married 0.1 1.1 0.1 0.9 0.1 1.0 School lacked basic facilities 1.1 0.5 2.0 2.0 1.9 1.8 Need to work, earn 10.6 1.1 11.2 0.5 11.1 0.5 Other 50.8 29.8 36.9 26.2 38.9 26.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,403 4,046 13,789 22,600 16,192 26,650 Housing Characteristics and Household Population • 29 Table 2.15 Reasons for children dropping out of school Percent distribution of de facto household members age 5-24 who dropped out of school by the main reason for not attending school, according to sex and residence, Afghanistan 2015 Reasons for dropping out Residence Total Urban Rural Male Female Male Female Male Female Too expensive 1.5 2.8 0.6 0.2 0.8 1.1 School too far 1.0 2.3 2.6 6.2 2.1 4.7 Insecure 0.9 4.0 10.0 9.1 7.7 7.2 Need to help at home 18.2 7.1 13.9 4.5 15.0 5.5 Parents did not send 3.1 25.0 2.1 32.3 2.4 29.7 Got married 0.8 21.2 3.6 18.0 2.9 19.2 School lacked basic facilities 0.7 2.3 1.5 1.6 1.3 1.8 Need to work, earn 47.6 5.1 42.7 2.0 43.9 3.1 Other 26.3 30.3 23.2 26.1 24.0 27.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,789 2,137 5,195 3,713 6,984 5,850 Characteristics of Respondents • 31 CHARACTERISTICS OF RESPONDENTS 3 Key Findings  Education: Nine percent of ever-married women and 31% of ever-married men age 15-49 in Afghanistan have completed at least some secondary education. However, only 5% of women and 17% of men have completed secondary school or beyond. Eighty-four percent of women and half of men have never attended school.  Literacy: Only 15% of women and 49% of men are literate.  Exposure to mass media: Nearly half of women (47%) and one-third of men (34%) have no regular exposure to any mass media.  Employment: Twelve percent of women and 91% of men are currently employed.  Tobacco use: Half of men use tobacco products, as compared with only 6% of women. his chapter presents information on the demographic and socioeconomic characteristics of the survey respondents such as age, education, place of residence, marital status, employment, and wealth status. This information is useful for understanding the factors that affect use of reproductive health services, contraceptive use, and other health behaviors. 3.1 BASIC CHARACTERISTICS OF SURVEY RESPONDENTS A total of 29,461 ever-married women and 10,760 ever-married men age 15-49 were interviewed in the 2015 AfDHS. Forty-eight percent of ever-married women and 35% percent of ever-married men are under age 30. Among those who have ever been married, 6% of women and only 1% of men are age 15-19, a reflection of the somewhat older age at marriage among men than women (Table 3.1). Three percent of women and only 1% of men are widowed or divorced. The geographical distributions of women and men are similar. More than three quarters of ever-married women and men (77% each) are living in rural areas, and about one quarter (23%) are living in urban areas. 3.2 EDUCATION AND LITERACY Literacy Respondents who had attended secondary school or higher were assumed to be literate. All other respondents were given a sentence to read, and they were considered to be literate if they could read all or part of the sentence. Sample: Ever-married women and men age 15-49 In Afghanistan, educational levels and literacy rates are both low. The proportion of ever-married women with no education is higher than the proportion among men (84% versus 51%) (Figure 3.1). Nine percent T 32 • Characteristics of Respondents of women and 31% of men have completed at least some secondary education. However, only 5% of women and 17% of men have completed secondary school or beyond (Table 3.2.1 and Table 3.2.2). Overall, 15% of women and 49% of men are literate (Table 3.3.1 and Table 3.3.2). Patterns by background characteristics  Younger respondents have more education than older ones. Ever-married women age 15- 19 are five times more likely than women age 45-49 to have completed at least some secondary education (17% versus 3%), and the pattern is similar for men (49% versus 24%) (Table 3.2.1 and Table 3.2.2).  Kabul (6%), Faryab (4%), and Jawzjan (4%) have the highest proportions of women with more than a secondary school education (Figure 3.2). The pattern is different among men; 15% of men in Kunarha, 14% in Nangarhar, and 13% each in Panjsher, Kapisa, and Jawzjan have more than a secondary education (Table 3.2.1 and Table 3.2.2).  Women in urban areas are more than three times as likely to be literate as those in rural areas (32% versus 10%). Similarly, urban men are more likely to be literate than rural men (65% versus 45%) (Table 3.3.1 and Table 3.3.2).  Women in the highest wealth quintile are six times more likely than those in the lowest quintile to have at least some secondary education (24% versus 4%); the gap is smaller among men (53% versus 21%). The literacy rate also increases with wealth, rising from 7-8% among women in the lowest three quintiles to 38% among those in the highest quintile and from 37% among men in the lowest quintile to 71% among those in the highest quintile (Table 3.2.1 and Table 3.2.2). Figure 3.1 Education of survey respondents 84 51 6 13 2 6 4 14 3 11 2 7 Women Men Percent distribution of ever-married women and men age 15-49 by highest level of schooling attended or completed More than secondary Completed secondary Some secondary Primary complete Primary incomplete No education Characteristics of Respondents • 33 Figure 3.2 Women with more than a secondary education Percentage of women age 15-49 with more than secondary education or higher 3.3 MASS MEDIA EXPOSURE Exposure to mass media Respondents were asked how often they read a newspaper, listened to the radio, or watched television. Those who responded at least once a week are considered to be regularly exposed to that form of media. Sample: Ever-married women and men age 15-49 Mass media are important means of conveying messages on family planning, HIV/AIDS awareness, and other health topics. In Afghanistan, ever-married men are more likely than women to be regularly exposed to all three major forms of mass media (newspapers, television, and radio) (Figure 3.3). About half of women (47%) and one-third of men (34%) are not regularly exposed to any of these media. Figure 3.3 Exposure to mass media 3 39 24 1 47 13 46 44 7 34 Reads newspaper Watches television Listens to radio All three media None of these media Percentage of ever-married women and men age 15-49 who are exposed to media on a weekly basis Women Men 34 • Characteristics of Respondents Patterns by background characteristics  Rural women are almost three times more likely than urban women to have no regular exposure to any form of mass media (55% versus 21%) (Table 3.4.1). The same pattern holds true for men (41% versus 11%) (Table 3.4.2).  Highly educated women and men are much more likely to have regular exposure to mass media. Only 6% of women and 7% of men with more than a secondary education lack regular exposure to any media, as compared with 52% of women and 46% of men with no education (Table 3.4.1 and Table 3.4.2). 3.4 EMPLOYMENT Currently employed Respondents who were employed in the 7 days before the survey. Sample: Ever-married women and men age 15-49 Men are more likely than women to be employed. Ninety-one percent of ever-married men are currently employed, compared with 12% of ever-married women (Tables 3.5.1 and 3.5.2). An additional 5% of men and 2% of women reported working in the past 12 months even though they were not currently employed. Patterns by background characteristics  Women are more likely to work if they are divorced, separated, or widowed than if they are married (21% versus 11%). There is no relation between men’s marital status and employment (Table 3.5.1 and Table 3.5.2).  Women with more than a secondary education are almost four times as likely as women with no education to be currently employed (41% versus 11%). Among men, employment is not related to education (Figure 3.4).  There are large provincial differences in employment levels, especially for women. However, there is no difference in current employment levels by urban-rural residence among either women or men (Table 3.5.1 and Table 3.5.2). 3.5 OCCUPATION Occupation Categorized as professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual, domestic service, agriculture, and other. Sample: Ever-married women and men age 15-49 who were currently employed or had worked in the 12 months before the survey Women are most often employed in professional, technical, or managerial positions (50%), followed by skilled manual jobs (25%) (Table 3.6.1). Men are most commonly employed in agriculture (31%) and skilled manual labor (20%) (Table 3.6.2, Figure 3.5). Figure 3.4. Employment by education 11 14 15 41 12 91 93 92 91 91 No education Primary Secondary More than secondary Total Percentage of ever-married women and men age 15-49 who are currently employed Women Men Characteristics of Respondents • 35 Patterns by background characteristics  Agriculture is the leading occupation in rural areas for men (39%); among rural women, however, the leading type of occupation is professional/technical/managerial (41%). In urban areas, the most common occupations are professional/technical/managerial among women (77%) and sales and services and skilled manual labor among men (29% and 25%, respectively) (Table 3.6.1 and Table 3.6.2).  Most women and men with more than a secondary education are employed in professional, technical, and managerial occupations (91% and 62%, respectively). Men with no education or only a primary education most often work in agriculture (Table 3.6.1 and Table 3.6.2).  Employed men in the lowest wealth quintile are concentrated in agricultural occupations (55%). In the highest wealth quintile, the most common occupations are professional/technical/managerial among women (84%) and sales and services among men (31%) (Table 3.6.1 and Table 3.6.2).  Most of the women who had worked in the past year were employed entirely for cash (61%); however, 27% worked without pay. Cash earnings were more common for work in the non- agricultural sector than for jobs in agriculture (Table 3.7). Women employed in the agricultural sector were more likely to work for a family member (93%) than those employed in the non- agricultural sector (42%). 3.6 TOBACCO AND DRUG USE The vast majority of women (94%) and more than half of men age 15-49 (52%) reported that they do not use any tobacco product (Table 3.8.1 and Table 3.8.2). Among men, 22% smoke cigarettes (Figure 3.6). Fifty-eight percent of these men reported smoking 10 or more cigarettes in the 24 hours prior to the interview. Patterns by background characteristics  Among men, cigarette smoking generally rises with age, from a low of 14% among men age 15-19 to 28% among men age 35-39 (Table 3.8.2).  There is little difference in cigarette smoking among men by residence. Twenty-four percent of men in urban areas and 21% of men in rural areas smoke cigarettes.  Men with more than a secondary education are less likely to smoke cigarettes than men with less education (10% versus 19-24%).  Use of drugs is not common among ever-married women, while 3% of ever-married men reported using drugs (Table 3.9). The most commonly used drug is opium, reported by 45% of men who use drugs. Figure 3.5 Occupation 31 17 20 17 3 12 16 8 25 1 0 50 Agriculture Unskilled manual Skilled manual Sales and services Clerical Professional/ technical/ managerial Percentage of ever-married women and men age 15-49 by occupation Women Men 36 • Characteristics of Respondents 3.7 KNOWLEDGE OF TUBERCULOSIS Knowledge of tuberculosis among the general population is widespread. The majority of ever- married women and men have heard of tuberculosis (82% and 83%, respectively). Among those who have heard of tuberculosis, 63% of women and 72% of men believe that the disease can spread through the air via coughing. More than four in five women (81%) and men (88%) believe that tuberculosis can be cured, while 7% of women and 5% of men have ever been told by a doctor or nurse that they had tuberculosis (Table 3.10.1 and Table 3.10.2). Patterns by background characteristics  Among women who have heard of tuberculosis, there is a slight rise with age in the proportion who were ever told they had the disease, from 5% among those age 15-19 to 10% among those age 45- 49. There is no such pattern among men (Table 3.10.1 and Table 3.10.2).  Data by residence show that rural women are twice as likely as urban women to have been diagnosed with tuberculosis (8% versus 4%). However, there are minimal differences among men by urban and rural residence (4% versus 5%). 3.8 KNOWLEDGE OF HEPATITIS Overall, 67% of both women and men have heard of hepatitis. The results in Table 3.11.1 and Table 3.11.2 indicate that knowledge about ways to prevent hepatitis is slightly higher among men than among women. Among those who have heard of hepatitis, women most often reported avoiding contaminated food and water (21%), using disposable syringes (20%), and having safe sex and safe blood transfusions (17% each) as means of avoiding the disease. Similarly, men most often reported using disposable syringes and having safe sex (32% each). Patterns by background characteristics  There is a slight rise with age in knowledge of hepatitis, from 64% among women age 15-19 to 71% among women age 45-49. The pattern is similar among men (59% and 69%, respectively) (Table 3.11.1 and Table 3.11.2).  There is no difference in awareness of hepatitis between rural and urban respondents.  Knowledge of hepatitis increases with increasing education. Sixty-six percent of women and 61% men who have no education have heard of hepatitis, as compared with 83% of women and 90% of men with more than a secondary education. 3.9 HEPATITIS PREVALENCE Among ever-married women and men who have heard of hepatitis, 8% of women and 6% of men have ever been told by a doctor or nurse that they had hepatitis. Among women ever diagnosed with hepatitis, 60%, 25%, and 11% were diagnosed with hepatitis A, B, and C, respectively. Two in five women who had ever been diagnosed with hepatitis were currently suffering from it, as compared with only 16% of men (Table 3.12.1 and Table 3.12.2). Figure 3.6 Use of tobacco 1 3 3 22 2 32 Cigarettes Chelam Other tobacco products Percentage of ever-married women and men age 15-49 who use specific types of tobacco Women Men Characteristics of Respondents • 37 3.10 CANCER PREVALENCE AND DEATHS RELATED TO CANCER All households were asked if any household members had been diagnosed with cancer. Overall, 3% of households reported that a member had been diagnosed with cancer (Table 3.13). Among the households that reported a member diagnosed with cancer, 21% had members diagnosed with breast cancer and 19% each had members diagnosed with intestinal cancer and liver cancer. Sixteen percent had a member diagnosed with lung cancer, and 5% reported a member diagnosed with cervical cancer. Among households in which any member had been diagnosed with cancer, 16% had a death in the three years before the survey from breast cancer, 14% had a death from liver cancer, 11% had a death from intestinal cancer, 10% had a death from lung cancer, and 3% had a death from cervical cancer (Table 3.14). Patterns by background characteristics  Among households that reported a member diagnosed with cancer, the proportion in which a cancer death occurred in the three years before the survey was about twice as high in rural areas as in urban areas.  Fifty-nine percent of households in the highest wealth quintile in which a member had been diagnosed with cancer reported no cancer deaths, as compared with only 31% of households in the lowest quintile. LIST OF TABLES For more information on the characteristics of survey respondents, see the following tables:  Table 3.1 Background characteristics of respondents  Table 3.2.1 Educational attainment: Women  Table 3.2.2 Educational attainment: Men  Table 3.3.1 Literacy: Women  Table 3.3.2 Literacy: Men  Table 3.4.1 Exposure to mass media: Women  Table 3.4.2 Exposure to mass media: Men  Table 3.5.1 Employment status: Women  Table 3.5.2 Employment status: Men  Table 3.6.1 Occupation: Women  Table 3.6.2 Occupation: Men  Table 3.7 Type of employment: Women  Table 3.8.1 Use of tobacco: Women  Table 3.8.2 Use of tobacco: Men  Table 3.9 Use of drugs  Table 3.10.1 Knowledge concerning tuberculosis: Women  Table 3.10.2 Knowledge concerning tuberculosis: Men  Table 3.11.1 Knowledge concerning hepatitis: Women  Table 3.11.2 Knowledge concerning hepatitis: Men  Table 3.12.1 Reported prevalence of hepatitis: Women 38 • Characteristics of Respondents  Table 3.12.2 Reported prevalence of hepatitis: Men  Table 3.13 Households with members diagnosed with cancer  Table 3.14 Deaths of household members diagnosed with cancer Characteristics of Respondents • 39 Table 3.1 Background characteristics of respondents Percent distribution of ever-married women and ever-married men age 15-49 by selected background characteristics, Afghanistan 2015 Women Men Background characteristic Weighted percent Weighted number Un- weighted number Weighted percent Weighted number Un- weighted number Age 15-19 6.2 1,825 1,829 1.3 142 158 20-24 20.7 6,089 6,083 10.8 1,162 1,302 25-29 21.4 6,299 6,447 22.5 2,422 2,355 30-34 14.6 4,302 4,481 18.7 2,008 2,017 35-39 15.1 4,463 4,304 18.0 1,935 1,850 40-44 10.6 3,113 3,191 13.0 1,402 1,483 45-49 11.4 3,369 3,126 15.7 1,688 1,595 Marital status Married 97.3 28,671 28,661 99.3 10,679 10,687 Divorced/separated 0.2 59 86 0.2 17 14 Widowed 2.5 731 714 0.6 64 59 Residence Urban 23.3 6,870 7,025 23.0 2,479 2,333 Rural 76.7 22,591 22,436 77.0 8,281 8,427 Province1 Kabul 12.4 3,658 755 12.5 1,350 207 Kapisa 0.7 205 874 0.6 63 280 Parwan 2.1 625 744 2.0 220 259 Wardak 1.3 382 870 1.6 171 418 Logar 1.6 472 915 1.9 204 404 Nangarhar 2.7 794 1,023 2.5 273 353 Laghman 2.0 583 800 2.1 227 334 Panjsher 0.2 54 681 0.2 18 202 Baghlan 2.8 839 740 2.6 281 246 Bamyan 1.0 303 652 0.9 94 193 Ghazni 4.5 1,328 1,146 5.8 619 576 Paktika 2.7 792 1,110 3.0 322 451 Paktya 1.8 542 1,174 1.9 206 472 Khost 2.9 851 1,338 3.1 334 560 Kunarha 1.9 559 734 1.4 151 186 Nooristan 0.8 222 1,398 0.6 66 419 Badakhshan 3.4 1,004 835 2.9 316 246 Takhar 3.8 1,105 819 2.8 296 217 Kunduz 4.2 1,232 839 4.5 479 297 Samangan 1.1 330 682 1.2 125 269 Balkh 6.0 1,781 909 5.7 616 314 Sar-E-Pul 2.2 654 812 1.8 195 260 Ghor 2.4 715 886 3.0 322 398 Daykundi 1.1 329 669 0.7 77 150 Urozgan 0.8 230 805 0.9 92 337 Kandahar 7.6 2,227 952 8.1 874 411 Jawzjan 2.1 614 865 2.0 218 331 Faryab 7.2 2,114 742 6.6 706 230 Helmand 3.0 875 843 3.3 355 344 Badghis 2.2 650 875 2.1 231 304 Herat 7.9 2,316 989 8.0 863 367 Farah 2.6 777 1,133 2.7 295 457 Nimroz 0.9 278 680 0.9 93 199 Education No education 83.5 24,604 25,201 50.6 5,447 5,516 Primary 7.9 2,330 1,978 18.5 1,987 1,741 Secondary 6.7 1,971 1,786 24.5 2,632 2,717 More than secondary 1.9 556 496 6.5 695 786 Wealth quintile Lowest 20.0 5,904 5,647 18.9 2,029 1,965 Second 20.4 6,001 6,756 20.8 2,233 2,482 Middle 20.0 5,888 6,356 20.1 2,160 2,420 Fourth 20.4 6,010 6,253 21.0 2,260 2,387 Highest 19.2 5,657 4,449 19.3 2,078 1,506 Total 100.0 29,461 29,461 100.0 10,760 10,760 Note: Education categories refer to the highest level of education attended. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 40 • Characteristics of Respondents Table 3.2.1 Educational attainment: Women Percent distribution of ever-married women age 15-49 by highest level of schooling attended or completed, according to background characteristics, Afghanistan 2015 Highest level of schooling Background characteristic No edu- cation Some primary Com- pleted primary1 Some secon- dary Com- pleted secon- dary2 More than secon- dary Total Number of women Age 15-24 71.4 8.7 3.7 8.7 4.9 2.6 100.0 7,915 15-19 67.6 11.2 4.1 12.7 3.4 1.2 100.0 1,825 20-24 72.6 7.9 3.6 7.5 5.3 3.0 100.0 6,089 25-29 83.0 6.8 1.9 3.5 3.0 1.9 100.0 6,299 30-34 88.4 4.8 1.6 2.4 1.5 1.2 100.0 4,302 35-39 90.3 3.1 1.0 2.4 1.1 2.1 100.0 4,463 40-44 90.9 4.1 0.8 1.6 1.0 1.6 100.0 3,113 45-49 90.9 5.0 0.7 0.9 1.4 1.0 100.0 3,369 Residence Urban 66.9 10.1 3.3 8.0 6.0 5.7 100.0 6,870 Rural 88.6 4.7 1.6 2.9 1.6 0.7 100.0 22,591 Province3 Kabul 65.7 10.4 3.8 8.1 6.5 5.5 100.0 3,658 Kapisa 77.2 6.8 4.0 5.3 4.0 2.7 100.0 205 Parwan 86.0 4.6 1.6 3.0 2.3 2.5 100.0 625 Wardak 94.5 3.1 0.8 1.3 0.2 0.0 100.0 382 Logar 72.4 8.4 3.8 8.5 5.2 1.7 100.0 472 Nangarhar 84.6 6.4 2.4 3.6 1.7 1.3 100.0 794 Laghman 92.2 4.2 0.7 1.5 0.8 0.5 100.0 583 Panjsher 82.4 5.3 1.7 4.3 5.2 1.2 100.0 54 Baghlan 85.3 4.0 3.3 4.3 1.9 1.3 100.0 839 Bamyan 84.5 6.0 2.6 4.9 0.9 1.0 100.0 303 Ghazni 89.4 4.3 1.7 3.0 0.9 0.7 100.0 1,328 Paktika 98.7 0.2 0.3 0.4 0.4 0.0 100.0 792 Paktya 96.6 2.0 0.4 0.6 0.4 0.1 100.0 542 Khost 98.5 0.3 0.4 0.8 0.0 0.0 100.0 851 Kunarha 89.8 3.9 2.6 2.1 1.1 0.5 100.0 559 Nooristan 96.4 1.8 0.6 0.9 0.3 0.0 100.0 222 Badakhshan 76.3 7.2 3.5 8.0 3.2 1.8 100.0 1,004 Takhar 84.9 4.4 1.6 5.2 1.5 2.4 100.0 1,105 Kunduz 90.2 4.4 0.6 2.2 1.2 1.5 100.0 1,232 Samangan 88.2 3.7 1.7 3.8 1.1 1.5 100.0 330 Balkh 77.4 9.5 2.0 4.8 4.4 1.9 100.0 1,781 Sar-E-Pul 80.6 7.0 5.4 4.2 1.5 1.2 100.0 654 Ghor 89.0 1.5 2.9 3.8 2.1 0.7 100.0 715 Daykundi 82.3 2.9 1.8 8.7 2.8 1.5 100.0 329 Urozgan 98.2 0.1 0.2 1.0 0.5 0.0 100.0 230 Kandahar 95.5 1.9 0.8 1.0 0.6 0.3 100.0 2,227 Jawzjan 72.6 12.0 2.7 3.2 5.9 3.5 100.0 614 Faryab 72.1 10.4 2.0 6.0 6.1 3.5 100.0 2,114 Helmand 94.5 1.1 1.0 2.2 0.6 0.5 100.0 875 Badghis 93.3 3.9 1.5 0.9 0.3 0.1 100.0 650 Herat 82.4 8.3 1.0 4.4 1.6 2.3 100.0 2,316 Farah 91.9 4.4 0.9 1.4 1.0 0.3 100.0 777 Nimroz 77.5 11.9 1.5 6.0 2.1 0.9 100.0 278 Wealth quintile Lowest 90.6 4.2 1.7 2.5 0.8 0.3 100.0 5,904 Second 91.0 4.5 1.0 2.4 0.8 0.3 100.0 6,001 Middle 90.8 4.1 1.2 2.2 1.3 0.4 100.0 5,888 Fourth 81.6 7.4 2.2 4.6 2.6 1.5 100.0 6,010 Highest 62.7 9.6 3.7 9.0 7.8 7.2 100.0 5,657 Total 83.5 6.0 2.0 4.1 2.6 1.9 100.0 29,461 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Characteristics of Respondents • 41 Table 3.2.2 Educational attainment: Men Percent distribution of ever-married men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Afghanistan 2015 Highest level of schooling Background characteristic No edu- cation Some primary Com- pleted primary1 Some secon- dary Com- pleted secon- dary2 More than secon- dary Total Median years com- pleted Number of men Age 15-24 42.8 10.8 5.0 19.1 14.6 7.8 100.0 4.3 1,305 15-19 28.9 11.6 10.2 33.6 12.5 3.3 100.0 5.9 142 20-24 44.5 10.7 4.3 17.3 14.8 8.3 100.0 4.0 1,162 25-29 44.4 11.7 7.0 15.5 13.2 8.2 100.0 2.6 2,422 30-34 49.2 15.9 5.8 13.4 10.0 5.7 100.0 1.3 2,008 35-39 50.8 13.0 5.1 12.6 12.3 6.3 100.0 0.0 1,935 40-44 59.1 13.2 5.7 9.5 6.8 5.7 100.0 0.0 1,402 45-49 60.0 11.1 5.3 11.5 7.3 4.8 100.0 0.0 1,688 Residence Urban 31.3 16.3 6.7 16.9 15.8 13.0 100.0 5.4 2,479 Rural 56.4 11.6 5.5 12.6 9.4 4.5 100.0 0.0 8,281 Province3 Kabul 28.4 16.4 6.9 18.3 18.4 11.6 100.0 5.8 1,350 Kapisa 26.7 18.0 8.6 20.0 13.7 12.8 100.0 5.6 63 Parwan 38.3 13.9 3.3 22.1 12.0 10.4 100.0 4.2 220 Wardak 49.4 5.7 6.0 15.0 13.5 10.4 100.0 1.7 171 Logar 35.6 11.7 2.9 22.0 20.2 7.6 100.0 5.9 204 Nangarhar 38.5 11.4 6.2 17.8 12.3 13.8 100.0 5.0 273 Laghman 51.6 13.4 5.7 13.1 9.1 7.2 100.0 0.0 227 Panjsher 32.2 6.5 3.5 17.1 27.6 13.2 100.0 8.1 18 Baghlan 43.4 8.2 8.5 16.1 17.6 6.1 100.0 4.1 281 Bamyan 60.7 14.4 3.1 10.2 3.3 8.2 100.0 0.0 94 Ghazni 58.9 10.9 8.0 12.7 5.4 4.2 100.0 0.0 619 Paktika 59.2 2.5 3.6 13.4 16.6 4.8 100.0 0.0 322 Paktya 52.7 11.0 6.4 14.4 9.5 6.0 100.0 0.0 206 Khost 57.2 2.5 9.0 9.8 15.5 6.1 100.0 0.0 334 Kunarha 44.7 9.8 6.7 13.6 10.3 14.9 100.0 3.3 151 Nooristan 66.6 5.2 3.4 15.4 7.7 1.7 100.0 0.0 66 Badakhshan 54.9 16.0 3.1 10.3 8.7 7.0 100.0 0.0 316 Takhar 58.9 19.2 3.2 7.5 4.8 6.4 100.0 0.0 296 Kunduz 56.3 13.6 1.8 13.8 9.5 4.9 100.0 0.0 479 Samangan 69.0 4.5 6.9 8.8 5.9 4.9 100.0 0.0 125 Balkh 50.2 16.4 6.2 14.7 7.0 5.4 100.0 0.0 616 Sar-E-Pul 54.8 21.3 9.4 7.4 3.0 4.1 100.0 0.0 195 Ghor 49.8 3.7 4.2 13.8 20.9 7.6 100.0 2.1 322 Daykundi 63.1 13.8 1.5 10.8 7.8 2.9 100.0 0.0 77 Urozgan 81.4 3.8 1.3 7.4 5.1 1.1 100.0 0.0 92 Kandahar 69.0 8.4 3.8 9.8 5.6 3.5 100.0 0.0 874 Jawzjan 32.3 16.8 4.1 11.9 21.7 13.2 100.0 5.2 218 Faryab 33.7 20.2 11.8 16.1 15.0 3.2 100.0 4.3 706 Helmand 44.7 12.2 9.2 21.7 8.5 3.7 100.0 3.6 355 Badghis 77.1 5.9 1.2 11.2 3.2 1.4 100.0 0.0 231 Herat 63.5 14.1 3.5 9.2 4.2 5.4 100.0 0.0 863 Farah 58.2 16.1 7.3 7.2 8.8 2.4 100.0 0.0 295 Nimroz 61.4 19.0 3.4 8.5 5.3 2.4 100.0 0.0 93 Wealth quintile Lowest 64.3 10.5 4.4 10.3 7.8 2.6 100.0 0.0 2,029 Second 60.0 12.7 5.9 11.8 6.7 3.0 100.0 0.0 2,233 Middle 58.3 11.0 6.0 12.1 8.7 3.9 100.0 0.0 2,160 Fourth 44.3 15.0 6.0 15.1 12.3 7.2 100.0 2.9 2,260 Highest 26.1 14.1 6.5 18.6 19.0 15.7 100.0 6.8 2,078 Total 50.6 12.7 5.8 13.6 10.9 6.5 100.0 0.0 10,760 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 42 • Characteristics of Respondents Table 3.3.1 Literacy: Women Percent distribution of ever-married women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Afghanistan 2015 No schooling or primary school Background characteristic Secon- dary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Percent- age literate1 Number of women Age 15-24 16.2 3.2 6.2 74.3 0.1 0.0 0.1 100.0 25.5 7,915 15-19 17.2 3.6 6.8 72.3 0.0 0.0 0.1 100.0 27.6 1,825 20-24 15.9 3.0 6.0 74.9 0.1 0.0 0.1 100.0 24.9 6,089 25-29 8.3 1.8 5.3 84.3 0.1 0.0 0.2 100.0 15.5 6,299 30-34 5.2 1.5 3.6 89.6 0.0 0.0 0.2 100.0 10.3 4,302 35-39 5.6 1.3 3.1 89.9 0.0 0.0 0.1 100.0 10.0 4,463 40-44 4.2 1.0 3.0 91.8 0.0 0.0 0.0 100.0 8.2 3,113 45-49 3.4 0.8 2.0 93.7 0.0 0.0 0.0 100.0 6.2 3,369 Residence Urban 19.7 5.0 7.3 67.9 0.0 0.0 0.0 100.0 32.1 6,870 Rural 5.2 0.9 3.4 90.3 0.0 0.0 0.1 100.0 9.5 22,591 Province2 Kabul 20.1 5.8 7.2 66.6 0.2 0.0 0.0 100.0 33.2 3,658 Kapisa 12.0 2.1 6.0 79.5 0.0 0.0 0.4 100.0 20.1 205 Parwan 7.8 0.4 4.0 87.4 0.0 0.0 0.4 100.0 12.2 625 Wardak 1.5 2.2 3.3 92.9 0.0 0.0 0.1 100.0 7.0 382 Logar 15.4 0.1 9.6 74.7 0.0 0.0 0.3 100.0 25.0 472 Nangarhar 6.6 1.5 3.1 88.3 0.2 0.0 0.3 100.0 11.2 794 Laghman 2.8 0.2 4.0 92.7 0.0 0.1 0.1 100.0 7.1 583 Panjsher 10.7 1.3 9.2 78.3 0.0 0.0 0.5 100.0 21.1 54 Baghlan 7.5 1.5 4.8 86.2 0.0 0.0 0.0 100.0 13.8 839 Bamyan 6.8 2.7 4.6 85.1 0.0 0.0 0.7 100.0 14.2 303 Ghazni 4.6 2.1 4.6 88.6 0.0 0.0 0.1 100.0 11.3 1,328 Paktika 0.8 0.3 1.3 97.3 0.0 0.1 0.3 100.0 2.3 792 Paktya 1.1 0.1 1.8 96.7 0.0 0.0 0.4 100.0 3.0 542 Khost 0.9 0.2 0.6 98.3 0.0 0.0 0.0 100.0 1.7 851 Kunarha 3.7 0.3 4.5 91.3 0.0 0.2 0.0 100.0 8.4 559 Nooristan 1.2 0.5 1.4 96.8 0.0 0.0 0.1 100.0 3.1 222 Badakhshan 13.0 1.2 5.3 80.6 0.0 0.0 0.0 100.0 19.4 1,004 Takhar 9.1 1.0 4.4 85.5 0.0 0.0 0.0 100.0 14.5 1,105 Kunduz 4.8 1.0 3.9 89.7 0.0 0.0 0.6 100.0 9.7 1,232 Samangan 6.5 1.0 3.6 88.8 0.0 0.0 0.2 100.0 11.0 330 Balkh 11.2 2.5 4.0 82.3 0.0 0.0 0.0 100.0 17.7 1,781 Sar-E-Pul 7.0 4.0 5.9 83.0 0.0 0.0 0.0 100.0 17.0 654 Ghor 6.7 0.2 2.7 90.4 0.0 0.0 0.0 100.0 9.5 715 Daykundi 13.0 1.4 3.8 81.7 0.0 0.0 0.2 100.0 18.1 329 Urozgan 1.5 0.2 0.0 98.0 0.0 0.0 0.2 100.0 1.8 230 Kandahar 1.9 1.0 3.7 93.4 0.0 0.0 0.0 100.0 6.6 2,227 Jawzjan 12.6 0.9 6.6 79.9 0.0 0.0 0.0 100.0 20.1 614 Faryab 15.5 0.3 3.0 81.1 0.0 0.0 0.0 100.0 18.9 2,114 Helmand 3.3 0.2 1.7 94.5 0.0 0.0 0.2 100.0 5.3 875 Badghis 1.3 0.5 2.4 95.6 0.0 0.0 0.2 100.0 4.2 650 Herat 8.3 2.3 6.0 83.4 0.0 0.0 0.1 100.0 16.5 2,316 Farah 2.8 3.2 2.2 91.7 0.0 0.0 0.1 100.0 8.2 777 Nimroz 9.0 5.0 6.6 79.4 0.0 0.0 0.0 100.0 20.6 278 Wealth quintile Lowest 3.5 0.7 3.4 92.3 0.0 0.0 0.1 100.0 7.5 5,904 Second 3.5 0.7 2.9 92.8 0.0 0.0 0.1 100.0 7.0 6,001 Middle 3.9 0.8 2.8 92.3 0.0 0.0 0.1 100.0 7.6 5,888 Fourth 8.7 1.5 5.0 84.6 0.1 0.0 0.2 100.0 15.2 6,010 Highest 24.0 5.8 7.7 62.5 0.0 0.0 0.0 100.0 37.5 5,657 Total 8.6 1.8 4.3 85.1 0.0 0.0 0.1 100.0 14.8 29,461 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Characteristics of Respondents • 43 Table 3.3.2 Literacy: Men Percent distribution of ever-married men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Afghanistan 2015 No schooling or primary school Background characteristic Secon- dary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Percent- age literate1 Number of men Age 15-24 41.4 5.6 9.7 43.2 0.0 0.0 0.1 100.0 56.7 1,305 15-19 49.4 9.3 10.0 31.4 0.0 0.0 0.0 100.0 68.6 142 20-24 40.5 5.1 9.7 44.6 0.0 0.0 0.2 100.0 55.2 1,162 25-29 36.9 5.8 9.9 47.2 0.0 0.1 0.1 100.0 52.5 2,422 30-34 29.1 5.7 15.5 49.1 0.0 0.0 0.5 100.0 50.3 2,008 35-39 31.1 6.8 11.3 50.6 0.0 0.1 0.2 100.0 49.2 1,935 40-44 22.0 6.2 14.1 57.6 0.0 0.0 0.1 100.0 42.3 1,402 45-49 23.6 6.5 13.3 56.4 0.1 0.0 0.1 100.0 43.4 1,688 Residence Urban 45.7 6.7 12.5 35.0 0.0 0.0 0.1 100.0 64.9 2,479 Rural 26.5 5.9 12.2 55.1 0.0 0.0 0.2 100.0 44.6 8,281 Province2 Kabul 48.3 7.1 10.3 34.3 0.0 0.0 0.0 100.0 65.7 1,350 Kapisa 46.6 1.5 14.6 37.2 0.0 0.0 0.0 100.0 62.8 63 Parwan 44.5 2.6 9.6 42.9 0.0 0.0 0.4 100.0 56.7 220 Wardak 38.9 11.0 8.5 41.0 0.0 0.6 0.0 100.0 58.4 171 Logar 49.8 1.5 9.4 39.1 0.0 0.0 0.2 100.0 60.7 204 Nangarhar 44.0 2.4 14.2 38.5 0.2 0.0 0.7 100.0 60.6 273 Laghman 29.4 1.1 17.3 51.8 0.0 0.0 0.4 100.0 47.8 227 Panjsher 57.9 1.4 6.9 33.5 0.0 0.0 0.3 100.0 66.2 18 Baghlan 39.9 4.4 14.6 41.2 0.0 0.0 0.0 100.0 58.8 281 Bamyan 21.7 18.5 18.0 41.3 0.0 0.0 0.4 100.0 58.2 94 Ghazni 22.2 9.1 11.8 54.6 0.2 0.0 2.1 100.0 43.1 619 Paktika 34.8 1.5 14.5 48.9 0.0 0.0 0.3 100.0 50.8 322 Paktya 29.9 5.1 10.7 54.3 0.0 0.0 0.0 100.0 45.7 206 Khost 31.4 9.3 4.1 55.2 0.0 0.0 0.0 100.0 44.8 334 Kunarha 38.7 0.6 10.6 50.1 0.0 0.0 0.0 100.0 49.9 151 Nooristan 24.8 8.1 22.0 44.9 0.2 0.0 0.0 100.0 54.9 66 Badakhshan 26.0 4.4 13.7 56.0 0.0 0.0 0.0 100.0 44.0 316 Takhar 18.7 7.1 7.8 66.4 0.0 0.0 0.0 100.0 33.6 296 Kunduz 28.2 2.9 8.6 60.2 0.0 0.0 0.0 100.0 39.8 479 Samangan 19.6 5.1 8.2 67.0 0.0 0.0 0.0 100.0 33.0 125 Balkh 27.1 6.9 10.8 55.1 0.0 0.0 0.0 100.0 44.9 616 Sar-E-Pul 14.4 13.5 18.7 53.3 0.0 0.0 0.0 100.0 46.7 195 Ghor 42.2 2.7 6.9 48.2 0.0 0.0 0.0 100.0 51.8 322 Daykundi 21.6 11.8 12.7 54.0 0.0 0.0 0.0 100.0 46.0 77 Urozgan 13.6 1.3 3.4 81.7 0.0 0.0 0.0 100.0 18.3 92 Kandahar 18.8 2.2 14.0 64.9 0.0 0.0 0.0 100.0 35.1 874 Jawzjan 46.7 4.5 10.8 37.9 0.0 0.0 0.0 100.0 62.1 218 Faryab 34.3 6.9 13.9 44.9 0.0 0.0 0.0 100.0 55.1 706 Helmand 33.9 2.1 18.3 44.9 0.0 0.0 0.8 100.0 54.3 355 Badghis 15.8 3.1 9.4 71.7 0.0 0.0 0.0 100.0 28.3 231 Herat 18.9 10.9 16.0 53.9 0.0 0.3 0.0 100.0 45.8 863 Farah 18.5 14.2 17.6 49.6 0.0 0.0 0.1 100.0 50.3 295 Nimroz 16.2 12.5 13.8 57.4 0.0 0.0 0.2 100.0 42.4 93 Wealth quintile Lowest 20.8 5.3 10.9 62.9 0.0 0.0 0.1 100.0 37.1 2,029 Second 21.4 6.7 13.1 58.4 0.1 0.0 0.3 100.0 41.2 2,233 Middle 24.7 5.7 11.6 57.5 0.0 0.1 0.4 100.0 42.0 2,160 Fourth 34.7 6.5 13.7 44.8 0.0 0.0 0.2 100.0 55.0 2,260 Highest 53.3 6.2 11.6 28.9 0.0 0.0 0.1 100.0 71.0 2,078 Total 30.9 6.1 12.2 50.5 0.0 0.0 0.2 100.0 49.3 10,760 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 44 • Characteristics of Respondents Table 3.4.1 Exposure to mass media: Women Percentage of ever-married women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Afghanistan 2015 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 4.3 36.7 23.5 1.5 47.9 1,825 20-24 3.5 37.6 27.0 1.1 46.4 6,089 25-29 2.7 38.8 25.3 1.2 46.2 6,299 30-34 1.4 40.3 23.1 0.4 47.2 4,302 35-39 2.7 41.8 21.4 1.5 47.5 4,463 40-44 1.7 38.5 23.2 0.9 47.6 3,113 45-49 1.4 40.2 21.3 0.9 48.5 3,369 Residence Urban 7.6 71.1 26.3 3.2 20.7 6,870 Rural 1.0 29.6 23.2 0.4 55.1 22,591 Province1 Kabul 9.2 70.4 27.1 4.0 21.2 3,658 Kapisa 6.5 41.6 47.0 4.2 37.9 205 Parwan 1.8 20.5 36.0 0.2 50.9 625 Wardak 0.0 16.9 10.1 0.0 76.1 382 Logar 5.9 15.1 52.1 1.6 41.9 472 Nangarhar 2.3 31.2 18.6 1.0 59.0 794 Laghman 1.4 14.2 36.5 0.4 59.9 583 Panjsher 4.8 52.3 10.4 0.6 42.9 54 Baghlan 3.8 51.3 11.1 1.2 43.0 839 Bamyan 1.8 38.6 10.8 0.6 56.0 303 Ghazni 1.8 31.8 34.1 0.5 48.1 1,328 Paktika 0.0 7.2 40.4 0.0 55.5 792 Paktya 0.1 20.6 60.4 0.1 37.4 542 Khost 0.2 33.6 55.6 0.1 38.8 851 Kunarha 1.5 6.1 13.7 0.7 83.2 559 Nooristan 0.6 0.1 2.0 0.0 97.9 222 Badakhshan 1.0 12.8 5.5 0.8 85.7 1,004 Takhar 0.5 22.3 19.7 0.2 70.4 1,105 Kunduz 1.9 49.1 23.9 1.2 46.0 1,232 Samangan 1.3 20.3 6.8 0.8 77.4 330 Balkh 2.1 53.2 7.2 0.7 44.0 1,781 Sar-E-Pul 1.2 26.6 2.1 0.4 72.5 654 Ghor 0.5 39.3 16.5 0.3 55.9 715 Daykundi 0.3 11.9 1.2 0.2 87.2 329 Urozgan 0.0 5.7 20.8 0.0 77.4 230 Kandahar 0.8 16.2 55.8 0.2 40.0 2,227 Jawzjan 5.1 54.0 22.8 3.3 42.5 614 Faryab 2.5 76.8 5.9 1.3 20.9 2,114 Helmand 0.8 23.2 40.8 0.4 46.7 875 Badghis 0.3 6.8 2.4 0.2 92.1 650 Herat 1.9 55.6 12.5 0.7 37.7 2,316 Farah 0.2 38.6 28.9 0.1 46.6 777 Nimroz 1.4 57.3 1.1 0.0 42.3 278 Education No education 0.2 33.2 24.1 0.0 51.8 24,604 Primary 3.8 64.7 20.5 1.9 28.0 2,330 Secondary 18.4 70.2 22.0 6.3 21.7 1,971 More than secondary 43.4 89.1 40.4 24.9 6.1 556 Wealth quintile Lowest 0.3 22.1 10.9 0.1 71.0 5,904 Second 0.5 24.1 22.3 0.2 59.5 6,001 Middle 0.7 26.4 27.2 0.3 53.3 5,888 Fourth 1.9 48.2 30.7 0.6 34.8 6,010 Highest 9.6 77.0 28.8 4.3 15.4 5,657 Total 2.5 39.2 24.0 1.1 47.1 29,461 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Characteristics of Respondents • 45 Table 3.4.2 Exposure to mass media: Men Percentage of ever-married men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Afghanistan 2015 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 13.3 44.4 50.8 6.2 30.3 142 20-24 12.6 39.7 45.5 6.6 37.0 1,162 25-29 13.3 46.3 43.6 5.9 33.3 2,422 30-34 10.7 43.6 43.6 6.0 35.2 2,008 35-39 17.3 51.1 42.1 8.9 31.9 1,935 40-44 11.2 45.9 47.6 6.3 32.7 1,402 45-49 12.8 46.0 43.4 7.7 34.9 1,688 Residence Urban 26.2 79.5 56.9 16.4 11.0 2,479 Rural 9.2 35.7 40.3 4.0 40.8 8,281 Province1 Kabul 30.6 80.7 60.6 18.4 8.4 1,350 Kapisa 25.0 69.0 83.8 20.5 11.2 63 Parwan 5.5 54.9 57.4 4.5 25.7 220 Wardak 4.5 19.4 60.1 2.2 33.8 171 Logar 25.7 25.7 64.0 7.1 27.6 204 Nangarhar 18.4 36.3 60.3 8.1 25.7 273 Laghman 9.3 15.0 37.1 3.5 57.4 227 Panjsher 32.0 70.5 52.7 22.1 21.5 18 Baghlan 6.4 32.5 8.9 2.9 63.9 281 Bamyan 15.4 38.4 26.6 7.8 48.7 94 Ghazni 7.4 42.1 51.0 3.9 34.3 619 Paktika 7.6 11.6 52.3 4.0 45.9 322 Paktya 14.0 27.4 81.8 6.5 11.7 206 Khost 14.5 46.7 60.8 11.6 25.0 334 Kunarha 17.4 16.4 37.3 10.4 58.4 151 Nooristan 5.7 0.5 34.5 0.0 62.9 66 Badakhshan 12.6 28.2 35.0 7.9 54.7 316 Takhar 8.5 45.5 32.8 4.8 42.4 296 Kunduz 5.8 50.9 38.2 4.4 33.8 479 Samangan 5.4 21.1 15.5 2.5 71.6 125 Balkh 12.9 55.3 28.5 7.3 40.5 616 Sar-E-Pul 2.5 48.8 21.2 1.1 45.1 195 Ghor 12.9 46.7 39.0 3.3 34.0 322 Daykundi 8.8 34.3 18.2 7.6 63.1 77 Urozgan 1.2 13.4 49.6 0.5 43.2 92 Kandahar 4.5 23.6 61.2 3.2 35.0 874 Jawzjan 26.8 60.5 69.0 15.6 19.2 218 Faryab 22.1 74.6 16.7 3.2 21.4 706 Helmand 6.2 22.4 33.5 3.9 57.4 355 Badghis 3.2 14.3 14.6 0.5 71.5 231 Herat 10.0 57.3 41.4 7.0 27.2 863 Farah 3.3 41.4 39.4 2.1 40.4 295 Nimroz 7.5 69.2 30.2 4.9 25.3 93 Education No education 0.4 32.1 36.3 0.2 46.2 5,447 Primary 7.5 55.9 43.0 3.6 27.8 1,987 Secondary 30.8 59.0 56.1 16.4 20.2 2,632 More than secondary 61.4 74.4 63.6 32.8 6.7 695 Wealth quintile Lowest 4.9 31.1 28.6 2.0 53.7 2,029 Second 5.4 28.7 37.7 1.9 45.9 2,233 Middle 8.1 30.8 42.8 3.0 40.1 2,160 Fourth 14.0 55.1 52.1 7.7 22.8 2,260 Highest 33.5 84.0 58.9 20.1 7.3 2,078 Total 13.1 45.8 44.1 6.9 33.9 10,760 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 46 • Characteristics of Respondents Table 3.5.1 Employment status: Women Percent distribution of ever-married women age 15-49 by employment status, according to background characteristics, Afghanistan 2015 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/don’t know Total Number of women Currently employed1 Not currently employed Age 15-19 8.8 1.2 89.9 0.1 100.0 1,825 20-24 11.0 2.0 86.8 0.2 100.0 6,089 25-29 11.7 1.8 86.2 0.3 100.0 6,299 30-34 10.1 1.4 88.4 0.1 100.0 4,302 35-39 13.5 1.5 84.5 0.5 100.0 4,463 40-44 13.2 1.1 85.4 0.3 100.0 3,113 45-49 12.6 0.8 86.4 0.2 100.0 3,369 Marital status Married 11.4 1.5 86.9 0.2 100.0 28,671 Divorced/separated/widowed 21.2 1.4 75.7 1.8 100.0 790 Number of living children 0 11.8 1.2 86.9 0.1 100.0 2,948 1-2 10.8 1.5 87.2 0.5 100.0 7,353 3-4 12.9 1.7 85.2 0.2 100.0 7,698 5+ 11.4 1.5 87.0 0.2 100.0 11,463 Residence Urban 12.4 2.2 84.9 0.6 100.0 6,870 Rural 11.5 1.3 87.1 0.2 100.0 22,591 Province2 Kabul 12.2 1.9 85.2 0.8 100.0 3,658 Kapisa 0.6 0.2 99.3 0.0 100.0 205 Parwan 10.2 0.0 89.8 0.1 100.0 625 Wardak 2.4 0.5 97.0 0.1 100.0 382 Logar 8.0 0.0 92.0 0.0 100.0 472 Nangarhar 12.6 0.8 86.3 0.2 100.0 794 Laghman 15.6 0.5 83.6 0.3 100.0 583 Panjsher 4.5 0.0 95.5 0.0 100.0 54 Baghlan 1.0 0.1 99.0 0.0 100.0 839 Bamyan 8.8 0.2 91.0 0.0 100.0 303 Ghazni 19.7 0.2 79.5 0.6 100.0 1,328 Paktika 2.0 0.1 97.2 0.7 100.0 792 Paktya 6.3 0.0 92.3 1.3 100.0 542 Khost 2.6 0.4 97.0 0.0 100.0 851 Kunarha 1.4 0.2 98.3 0.0 100.0 559 Nooristan 43.9 42.6 13.4 0.0 100.0 222 Badakhshan 1.5 0.2 98.3 0.0 100.0 1,004 Takhar 4.3 0.0 95.6 0.0 100.0 1,105 Kunduz 11.0 0.2 88.4 0.4 100.0 1,232 Samangan 2.0 0.5 97.5 0.0 100.0 330 Balkh 18.7 0.2 80.8 0.3 100.0 1,781 Sar-E-Pul 15.5 0.3 84.2 0.0 100.0 654 Ghor 13.2 0.1 86.7 0.0 100.0 715 Daykundi 2.8 0.2 97.1 0.0 100.0 329 Urozgan 0.7 0.0 99.1 0.2 100.0 230 Kandahar 15.7 9.5 74.5 0.3 100.0 2,227 Jawzjan 33.4 0.0 66.6 0.0 100.0 614 Faryab 32.8 1.3 65.7 0.1 100.0 2,114 Helmand 0.4 0.1 99.4 0.1 100.0 875 Badghis 2.6 0.0 97.4 0.0 100.0 650 Herat 4.3 0.2 95.5 0.0 100.0 2,316 Farah 9.7 0.2 90.1 0.0 100.0 777 Nimroz 9.3 0.0 90.6 0.1 100.0 278 Education No education 10.5 1.5 87.7 0.3 100.0 24,604 Primary 14.1 1.3 84.6 0.0 100.0 2,330 Secondary 15.1 1.6 83.2 0.2 100.0 1,971 More than secondary 41.3 2.6 55.7 0.4 100.0 556 Wealth quintile Lowest 10.1 0.2 89.7 0.0 100.0 5,904 Second 13.8 1.1 84.9 0.1 100.0 6,001 Middle 11.3 2.0 86.5 0.2 100.0 5,888 Fourth 11.0 2.0 86.8 0.2 100.0 6,010 Highest 12.1 2.2 84.9 0.8 100.0 5,657 Total 11.7 1.5 86.6 0.3 100.0 29,461 1 "Currently employed" is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Characteristics of Respondents • 47 Table 3.5.2 Employment status: Men Percent distribution of ever-married men age 15-49 by employment status, according to background characteristics, Afghanistan 2015 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/don’t know Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 83.2 3.9 12.9 0.0 100.0 142 20-24 87.4 6.3 6.0 0.3 100.0 1,162 25-29 92.6 4.4 2.9 0.1 100.0 2,422 30-34 93.8 4.5 1.6 0.1 100.0 2,008 35-39 91.1 6.3 2.3 0.3 100.0 1,935 40-44 93.1 5.0 1.8 0.2 100.0 1,402 45-49 89.1 6.8 4.1 0.1 100.0 1,688 Marital status Married 91.4 5.4 3.1 0.2 100.0 10,679 Divorced/separated/widowed 92.6 4.1 3.2 0.0 100.0 81 Number of living children 0 88.3 5.0 6.7 0.0 100.0 1,087 1-2 91.1 5.5 3.2 0.2 100.0 2,831 3-4 93.1 5.1 1.6 0.2 100.0 2,843 5+ 91.2 5.7 3.0 0.2 100.0 3,999 Residence Urban 91.5 5.1 3.1 0.3 100.0 2,479 Rural 91.3 5.5 3.0 0.1 100.0 8,281 Province2 Kabul 88.4 8.1 3.6 0.0 100.0 1,350 Kapisa 83.0 12.0 5.0 0.0 100.0 63 Parwan 97.4 2.0 0.3 0.4 100.0 220 Wardak 97.3 1.2 1.2 0.3 100.0 171 Logar 97.3 2.4 0.3 0.0 100.0 204 Nangarhar 92.3 0.7 7.0 0.0 100.0 273 Laghman 92.4 1.9 5.7 0.0 100.0 227 Panjsher 91.9 4.2 3.9 0.0 100.0 18 Baghlan 85.4 13.1 1.3 0.2 100.0 281 Bamyan 95.0 3.4 1.6 0.0 100.0 94 Ghazni 96.6 2.2 1.1 0.2 100.0 619 Paktika 94.0 1.0 4.8 0.1 100.0 322 Paktya 97.4 1.3 1.3 0.0 100.0 206 Khost 91.8 0.5 7.6 0.0 100.0 334 Kunarha 78.6 1.6 19.8 0.0 100.0 151 Nooristan 96.1 2.0 1.0 0.9 100.0 66 Badakhshan 89.8 6.4 3.8 0.0 100.0 316 Takhar 94.5 4.6 0.9 0.0 100.0 296 Kunduz 95.8 3.2 1.0 0.0 100.0 479 Samangan 71.4 24.5 4.1 0.0 100.0 125 Balkh 88.2 6.6 3.5 1.7 100.0 616 Sar-E-Pul 94.8 5.1 0.1 0.0 100.0 195 Ghor 75.5 19.5 5.0 0.0 100.0 322 Daykundi 96.5 0.9 2.6 0.0 100.0 77 Urozgan 95.5 0.4 4.1 0.0 100.0 92 Kandahar 97.8 0.3 1.7 0.2 100.0 874 Jawzjan 93.7 5.8 0.5 0.0 100.0 218 Faryab 94.3 5.1 0.6 0.0 100.0 706 Helmand 89.9 2.6 7.3 0.2 100.0 355 Badghis 73.9 22.8 3.3 0.0 100.0 231 Herat 90.5 7.1 2.4 0.0 100.0 863 Farah 95.9 1.4 2.7 0.0 100.0 295 Nimroz 86.4 9.9 3.6 0.0 100.0 93 Education No education 90.8 6.5 2.5 0.2 100.0 5,447 Primary 92.7 5.3 1.9 0.1 100.0 1,987 Secondary 91.7 3.8 4.4 0.1 100.0 2,632 More than secondary 90.9 3.5 5.6 0.0 100.0 695 Wealth quintile Lowest 86.5 10.2 3.0 0.2 100.0 2,029 Second 92.7 4.8 2.5 0.1 100.0 2,233 Middle 93.4 4.2 2.3 0.1 100.0 2,160 Fourth 91.5 3.7 4.6 0.2 100.0 2,260 Highest 92.5 4.6 2.8 0.1 100.0 2,078 Total 91.4 5.4 3.1 0.2 100.0 10,760 1 "Currently employed" is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 48 • Characteristics of Respondents Table 3.6.1 Occupation: Women Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Afghanistan 2015 Background characteristic Profes- sional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 49.8 0.1 0.0 21.0 5.5 23.2 0.4 100.0 182 20-24 62.1 0.0 0.5 15.3 6.8 14.9 0.5 100.0 790 25-29 56.9 0.3 0.7 21.1 5.8 15.1 0.2 100.0 847 30-34 43.3 0.2 0.5 24.6 12.1 17.6 1.7 100.0 493 35-39 47.9 0.6 0.3 29.5 5.6 15.9 0.3 100.0 670 40-44 45.1 0.5 0.5 28.0 9.3 15.8 0.8 100.0 447 45-49 30.7 1.2 1.7 40.0 8.9 17.0 0.5 100.0 454 Marital status Married 50.5 0.4 0.6 24.1 7.4 16.4 0.6 100.0 3,705 Divorced/separated/ widowed 37.3 0.2 0.4 39.5 9.9 12.3 0.5 100.0 178 Number of living children 0 52.2 0.0 0.4 26.1 4.5 16.1 0.7 100.0 384 1-2 53.1 0.6 0.5 22.2 7.5 15.6 0.5 100.0 905 3-4 54.1 0.1 0.9 22.1 7.9 14.2 0.6 100.0 1,124 5+ 44.1 0.6 0.5 28.1 8.0 18.1 0.6 100.0 1,471 Residence Urban 77.1 0.8 1.4 11.5 7.9 0.4 0.9 100.0 1,000 Rural 40.5 0.3 0.3 29.4 7.4 21.6 0.5 100.0 2,883 Education No education 43.1 0.1 0.5 27.0 8.6 20.2 0.5 100.0 2,953 Primary 55.0 0.9 0.8 32.8 7.0 3.4 0.2 100.0 358 Secondary 74.8 1.5 1.6 14.7 2.5 4.8 0.2 100.0 328 More than secondary 91.1 2.1 0.0 0.0 1.7 2.0 3.1 100.0 244 Wealth quintile Lowest 31.1 0.3 0.6 45.4 2.3 19.7 0.6 100.0 608 Second 33.3 0.0 0.2 21.1 10.4 34.6 0.4 100.0 897 Middle 39.4 0.0 0.4 33.8 9.5 16.5 0.3 100.0 784 Fourth 59.2 0.8 0.4 22.6 8.3 8.1 0.5 100.0 781 Highest 83.5 0.9 1.4 7.0 5.5 0.6 1.1 100.0 813 Total 49.9 0.4 0.6 24.8 7.5 16.2 0.6 100.0 3,883 Note: Provincial-level estimates are not presented because there are too few cases. Characteristics of Respondents • 49 Table 3.6.2 Occupation: Men Percent distribution of ever-married men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Afghanistan 2015 Background characteristic Profes- sional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 16.2 0.2 8.1 15.4 18.2 41.8 0.0 100.0 124 20-24 13.5 2.8 18.0 19.8 16.0 29.9 0.0 100.0 1,089 25-29 15.3 2.4 14.7 23.3 17.1 27.1 0.0 100.0 2,347 30-34 11.6 2.3 17.3 18.0 17.7 33.1 0.0 100.0 1,974 35-39 11.8 3.8 19.4 20.6 16.9 27.6 0.1 100.0 1,886 40-44 10.3 2.6 20.9 17.0 15.7 31.9 1.5 100.0 1,375 45-49 8.3 1.9 16.0 19.1 15.5 39.2 0.0 100.0 1,618 Marital status Married 12.0 2.6 17.3 19.9 16.6 31.4 0.2 100.0 10,337 Divorced/separated/ widowed 16.0 5.0 16.6 14.7 26.0 21.6 0.0 100.0 78 Number of living children 0 12.9 3.6 16.5 22.0 22.1 23.0 0.0 100.0 1,014 1-2 14.5 2.6 14.4 20.8 16.3 30.6 0.8 100.0 2,734 3-4 11.0 2.8 19.4 22.4 15.6 28.8 0.0 100.0 2,793 5+ 10.8 2.2 18.1 16.8 16.2 35.8 0.0 100.0 3,874 Residence Urban 17.6 5.1 29.1 25.1 15.6 6.6 0.9 100.0 2,395 Rural 10.4 1.8 13.8 18.3 16.9 38.7 0.0 100.0 8,019 Province1 Kabul 17.9 4.0 25.2 21.2 18.1 12.0 1.6 100.0 1,302 Kapisa 31.0 3.3 12.5 25.2 10.6 17.3 0.0 100.0 60 Parwan 21.3 2.1 13.6 19.5 5.7 37.8 0.0 100.0 219 Wardak 11.1 4.9 6.6 4.6 9.8 62.9 0.1 100.0 169 Logar 17.7 6.2 14.1 33.2 3.8 24.9 0.0 100.0 203 Nangarhar 15.3 4.4 17.5 19.5 23.8 19.5 0.0 100.0 254 Laghman 15.6 0.1 10.9 16.6 33.7 22.6 0.4 100.0 214 Panjsher 34.7 7.2 12.0 10.5 6.9 28.5 0.0 100.0 17 Baghlan 15.3 3.7 19.9 21.8 10.8 28.5 0.0 100.0 277 Bamyan 6.6 1.6 8.7 7.9 20.9 54.3 0.0 100.0 92 Ghazni 6.3 2.4 23.9 19.6 6.3 41.5 0.0 100.0 611 Paktika 15.1 4.6 18.9 18.7 17.5 25.0 0.2 100.0 306 Paktya 11.9 1.4 17.0 28.9 22.6 18.2 0.0 100.0 203 Khost 19.7 3.5 17.5 23.0 24.8 11.5 0.0 100.0 309 Kunarha 31.7 0.8 4.8 4.3 45.2 13.2 0.0 100.0 121 Nooristan 9.0 2.8 11.1 9.9 15.5 51.5 0.2 100.0 65 Badakhshan 10.8 0.5 6.8 7.1 29.9 45.0 0.0 100.0 304 Takhar 8.4 1.3 8.9 18.5 35.1 27.7 0.0 100.0 293 Kunduz 7.8 2.3 27.9 21.5 15.9 24.7 0.0 100.0 475 Samangan 6.0 1.8 8.5 11.1 39.1 33.6 0.0 100.0 120 Balkh 7.5 1.8 14.7 25.9 9.9 40.2 0.0 100.0 584 Sar-E-Pul 9.9 0.6 16.0 19.4 27.9 26.2 0.0 100.0 195 Ghor 24.5 2.6 7.8 11.3 2.5 50.9 0.3 100.0 306 Daykundi 9.2 0.6 10.5 9.5 18.7 51.5 0.0 100.0 75 Urozgan 5.0 1.0 10.5 7.9 7.7 68.0 0.0 100.0 88 Kandahar 8.6 2.7 17.9 19.0 10.3 41.6 0.0 100.0 857 Jawzjan 23.0 4.0 22.4 18.8 8.1 23.7 0.0 100.0 217 Faryab 4.6 1.0 12.9 45.6 20.5 15.4 0.0 100.0 702 Helmand 12.8 1.9 31.9 16.6 5.4 31.6 0.0 100.0 328 Badghis 12.2 0.6 7.6 7.1 2.8 69.6 0.0 100.0 223 Herat 5.7 3.2 16.3 14.6 24.4 35.8 0.0 100.0 842 Farah 9.5 2.3 14.5 7.2 8.3 58.2 0.0 100.0 287 Nimroz 8.9 2.4 20.1 19.8 35.5 13.2 0.0 100.0 90 Education No education 3.5 0.3 15.9 17.7 19.5 42.8 0.4 100.0 5,298 Primary 5.9 0.5 18.3 26.8 20.1 28.4 0.0 100.0 1,948 Secondary 21.9 6.0 22.1 22.8 10.5 16.7 0.0 100.0 2,513 More than secondary 62.1 14.7 7.7 5.4 7.0 3.2 0.0 100.0 656 Wealth quintile Lowest 8.2 0.9 10.2 10.5 14.9 55.4 0.1 100.0 1,962 Second 8.6 1.2 12.7 15.7 19.1 42.7 0.0 100.0 2,176 Middle 11.1 1.4 15.3 19.3 17.3 35.5 0.0 100.0 2,108 Fourth 12.8 3.9 18.1 28.2 19.4 17.6 0.0 100.0 2,151 Highest 19.7 5.7 30.5 25.1 12.1 5.8 1.0 100.0 2,018 Total 12.0 2.6 17.3 19.9 16.6 31.3 0.2 100.0 10,415 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 50 • Characteristics of Respondents Table 3.7 Type of employment: Women Percent distribution of ever-married women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Afghanistan 2015 Employment characteristic Agricultural work Non- agricultural work Total Type of earnings Cash only 6.1 71.2 60.6 Cash and in-kind 12.8 5.7 6.8 In-kind only 18.3 2.5 5.0 Not paid 61.9 20.1 27.0 Missing 0.9 0.4 0.6 Total 100.0 100.0 100.0 Type of employer Employed by family member 93.0 42.3 50.6 Employed by non-family member 2.0 33.7 28.5 Self-employed 4.1 23.0 19.8 Missing 0.8 1.0 1.1 Total 100.0 100.0 100.0 Continuity of employment All year 48.7 64.8 62.2 Seasonal 45.0 18.3 22.6 Occasional 5.8 16.9 15.0 Missing 0.5 0.1 0.2 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 628 3,233 3,883 Note: Total includes women with missing information on type of employment who are not shown separately. Characteristics of Respondents • 51 Table 3.8.1 Use of tobacco: Women Percentage of ever-married women age 15-49 who smoke cigarettes or a chelam or use other tobacco products, according to background characteristics and maternity status, Afghanistan 2015 Uses tobacco Does not use tobacco Number of women Background characteristic Cigarettes Chelam Other tobacco Age 15-19 0.5 0.5 0.5 98.5 1,825 20-24 0.7 1.0 0.9 97.3 6,089 25-29 1.3 1.2 1.1 96.2 6,299 30-34 0.7 1.8 2.2 95.3 4,302 35-39 1.3 2.7 3.2 92.8 4,463 40-44 1.2 4.1 5.2 89.6 3,113 45-49 1.2 7.8 6.9 85.2 3,369 Maternity status Pregnant 0.9 1.7 2.0 95.5 6,412 Breastfeeding (not pregnant) 1.0 1.0 1.5 96.4 2,904 Neither 1.0 3.0 3.0 93.1 20,145 Residence Urban 1.1 1.2 0.6 96.7 6,870 Rural 1.0 2.9 3.2 93.1 22,591 Province1 Kabul 0.8 0.0 0.6 97.6 3,658 Kapisa 0.1 0.0 0.1 99.8 205 Parwan 0.9 0.0 0.1 98.8 625 Wardak 0.6 0.0 2.3 97.1 382 Logar 0.7 0.7 1.6 97.3 472 Nangarhar 0.0 0.0 0.3 99.5 794 Laghman 0.9 0.0 0.9 98.6 583 Panjsher 0.1 0.0 0.1 99.8 54 Baghlan 1.0 0.3 3.6 95.4 839 Bamyan 0.0 0.0 2.6 97.4 303 Ghazni 0.8 0.4 3.2 95.5 1,328 Paktika 0.0 0.0 1.2 98.0 792 Paktya 0.2 0.0 14.9 83.5 542 Khost 0.0 0.0 1.0 99.0 851 Kunarha 0.2 0.0 1.1 98.8 559 Nooristan 0.9 0.1 3.4 95.4 222 Badakhshan 0.1 0.0 0.0 99.9 1,004 Takhar 0.0 0.0 0.0 99.8 1,105 Kunduz 0.3 0.2 0.1 99.5 1,232 Samangan 0.0 0.0 1.9 98.0 330 Balkh 4.7 3.4 6.4 87.2 1,781 Sar-E-Pul 4.8 0.3 3.0 92.1 654 Ghor 0.2 4.6 18.0 77.3 715 Daykundi 0.1 0.0 1.5 98.4 329 Urozgan 0.2 0.0 3.4 96.2 230 Kandahar 0.4 5.3 0.2 93.8 2,227 Jawzjan 4.5 0.5 4.0 92.7 614 Faryab 1.0 0.0 1.4 97.4 2,114 Helmand 3.5 4.2 1.5 91.5 875 Badghis 0.6 15.3 6.1 78.3 650 Herat 0.5 12.7 2.3 85.1 2,316 Farah 0.2 9.1 10.3 83.6 777 Nimroz 0.0 3.8 0.5 95.3 278 Education No education 1.0 2.9 3.0 93.2 24,604 Primary 1.9 0.7 0.9 96.7 2,330 Secondary 0.7 0.2 0.4 98.5 1,971 More than secondary 0.1 0.1 0.0 99.4 556 Wealth quintile Lowest 1.3 4.2 5.5 89.7 5,904 Second 1.0 2.8 3.6 92.9 6,001 Middle 0.9 3.2 2.1 93.9 5,888 Fourth 0.6 1.3 1.2 96.8 6,010 Highest 1.2 1.1 0.5 96.6 5,657 Total 1.0 2.5 2.6 94.0 29,461 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 52 • Characteristics of Respondents Table 3.8.2 Use of tobacco: Men Percentage of ever-married men age 15-49 who smoke cigarettes or a chelam or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in the preceding 24 hours, according to background characteristics, Afghanistan 2015 Uses tobacco Does not use tobacco Number of men Percent distribution of men who smoke cigarettes by number of cigarettes smoked in the past 24 hours Total Number of ciga- rette smok- ers Background characteristic Ciga- rettes Chelam Other tobacco 0 1-2 3-5 6-9 10+ Don’t know/ missing Age 15-19 13.9 0.0 18.4 71.3 142 (0.0) (3.5) (21.9) (20.6) (40.0) (14.0) 100.0 20 20-24 20.4 0.5 25.0 59.0 1,162 0.0 2.0 18.7 17.7 60.0 1.6 100.0 237 25-29 23.7 1.7 29.6 54.0 2,422 0.0 8.1 17.8 14.5 57.6 2.0 100.0 574 30-34 19.6 1.4 31.5 53.7 2,008 0.1 6.6 18.4 18.0 54.7 2.1 100.0 394 35-39 28.1 1.0 30.4 48.0 1,935 0.1 10.8 22.2 13.3 52.0 1.5 100.0 544 40-44 19.2 1.8 37.0 49.6 1,402 0.7 2.8 17.1 13.3 64.8 1.4 100.0 270 45-49 18.8 2.4 39.5 45.9 1,688 2.1 3.9 13.2 8.9 70.0 1.9 100.0 317 Residence Urban 23.6 0.2 17.4 62.0 2,479 0.0 12.0 13.6 10.7 62.7 1.0 100.0 584 Rural 21.4 1.9 36.3 48.7 8,281 0.5 4.9 19.9 15.5 57.0 2.2 100.0 1,771 Province1 Kabul 24.2 0.2 12.8 64.6 1,350 (0.0) (16.1) (14.3) (10.3) (58.4) (0.9) 100.0 327 Kapisa 27.3 0.0 29.0 49.9 63 0.0 6.5 25.2 21.0 41.9 5.4 100.0 17 Parwan 28.7 0.3 29.3 52.6 220 0.0 2.3 5.1 3.0 89.6 0.0 100.0 63 Wardak 18.2 0.3 39.8 48.5 171 4.6 8.6 41.0 12.8 33.0 0.0 100.0 31 Logar 19.5 2.3 16.2 66.5 204 0.0 5.6 15.4 18.7 58.8 1.5 100.0 40 Nangarhar 23.4 0.0 21.3 59.5 273 0.0 3.0 22.4 20.6 54.0 0.0 100.0 64 Laghman 23.2 1.2 37.5 49.2 227 0.0 1.5 28.4 25.1 41.8 3.2 100.0 53 Panjsher 28.2 0.0 26.3 58.5 18 0.0 0.0 6.6 10.4 81.2 1.8 100.0 5 Baghlan 15.8 0.6 56.6 32.6 281 (0.0) (10.9) (7.2) (22.5) (57.7) (1.7) 100.0 45 Bamyan 6.9 0.0 36.0 58.3 94 * * * * * * 100.0 6 Ghazni 25.6 2.2 37.7 45.4 619 0.9 4.4 23.5 28.9 42.2 0.0 100.0 159 Paktika 11.0 1.7 51.5 43.4 322 0.0 1.4 17.3 17.4 63.9 0.0 100.0 35 Paktya 14.0 0.7 48.1 46.3 206 0.0 7.1 7.2 3.9 81.8 0.0 100.0 29 Khost 16.5 0.0 61.0 31.9 334 0.0 2.3 13.7 25.0 59.1 0.0 100.0 55 Kunarha 5.4 0.0 36.0 61.8 151 * * * * * * 100.0 8 Nooristan 27.1 2.0 46.3 36.8 66 0.9 16.2 48.6 17.5 16.2 0.6 100.0 18 Badakhshan 4.0 1.6 12.5 85.3 316 * * * * * * 100.0 12 Takhar 8.2 0.0 15.4 77.1 296 * * * * * * 100.0 24 Kunduz 29.7 3.6 28.9 47.7 479 0.0 0.6 6.1 7.8 85.5 0.0 100.0 143 Samangan 8.3 0.3 22.1 71.6 125 (0.0) (6.9) (28.2) (5.0) (54.6) (5.3) 100.0 10 Balkh 15.7 0.0 25.1 59.6 616 (0.0) (13.1) (29.6) (7.0) (46.9) (3.4) 100.0 97 Sar-E-Pul 15.2 0.0 23.8 61.6 195 (0.0) (2.1) (43.1) (18.2) (36.7) (0.0) 100.0 30 Ghor 20.7 0.5 36.5 45.9 322 0.0 4.3 21.2 21.6 51.4 1.5 100.0 67 Daykundi 2.6 0.0 27.0 71.1 77 * * * * * * 100.0 2 Urozgan 24.9 0.4 40.4 34.4 92 0.0 0.0 0.0 1.1 90.1 8.8 100.0 23 Kandahar 33.6 3.1 55.3 29.9 874 0.0 9.0 6.9 9.0 74.7 0.4 100.0 294 Jawzjan 49.5 1.3 30.1 32.2 218 0.0 0.9 4.3 12.4 81.5 0.9 100.0 108 Faryab 22.3 2.9 11.3 71.5 706 (2.5) (0.6) (47.7) (25.5) (22.9) (0.9) 100.0 157 Helmand 19.3 3.4 31.4 55.4 355 0.0 4.6 5.5 5.3 72.0 12.6 100.0 69 Badghis 13.0 3.7 28.6 58.0 231 (0.0) (0.0) (12.9) (6.6) (57.6) (22.9) 100.0 30 Herat 25.5 2.7 46.8 32.0 863 1.1 3.5 20.6 13.3 56.8 4.7 100.0 220 Farah 37.2 1.9 36.3 31.5 295 0.0 5.0 34.6 17.8 42.6 0.0 100.0 110 Nimroz 2.5 0.0 8.5 89.8 93 * * * * * * 100.0 2 Education No education 23.6 1.9 41.2 42.7 5,447 0.3 4.9 18.8 12.9 60.8 2.3 100.0 1,283 Primary 19.4 0.6 28.8 56.2 1,987 0.0 4.8 26.5 16.2 51.5 1.0 100.0 386 Secondary 23.4 1.6 22.2 58.5 2,632 0.8 11.7 13.2 14.8 58.0 1.5 100.0 616 More than secondary 10.1 0.1 5.9 84.7 695 0.0 4.2 12.1 23.4 57.3 3.0 100.0 70 Wealth quintile Lowest 19.2 2.2 37.1 46.5 2,029 0.6 3.1 18.0 12.5 63.5 2.3 100.0 389 Second 21.5 1.4 39.7 45.0 2,233 1.2 4.6 25.4 18.9 46.5 3.3 100.0 480 Middle 21.6 1.9 38.2 49.1 2,160 0.1 7.1 16.8 10.2 64.4 1.5 100.0 466 Fourth 23.4 1.7 30.5 53.3 2,260 0.1 5.5 17.8 14.6 60.6 1.4 100.0 530 Highest 23.6 0.3 13.7 65.3 2,078 0.0 12.4 13.8 14.8 57.9 1.1 100.0 490 Total 21.9 1.5 32.0 51.8 10,760 0.4 6.6 18.4 14.3 58.4 1.9 100.0 2,355 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Characteristics of Respondents • 53 Table 3.9 Use of drugs Percentage of ever-married women and ever-married men age 15-49 who use drugs and among men using drugs, the percentage using different types of drugs, according to background characteristics, Afghanistan 2015 Background characteristic Women Men Uses drugs Number of women Uses drugs Number of men Percentage by type of drugs used: Opium Heroin Other Number of men Age 15-19 0.1 1,825 0.7 142 * * * 1 20-24 0.2 6,089 1.9 1,162 * * * 22 25-29 0.0 6,299 3.0 2,422 71.6 0.6 53.2 73 30-34 0.1 4,302 2.6 2,008 (26.6) (10.1) (68.2) 53 35-39 0.1 4,463 2.0 1,935 (57.9) (3.9) (38.1) 38 40-44 0.2 3,113 2.9 1,402 (39.1) (0.0) (59.6) 40 45-49 0.4 3,369 2.4 1,688 (27.7) (3.4) (67.6) 40 Residence Urban 0.1 6,870 1.5 2,479 * * * 37 Rural 0.2 22,591 2.8 8,281 44.8 3.2 60.1 231 Education No education 0.1 24,604 3.0 5,447 41.7 3.4 53.5 165 Primary 0.3 2,330 2.1 1,987 (33.4) (7.8) (63.6) 42 Secondary 0.0 1,971 2.3 2,632 (63.6) (1.4) (69.5) 59 More than secondary 0.0 556 0.3 695 * * * 2 Wealth quintile Lowest 0.2 5,904 3.5 2,029 (48.7) (0.0) (50.0) 72 Second 0.2 6,001 2.8 2,233 40.1 4.3 52.9 62 Middle 0.1 5,888 1.7 2,160 (48.4) (10.0) (44.9) 36 Fourth 0.2 6,010 3.2 2,260 (49.3) (3.6) (75.3) 72 Highest 0.0 5,657 1.2 2,078 * * * 26 Total 0.1 29,461 2.5 10,760 45.3 3.6 58.3 268 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Provincial-level estimates are not presented because there are too few cases. 54 • Characteristics of Respondents Table 3.10.1 Knowledge concerning tuberculosis: Women Percentage of ever-married women age 15-49 who have heard of tuberculosis (TB), and among women who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who have ever been told by a doctor or nurse that they have TB, according to background characteristics, Afghanistan 2015 Among all respondents: Among respondents who have heard of TB: Background characteristic Percent- age who have heard of TB Number Percent- age who report that TB is spread through coughing Percent- age who believe that TB can be cured Percent- age who have been told by doctor/ nurse that they have TB Number Age 15-19 78.2 1,825 60.5 80.5 4.6 1,427 20-24 79.6 6,089 61.5 79.8 5.6 4,846 25-29 81.4 6,299 64.1 80.5 5.1 5,125 30-34 80.9 4,302 63.0 80.6 7.5 3,479 35-39 81.8 4,463 64.8 82.6 6.9 3,653 40-44 81.3 3,113 66.6 85.3 9.1 2,532 45-49 87.2 3,369 61.5 80.1 10.4 2,936 Residence Urban 74.3 6,870 76.1 88.2 4.0 5,105 Rural 83.6 22,591 59.7 79.3 7.7 18,892 Province1 Kabul 60.0 3,658 79.4 91.0 5.3 2,194 Kapisa 82.7 205 67.3 92.2 5.1 170 Parwan 92.3 625 60.8 87.0 11.2 577 Wardak 78.3 382 89.5 71.6 14.2 299 Logar 87.2 472 67.3 85.8 6.9 411 Nangarhar 95.9 794 57.7 95.0 4.7 762 Laghman 96.9 583 79.8 93.7 14.8 565 Panjsher 34.6 54 94.2 97.2 24.8 19 Baghlan 88.0 839 81.8 89.8 17.0 739 Bamyan 74.7 303 70.4 92.5 4.2 226 Ghazni 65.7 1,328 48.3 62.7 10.0 873 Paktika 58.9 792 18.9 31.0 6.4 466 Paktya 95.0 542 38.3 52.4 6.9 515 Khost 96.6 851 52.9 84.7 2.0 822 Kunarha 86.5 559 64.2 93.9 6.3 483 Nooristan 62.8 222 23.9 78.6 21.0 140 Badakhshan 65.1 1,004 86.6 91.7 5.6 654 Takhar 92.2 1,105 21.8 89.9 0.9 1,019 Kunduz 70.6 1,232 78.4 52.7 2.3 871 Samangan 65.9 330 62.6 86.8 16.2 217 Balkh 94.3 1,781 74.3 95.3 6.8 1,680 Sar-E-Pul 79.6 654 78.2 72.1 7.6 520 Ghor 98.0 715 92.2 93.7 23.3 700 Daykundi 44.4 329 70.0 86.6 8.0 146 Urozgan 47.3 230 72.7 36.2 5.1 109 Kandahar 95.5 2,227 64.1 53.0 5.0 2,127 Jawzjan 77.1 614 95.3 92.5 1.7 473 Faryab 87.8 2,114 47.4 68.2 1.9 1,855 Helmand 84.0 875 84.0 98.2 10.1 734 Badghis 98.7 650 89.8 97.8 13.5 641 Herat 98.5 2,316 38.4 96.4 4.0 2,281 Farah 67.3 777 59.7 75.3 12.2 523 Nimroz 64.2 278 53.8 83.9 1.7 179 Education No education 81.3 24,604 61.7 79.3 7.4 20,006 Primary 80.2 2,330 65.9 88.1 4.6 1,868 Secondary 83.2 1,971 73.6 92.2 4.0 1,640 More than secondary 87.0 556 82.6 95.0 3.4 484 Wealth quintile Lowest 83.7 5,904 63.1 84.0 9.5 4,941 Second 81.0 6,001 56.7 76.7 7.8 4,862 Middle 84.3 5,888 58.6 76.0 7.1 4,965 Fourth 81.8 6,010 63.8 82.2 5.9 4,919 Highest 76.2 5,657 75.6 87.6 3.6 4,310 Total 81.5 29,461 63.2 81.1 6.9 23,997 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Characteristics of Respondents • 55 Table 3.10.2 Knowledge concerning tuberculosis: Men Percentage of ever-married men age 15-49 who have heard of tuberculosis (TB), and among men who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who have ever been told by a doctor or nurse that they have TB, according to background characteristics, Afghanistan 2015 Among all respondents: Among respondents who have heard of TB: Background characteristic Percent- age who have heard of TB Number Percent- age who report that TB is spread through coughing Percent- age who believe that TB can be cured Percent- age who have been told by doc- tor/nurse that they have TB Number Age 15-19 81.9 142 74.5 84.4 4.4 117 20-24 81.5 1,162 69.8 87.7 2.9 947 25-29 81.9 2,422 72.3 87.8 5.1 1,984 30-34 82.5 2,008 71.9 86.6 5.0 1,656 35-39 85.1 1,935 73.2 88.8 5.4 1,646 40-44 81.2 1,402 72.9 88.9 3.1 1,139 45-49 85.9 1,688 72.4 87.9 5.0 1,451 Residence Urban 79.8 2,479 78.2 91.5 3.7 1,978 Rural 84.1 8,281 70.5 86.8 4.9 6,962 Province1 Kabul 73.0 1,350 82.9 88.2 4.6 985 Kapisa 96.6 63 73.6 95.5 3.4 61 Parwan 95.2 220 81.7 93.9 1.5 210 Wardak 83.5 171 90.8 89.1 6.8 143 Logar 61.6 204 54.4 78.1 6.9 126 Nangarhar 80.8 273 91.1 98.4 3.2 220 Laghman 90.0 227 73.0 96.0 7.2 204 Panjsher 89.6 18 99.1 86.3 0.7 16 Baghlan 67.8 281 47.5 94.8 8.0 191 Bamyan 83.8 94 66.9 88.2 2.5 78 Ghazni 82.5 619 82.4 87.3 5.2 511 Paktika 73.3 322 39.6 68.1 6.5 236 Paktya 98.4 206 73.5 98.7 0.5 202 Khost 98.4 334 62.7 86.2 2.1 329 Kunarha 81.6 151 89.8 91.8 2.6 123 Nooristan 74.5 66 34.8 81.2 14.1 49 Badakhshan 73.5 316 73.1 74.4 9.2 232 Takhar 83.8 296 74.6 91.6 4.5 248 Kunduz 74.9 479 83.8 96.4 11.7 359 Samangan 82.9 125 58.5 64.8 1.1 104 Balkh 83.7 616 83.2 83.0 1.7 515 Sar-E-Pul 94.6 195 72.8 86.3 5.2 184 Ghor 97.7 322 39.5 92.1 3.9 315 Daykundi 78.2 77 65.7 86.1 2.7 60 Urozgan 19.3 92 37.6 86.6 1.9 18 Kandahar 90.2 874 30.0 93.1 2.0 789 Jawzjan 91.4 218 74.0 86.9 3.1 200 Faryab 97.0 706 80.9 91.2 3.4 685 Helmand 83.3 355 86.1 85.2 6.1 296 Badghis 99.9 231 91.6 96.8 12.2 231 Herat 90.8 863 88.1 81.0 4.8 783 Farah 64.1 295 72.9 79.7 4.7 189 Nimroz 46.6 93 87.2 76.9 0.7 44 Education No education 79.9 5,447 67.5 83.3 4.9 4,350 Primary 83.8 1,987 72.5 89.3 3.4 1,665 Secondary 86.4 2,632 77.6 93.5 5.3 2,274 More than secondary 93.8 695 84.8 94.9 3.8 652 Wealth quintile Lowest 84.5 2,029 67.1 83.9 6.9 1,715 Second 79.7 2,233 74.3 85.9 3.6 1,780 Middle 85.2 2,160 68.0 86.3 5.5 1,841 Fourth 83.5 2,260 72.3 90.0 4.0 1,887 Highest 82.6 2,078 79.8 93.2 3.2 1,717 Total 83.1 10,760 72.3 87.9 4.6 8,940 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 56 • Characteristics of Respondents Table 3.11.1 Knowledge concerning hepatitis: Women Percentage of ever-married women age 15-49 who have heard of hepatitis, and among women who have heard of hepatitis, the percentage who believe that hepatitis can be avoided in different ways, according to background characteristics, Afghanistan 2015 Among all respondents: Among respondents who have heard of hepatitis, percentage who report that it can be avoided through: Background characteristic Per- centage who have heard of hepatitis Number Safe sex Safe blood transfer Using dis- posable syringes Avoiding contami- nated food/ water Avoiding contact with infected person Ensuring dentists use sterilized instru- ments Other Don’t know Number Age 15-19 63.6 1,825 16.3 14.6 18.9 21.9 13.7 1.8 5.1 2.4 1,161 20-24 66.3 6,089 17.9 16.0 19.6 20.2 16.0 2.4 4.7 3.1 4,035 25-29 67.2 6,299 17.2 16.7 20.0 19.2 15.8 2.9 5.1 2.2 4,231 30-34 65.9 4,302 16.9 17.6 19.5 21.0 15.4 3.1 4.6 2.6 2,834 35-39 68.7 4,463 15.1 18.3 20.8 20.5 15.2 2.9 4.5 2.6 3,067 40-44 68.4 3,113 16.7 17.8 21.8 22.9 17.8 4.1 4.2 4.4 2,129 45-49 71.0 3,369 16.3 14.7 19.2 20.0 15.1 2.1 5.0 2.2 2,393 Residence Urban 68.1 6,870 24.1 23.2 25.3 27.4 16.4 4.3 3.1 3.1 4,681 Rural 67.1 22,591 14.5 14.7 18.4 18.4 15.5 2.3 5.2 2.6 15,169 Province1 Kabul 54.4 3,658 22.6 26.6 30.3 31.3 15.4 5.1 7.6 4.7 1,992 Kapisa 78.1 205 9.3 12.9 7.9 15.9 1.5 0.5 61.4 6.2 160 Parwan 73.0 625 15.9 22.5 18.5 16.6 14.3 0.8 5.3 2.3 457 Wardak 60.3 382 8.8 19.6 17.0 5.4 7.9 0.7 0.4 0.0 230 Logar 74.9 472 8.0 8.6 36.2 55.2 25.0 0.4 0.8 1.1 353 Nangarhar 97.8 794 8.4 9.5 17.1 7.5 7.6 3.2 14.3 1.3 777 Laghman 94.8 583 50.8 37.6 42.3 52.8 25.5 7.2 1.6 5.9 552 Panjsher 22.1 54 6.0 58.6 58.1 5.7 3.7 0.4 0.0 3.3 12 Baghlan 49.3 839 22.8 25.9 15.4 11.1 4.0 0.5 0.0 0.4 414 Bamyan 62.6 303 3.5 12.4 3.4 34.2 3.7 0.0 0.1 9.8 190 Ghazni 32.9 1,328 11.0 21.2 16.6 12.9 10.7 4.7 0.4 1.0 436 Paktika 22.3 792 3.4 34.8 71.6 8.1 4.0 1.2 0.5 4.8 176 Paktya 94.3 542 5.7 4.1 7.6 10.6 20.9 1.0 0.0 0.3 512 Khost 98.6 851 3.2 4.6 8.9 13.9 14.8 0.6 17.6 0.7 839 Kunarha 89.4 559 9.7 2.3 5.5 9.2 12.7 3.4 2.2 17.6 500 Nooristan 46.7 222 0.2 0.0 3.4 1.3 4.8 0.0 15.6 0.8 104 Badakhshan 51.2 1,004 27.1 19.7 29.5 36.9 26.2 21.0 0.4 0.1 514 Takhar 90.3 1,105 7.0 3.7 3.6 10.5 19.9 1.0 0.2 1.5 998 Kunduz 52.9 1,232 26.0 27.5 26.4 20.9 9.8 15.1 0.0 1.4 652 Samangan 54.0 330 0.5 0.8 0.1 0.4 0.1 2.5 0.0 0.5 178 Balkh 77.4 1,781 18.8 11.9 20.2 36.2 31.7 2.4 0.7 8.0 1,378 Sar-E-Pul 63.4 654 43.4 36.8 42.9 43.9 49.5 6.7 2.1 0.7 415 Ghor 85.0 715 23.4 31.9 28.0 18.6 7.8 0.1 20.9 0.1 607 Daykundi 32.9 329 0.9 0.5 0.0 2.4 1.2 0.0 30.3 10.9 108 Urozgan 45.2 230 0.3 0.0 0.0 1.0 2.0 0.3 0.0 0.1 104 Kandahar 98.3 2,227 12.4 3.5 1.9 11.8 8.0 0.6 0.0 0.2 2,189 Jawzjan 62.0 614 8.6 9.4 11.1 5.4 0.8 0.0 4.2 0.2 381 Faryab 76.7 2,114 8.3 13.5 24.0 3.9 5.4 0.0 6.3 0.5 1,622 Helmand 41.2 875 83.7 89.3 80.5 61.9 38.5 4.4 0.0 0.2 361 Badghis 75.7 650 28.5 29.9 29.6 19.2 21.5 0.6 2.0 0.2 492 Herat 67.6 2,316 13.3 15.1 20.5 22.3 23.9 0.2 3.2 3.2 1,565 Farah 52.1 777 19.2 17.4 20.2 30.8 17.8 1.3 0.1 1.0 405 Nimroz 59.1 278 2.2 1.8 8.3 14.2 4.5 0.5 2.6 21.0 164 Education No education 66.4 24,604 14.4 14.8 17.5 18.9 14.9 2.2 4.7 2.7 16,339 Primary 68.0 2,330 23.1 19.9 26.2 26.7 16.0 3.6 5.7 3.1 1,583 Secondary 74.4 1,971 31.2 28.8 35.0 28.5 21.4 5.7 4.4 3.3 1,467 More than secondary 82.7 556 31.9 36.8 38.5 31.1 23.2 11.4 3.8 0.3 460 Wealth quintile Lowest 61.8 5,904 14.2 14.7 15.7 20.9 18.6 2.8 5.5 3.2 3,649 Second 61.1 6,001 14.6 14.4 16.6 19.3 16.2 2.6 5.6 3.2 3,667 Middle 70.7 5,888 14.4 14.4 18.7 18.3 14.1 1.9 3.5 2.2 4,161 Fourth 72.5 6,010 15.6 15.4 21.5 17.9 14.2 2.2 4.8 2.7 4,358 Highest 71.0 5,657 24.8 24.5 26.7 26.4 15.8 4.7 4.5 2.5 4,014 Total 67.4 29,461 16.8 16.7 20.0 20.5 15.7 2.8 4.7 2.8 19,850 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Characteristics of Respondents • 57 Table 3.11.2 Knowledge concerning hepatitis: Men Percentage of ever-married men age 15-49 who have heard of hepatitis, and among men who have heard of hepatitis, the percentage who believe that hepatitis can be avoided in different ways, according to background characteristics, Afghanistan 2015 Among all respondents: Among respondents who have heard of hepatitis, percentage who report that it can be avoided through: Background characteristic Per- centage who have heard of hepatitis Number Safe sex Safe blood transfer Using dis- posable syringes Avoiding con- taminated food/ water Avoiding contact with infected person Ensuring dentists use sterilized instru- ments Other Don’t know Number Age 15-19 58.7 142 43.1 34.8 42.1 46.7 28.1 24.6 4.7 0.7 84 20-24 67.3 1,162 32.4 28.4 34.3 31.6 22.9 12.5 3.3 1.6 782 25-29 64.6 2,422 34.2 30.9 32.1 30.1 19.1 15.0 4.6 0.9 1,564 30-34 67.0 2,008 32.4 29.0 34.4 30.0 24.6 16.0 5.5 1.4 1,345 35-39 70.9 1,935 32.7 26.6 29.6 27.1 20.8 10.3 5.2 0.5 1,372 40-44 67.0 1,402 29.1 28.3 27.2 31.0 20.6 15.7 5.6 2.1 939 45-49 69.4 1,688 29.1 30.9 34.6 30.1 24.7 11.3 4.1 1.1 1,172 Residence Urban 68.7 2,479 34.6 31.5 33.9 37.3 22.7 14.5 3.0 1.9 1,702 Rural 67.1 8,281 31.2 28.4 31.6 27.7 21.8 13.4 5.3 1.0 5,556 Province1 Kabul 57.9 1,350 41.3 39.6 41.8 39.9 26.5 17.4 5.1 1.9 782 Kapisa 94.3 63 21.3 19.4 11.6 16.4 25.6 0.7 32.6 3.5 59 Parwan 88.6 220 51.3 56.3 54.3 56.6 33.2 20.0 0.6 0.9 195 Wardak 58.6 171 22.7 12.2 9.9 13.4 16.7 0.8 16.6 2.3 100 Logar 49.9 204 35.2 12.7 14.8 22.7 25.2 1.9 0.0 0.6 102 Nangarhar 71.4 273 46.0 21.1 31.4 23.6 37.1 9.7 7.3 0.0 195 Laghman 77.9 227 36.5 33.2 36.1 47.7 33.9 16.6 1.0 2.0 176 Panjsher 56.1 18 88.1 88.8 88.1 86.4 79.4 16.2 0.0 0.0 10 Baghlan 65.4 281 10.6 27.9 22.5 11.0 6.8 1.0 0.0 0.1 184 Bamyan 69.4 94 10.3 16.5 10.3 25.4 11.7 0.9 5.3 3.4 65 Ghazni 33.9 619 25.6 33.1 34.2 18.3 11.0 9.4 0.0 0.2 210 Paktika 41.7 322 2.5 19.7 61.8 5.7 0.9 0.7 0.0 1.6 134 Paktya 97.8 206 56.3 14.4 48.5 54.8 51.2 46.7 0.0 0.0 201 Khost 97.8 334 30.6 22.6 23.7 40.0 22.9 35.6 17.4 0.7 327 Kunarha 77.0 151 51.9 42.2 26.4 14.3 20.8 39.6 1.2 0.9 116 Nooristan 18.2 66 4.1 5.7 8.9 13.9 13.2 4.6 2.0 2.2 12 Badakhshan 57.0 316 34.9 44.2 47.5 45.8 43.4 11.2 0.2 0.0 180 Takhar 79.0 296 8.5 10.2 9.8 4.6 3.4 0.0 6.3 1.4 234 Kunduz 57.7 479 47.5 37.3 41.1 50.1 29.8 15.6 0.0 1.6 277 Samangan 38.9 125 28.4 22.4 30.4 13.2 15.6 7.8 0.0 0.0 49 Balkh 82.7 616 34.8 32.8 29.8 41.7 30.2 12.0 0.6 0.3 510 Sar-E-Pul 68.2 195 27.7 28.1 31.5 32.5 25.8 18.3 2.2 1.0 133 Ghor 73.4 322 45.8 47.7 50.8 34.2 8.3 1.4 34.2 2.6 236 Daykundi 43.9 77 5.4 3.8 2.0 6.1 2.7 0.0 16.2 5.6 34 Urozgan 14.4 92 (12.9) (2.9) (2.7) (12.9) (2.7) (2.7) (0.0) (4.1) 13 Kandahar 89.6 874 5.4 4.2 11.5 29.9 2.9 1.6 7.9 0.8 783 Jawzjan 89.9 218 60.3 59.0 61.1 59.6 54.3 32.2 1.7 0.3 196 Faryab 75.2 706 37.6 31.8 26.3 5.5 19.3 3.1 1.3 0.5 531 Helmand 67.8 355 56.7 60.1 63.1 61.2 54.0 59.9 0.1 2.7 241 Badghis 74.4 231 35.1 40.9 46.0 17.9 44.8 7.0 5.8 1.6 172 Herat 73.4 863 20.4 19.1 20.4 3.5 3.8 10.2 0.3 0.0 633 Farah 41.5 295 53.5 40.1 48.9 46.5 19.5 7.5 0.0 0.1 122 Nimroz 42.0 93 0.0 1.9 6.8 19.2 15.0 0.6 0.0 37.5 39 Education No education 61.1 5,447 23.1 22.1 24.1 24.7 16.4 8.8 5.9 1.3 3,330 Primary 67.1 1,987 33.3 25.6 29.1 29.2 23.4 16.9 3.1 1.1 1,334 Secondary 74.8 2,632 41.7 38.9 42.6 36.8 27.0 17.2 3.8 1.4 1,969 More than secondary 90.0 695 46.2 43.8 48.8 38.2 33.2 21.0 5.6 0.3 625 Wealth quintile Lowest 66.1 2,029 27.6 27.1 28.6 23.5 16.1 7.2 6.5 0.9 1,342 Second 61.8 2,233 33.3 30.6 32.2 30.4 26.4 19.6 3.7 0.6 1,379 Middle 66.5 2,160 30.3 27.2 32.2 29.9 21.3 12.7 6.0 1.4 1,436 Fourth 71.1 2,260 31.9 29.0 33.7 27.5 24.5 12.1 4.5 0.8 1,606 Highest 71.9 2,078 36.5 31.7 33.6 38.3 21.3 16.4 3.3 2.1 1,495 Total 67.4 10,760 32.0 29.2 32.2 30.0 22.0 13.6 4.8 1.2 7,258 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 58 • Characteristics of Respondents Table 3.12.1 Reported prevalence of hepatitis: Women Among ever-married women age 15-49 who have heard of hepatitis, the percentage who have ever been diagnosed with hepatitis by type of hepatitis, and among those, the percentage with specific types of hepatitis, and the percentage of those currently suffering from hepatitis by type of hepatitis diagnosed, according to background characteristics, Afghanistan 2015 Among respondents who have heard of hepatitis: Among those who have ever been diagnosed with hepatitis, percentage diagnosed with specific types of hepatitis: Among respondents currently suffering from hepatitis, percentage having specific types of hepatitis: Background characteristic Percent- age who have ever been told by doctor/ nurse they have/had hepatitis Number of respon- dents Hepatitis A Hepatitis B Hepatitis C Don’t know Percent- age who are currently suffering from hepatitis Number of respon- dents Hepatitis A Hepatitis B Hepatitis C Number of respon- dents Age 15-19 8.8 1,161 61.9 17.9 13.8 10.7 23.3 102 * * * 24 20-24 8.0 4,035 59.2 21.6 10.0 10.0 45.3 323 54.7 41.4 4.2 146 25-29 7.6 4,231 59.4 24.3 10.2 6.8 34.7 320 52.1 36.8 7.3 111 30-34 8.0 2,834 64.1 21.4 12.7 4.6 39.9 227 54.4 35.2 10.4 91 35-39 8.4 3,067 63.5 22.2 12.3 3.0 39.7 258 53.6 31.0 17.4 103 40-44 9.1 2,129 53.5 35.1 10.6 4.7 45.4 193 35.5 53.6 11.2 88 45-49 8.0 2,393 57.7 30.9 5.9 7.0 48.1 192 46.4 45.2 7.2 93 Residence Urban 6.3 4,681 55.6 20.5 11.3 12.7 45.9 295 53.1 38.0 10.4 135 Rural 8.7 15,169 60.9 25.6 10.5 5.1 39.3 1,322 48.6 42.0 8.6 520 Education No education 9.0 16,339 60.4 24.3 10.7 6.2 40.6 1,477 50.0 41.7 8.4 599 Primary 4.8 1,583 54.5 30.3 10.2 10.8 43.5 77 (39.4) (41.6) (10.4) 33 Secondary 3.5 1,467 59.7 26.5 11.9 2.5 42.1 51 * * * 21 More than secondary 2.7 460 37.1 21.0 2.9 38.9 6.9 12 * * * 1 Wealth quintile Lowest 7.8 3,649 50.4 33.6 14.7 3.9 62.1 283 39.9 48.4 13.5 176 Second 9.6 3,667 57.9 27.6 9.2 7.6 39.4 354 47.2 45.6 6.8 139 Middle 10.7 4,161 64.7 25.1 9.3 2.8 35.4 445 55.6 40.6 5.7 157 Fourth 7.6 4,358 63.1 17.5 9.7 11.5 33.4 333 45.1 39.1 8.4 111 Highest 5.1 4,014 61.3 18.0 11.8 8.3 35.1 203 71.5 18.8 9.8 71 Total 8.1 19,850 59.9 24.7 10.6 6.5 40.5 1,617 49.5 41.2 8.9 655 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Provincial-level estimates are not presented because there are too few cases. Characteristics of Respondents • 59 Table 3.12.2 Reported prevalence of hepatitis: Men Among ever-married men age 15-49 who have heard of hepatitis, the percentage who have ever been diagnosed with hepatitis by type of hepatitis, and among those, the percentage with specific types of hepatitis, and the percentage of those currently suffering from hepatitis by type of hepatitis diagnosed, according to background characteristics, Afghanistan 2015 Among respondents who have heard of hepatitis: Among those who have ever been diagnosed with hepatitis, percentage diagnosed with specific types of hepatitis: Among respondents currently suffering from hepatitis, percentage having specific types of hepatitis: Background characteristic Percent- age who have ever been told by doctor/ nurse they have/had hepatitis Number of respon- dents Hepatitis A Hepatitis B Hepatitis C Don’t know Percent- age who are currently suffering from hepatitis Number of respon- dents Hepatitis A Hepatitis B Hepatitis C Number of respon- dents Age 15-19 6.2 84 * * * * * 5 * * * 5 20-24 6.0 782 (31.1) (28.6) (39.7) (6.6) (17.4) 47 * * * 8 25-29 6.3 1,564 36.4 18.2 44.5 0.8 14.4 99 * * * 14 30-34 5.9 1,345 37.4 30.4 30.4 2.2 18.5 79 * * * 15 35-39 6.8 1,372 27.0 18.8 53.9 0.3 12.9 94 * * * 12 40-44 6.4 939 24.7 24.8 46.0 2.3 20.0 60 * * * 12 45-49 5.3 1,172 34.4 16.8 40.9 9.6 10.7 62 * * * 7 Residence Urban 5.8 1,702 43.8 24.2 30.2 5.4 12.2 98 * * * 12 Rural 6.3 5,556 28.4 22.5 46.6 2.3 17.6 348 25.3 65.5 8.1 61 Education No education 7.6 3,330 34.6 21.3 41.3 2.5 16.2 253 (15.7) (77.6) (6.7) 41 Primary 7.6 1,334 26.7 25.5 46.2 5.1 15.2 101 * * * 15 Secondary 3.8 1,969 28.2 24.2 45.7 1.8 16.1 74 * * * 12 More than secondary 2.9 625 * * * * * 18 * * * 5 Wealth quintile Lowest 7.0 1,342 14.5 34.3 50.7 0.7 29.7 94 * * * 28 Second 5.7 1,379 16.3 18.3 64.1 1.2 16.3 79 * * * 13 Middle 7.1 1,436 42.3 23.1 33.4 1.2 11.6 102 * * * 12 Fourth 6.4 1,606 37.6 16.6 41.9 6.6 10.7 103 * * * 11 Highest 4.5 1,495 49.1 21.6 23.8 5.4 13.6 68 * * * 9 Total 6.1 7,258 31.8 22.9 43.0 3.0 16.4 446 25.5 62.7 10.9 73 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Provincial-level estimates are not presented because there are too few cases. 60 • Characteristics of Respondents Table 3.13 Households with members diagnosed with cancer Percentage of households with any member diagnosed with cancer, and percentage of households with any member diagnosed with cancer by type of cancer, according to residence and wealth quintile, Afghanistan 2015 Percentage of households by type of cancer Residence/ wealth quintile Percentage of households with member(s) diagnosed with cancer Number of households Breast cancer Lung cancer Liver cancer Intestinal cancer Cervical cancer Other1 Number of households with any member diagnosed with cancer Residence Urban 2.3 6,266 12.6 11.1 17.2 31.0 0.4 34.9 145 Rural 2.9 18,129 23.5 17.9 20.0 16.1 5.9 13.7 526 Wealth quintile Lowest 2.5 4,867 20.3 18.7 10.3 31.1 4.0 15.9 122 Second 2.8 4,798 26.8 26.7 17.7 13.2 5.1 13.1 133 Middle 2.6 4,833 19.8 18.1 21.3 12.5 4.9 13.2 127 Fourth 3.2 4,972 22.9 10.7 25.6 13.5 8.0 13.2 160 Highest 2.6 4,924 15.4 9.2 20.3 28.6 0.8 37.0 129 Total 2.8 24,395 21.2 16.4 19.4 19.4 4.7 18.3 671 Note: Provincial-level estimates are not presented because there are too few cases. 1 Includes “don’t know/missing” Table 3.14 Deaths of household members diagnosed with cancer Among households with any member diagnosed with cancer, the percentage with deaths related to specific types of cancer that occurred in the 3 years preceding the survey, according to residence and wealth quintile, Afghanistan 2015 Residence/ wealth quintile No deaths Breast cancer Lung cancer Liver cancer Intestinal cancer Cervical cancer Other1 Number of households with any member diagnosed with cancer Residence Urban 62.5 8.9 4.6 9.1 8.0 0.3 7.9 145 Rural 33.8 17.8 11.4 14.9 11.6 3.6 8.2 526 Wealth quintile Lowest 31.2 11.8 15.1 6.3 23.8 2.2 10.0 122 Second 36.5 25.8 13.8 11.3 6.7 4.2 9.3 133 Middle 36.7 16.6 11.1 14.5 8.8 3.2 7.2 127 Fourth 37.2 14.4 7.2 22.1 8.3 4.0 6.5 160 Highest 58.8 10.8 3.5 11.5 7.8 0.4 8.0 129 Total 40.0 15.9 10.0 13.6 10.8 2.9 8.1 671 Note: Provincial-level estimates are not presented because there are too few cases. 1 Includes “don’t know/missing” Marriage and Sexual Activity • 61 MARRIAGE AND SEXUAL ACTIVITY 4 Key Findings  Age at first marriage: Marriage is universal in Afghanistan, but women marry more than four years earlier than men, on average. The median age at first marriage for women and men is 18.5 years and 22.9 years, respectively.  Polygyny: Six percent of married women 15-49 reported that their husband had multiple wives, while only 3% of married men reported having more than one wife.  Sexual initiation: The median age at first sexual intercourse for women age 25-49 is 18.7 years, close to the median age at first marriage. A similar pattern is observed among men age 25-49 with the median age at first sexual intercourse (23.2 years) being slightly higher than age at marriage, implying that most women and men in Afghanistan wait until marriage to initiate sexual intercourse. arriage and sexual activity help determine the extent to which women are exposed to the risk of pregnancy. Thus, they are important determinants of fertility levels. However, the timing and circumstances of marriage and sexual activity also have profound consequences for women’s and men’s lives. This chapter presents information on marital status, polygyny, age at first marriage, and age at first sexual intercourse for both women and men. In the context of the 2015 AfDHS, the term marriage refers to legal or formal marriage. 4.1 MARITAL STATUS Currently married Women and men who report being married at the time of the survey. Sample: Women and men age 15-49 Marriage is universal in Afghanistan; by age 35-39, only 1% of women and men have never been married. Seventeen percent of women age 15-19 were married at the time of the survey, as compared with only 3% of men in that age group, indicating that women marry at a younger age than men. The percentage of currently married respondents increases rapidly between age 20-24 and age 35-39, from 66% to 97% among women and from 31% to 98% among men (Table 4.1). Overall, a higher proportion of men (42%) than women (30%) have never been married (Figure 4.1). A lower proportion of men than women are divorced, separated, or widowed (less than 1% and 2%, respectively). M 62 • Marriage and Sexual Activity Figure 4.1 Marital status Percent distribution of women and men age 15-19 by current marital status 4.2 POLYGYNY Polygyny Women who report that their husband has other wives are considered to be in a polygynous marriage. Sample: Currently married women age 15-49 Six percent of married women reported that their husband had other wives (Table 4.2.1). Men were less likely than women to report multiple wives (3% versus 6%) (Table 4.2.2). Patterns by background characteristics  Older women are slightly more likely than younger women to have co-wives. For instance, 3% of married women age 20-24 reported having co-wives, as compared with 11% of women age 45-49 (Table 4.2.1).  Rural women (7%) are slightly more likely to report having co-wives than urban women (5%).  Women who live in households in the highest wealth quintile are slightly less likely to have co-wives than those who live in households in the lowest quintile (5% versus 8%).  Men living in Nooristan, Ghor, Bamyan, and Farah are more likely to report having multiple wives (6% each) than men in other provinces (Figure 4.2). Never married 30% Married 68% Divorced or separated 0.2% Widowed 2% Women Never married 42% Married 57% Divorced or separated 0.1% Widowed 0.3% Men Marriage and Sexual Activity • 63 Figure 4.2 Polygyny Percent of currently married men age 15-49 in polygynous union 4.3 AGE AT FIRST MARRIAGE Median age at first marriage Age by which half of respondents have been married. Sample: Women and men age 25-49 The start of marriage is an important social and demographic indicator; women’s duration of exposure to the risk of pregnancy depends primarily on the age at which they first get married. On average, women who marry early are more likely to have their first child at a younger age and give birth to more children overall, contributing to higher fertility. Women tend to marry earlier than men in Afghanistan. Among respondents age 25-49, the median age at first marriage is 18.5 years among women and 22.9 years among men (Table 4.3). While 45% of women marry by age 18, only 11% of men marry that young. 64 • Marriage and Sexual Activity Patterns by background characteristics  Educated women and men marry later than those with less education. Although there is only a small difference in the median age at first marriage between men with the least and most education, this difference is 4 years among women (Table 4.4 and Figure 4.3).  Median age at first marriage among women is lowest (15.9 years) in Nimroz, and the figure in that province is 2.5 years below the national average. 4.4 AGE AT FIRST SEXUAL INTERCOURSE Median age at first sexual intercourse Age by which half of respondents have had sexual intercourse. Sample: Women and men age 25-49 The median age at first sexual intercourse is 18.7 years among women and 23.2 years among men, a difference of more than 4 years (Table 4.5). The fact that the median age at first sexual intercourse is higher than the median age at first marriage implies that most women and men in Afghanistan engage in sex after marriage (Figure 4.4). Women in Afghanistan are exposed to the risk of pregnancy at an early age, with 11 percent of women age 25-49 having had their first sexual intercourse by age 15 and 42% before age 18 (Table 4.5). By age 20, 62% of women have had sexual intercourse. On the contrary, men wait longer than women to initiate sex. One percent of men age 25-49 had sex before age 15, 9% had sex before age 18, and 21% had initiated sexual intercourse by age 20. Patterns by background characteristics  Educated women wait longer before having sex. There is more than a 4-year difference in the median age at first sex between women with no education and those with more than a secondary education (Table 4.6). However, this relationship is not as prominent among men.  Among both women and men, differences in median age at first sexual intercourse by household wealth and residence are minimal.  The median age at first sexual intercourse among women ranges from 16.3 years in Nimroz to 20.8 years in Paktika and Logar. Figure 4.3 Median age at first marriage by education Figure 4.4 Median age at first sexual intercourse and first marriage among women and men 18.3 18.6 19.9 22.522.5 22.9 23.4 23.9 No education Primary Secondary More than secondary Median age at first marriage in years, by education Women age 25-49 Men age 25-49 18.7 18.5 23.2 22.9 Median age at first sex Median age at first marriage Median age in years Women age 25-49 Men age 25-49 Marriage and Sexual Activity • 65 4.5 RECENT SEXUAL ACTIVITY The survey also collected data on recent sexual activity among ever-married women and men age 15-49. Eighty-seven percent of women and 94% of men reported having sexual intercourse within the 4 weeks before the survey. For more information on recent sexual activity, see Tables 4.7.1 and 4.7.2. For additional information on age at first marriage, see Table 4.3. LIST OF TABLES For more information on marriage and sexual activity, see the following tables:  Table 4.1 Current marital status  Table 4.2.1 Number of women’s co-wives  Table 4.2.2 Number of men’s wives  Table 4.3 Age at first marriage  Table 4.4 Median age at first marriage by background characteristics  Table 4.5 Age at first sexual intercourse  Table 4.6 Median age at first sexual intercourse by background characteristics  Table 4.7.1 Recent sexual activity: Women  Table 4.7.2 Recent sexual activity: Men 66 • Marriage and Sexual Activity Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Afghanistan 2015 Marital status Age Never married Married Divorced Separated Widowed Total Percentage of respondents currently in union Number of respondents WOMEN 15-19 83.0 16.9 0.0 0.0 0.1 100.0 16.9 10,747 20-24 33.1 66.2 0.1 0.0 0.6 100.0 66.2 9,103 25-29 9.6 88.9 0.1 0.0 1.4 100.0 88.9 6,967 30-34 2.5 95.8 0.2 0.1 1.5 100.0 95.8 4,411 35-39 0.9 97.1 0.0 0.2 1.8 100.0 97.1 4,503 40-44 0.2 95.4 0.1 0.1 4.2 100.0 95.4 3,120 45-49 0.0 90.8 0.1 0.1 9.0 100.0 90.8 3,369 Total 30.2 67.9 0.1 0.1 1.7 100.0 67.9 42,221 MEN 15-19 96.9 3.1 0.0 0.0 0.0 100.0 3.1 4,618 20-24 69.5 30.5 0.0 0.0 0.0 100.0 30.5 3,804 25-29 20.0 79.6 0.0 0.0 0.4 100.0 79.6 3,027 30-34 5.9 93.4 0.0 0.1 0.5 100.0 93.4 2,134 35-39 1.4 98.1 0.0 0.0 0.5 100.0 98.1 1,962 40-44 0.9 97.9 0.1 0.6 0.5 100.0 97.9 1,415 45-49 0.4 98.1 0.1 0.1 1.3 100.0 98.1 1,696 Total 42.3 57.2 0.0 0.1 0.3 100.0 57.2 18,656 Marriage and Sexual Activity • 67 Table 4.2.1 Number of women's co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Afghanistan 2015 Background characteristic Number of co-wives Total Number of women 0 1 2+ Don't know Missing Age 15-19 97.5 1.6 0.2 0.3 0.3 100.0 1,812 20-24 96.6 3.0 0.1 0.1 0.2 100.0 6,028 25-29 95.0 4.2 0.2 0.4 0.2 100.0 6,193 30-34 91.0 8.1 0.5 0.3 0.1 100.0 4,226 35-39 90.7 8.0 0.7 0.3 0.2 100.0 4,375 40-44 90.2 8.6 0.4 0.5 0.3 100.0 2,977 45-49 88.6 9.8 1.0 0.4 0.2 100.0 3,060 Residence Urban 95.0 4.3 0.3 0.2 0.1 100.0 6,673 Rural 92.5 6.5 0.4 0.4 0.2 100.0 21,998 Province1 Kabul 95.0 4.1 0.3 0.5 0.1 100.0 3,571 Kapisa 95.2 3.8 0.4 0.5 0.2 100.0 197 Parwan 96.7 2.5 0.0 0.0 0.8 100.0 592 Wardak 89.2 2.2 0.4 7.5 0.7 100.0 378 Logar 95.8 3.9 0.2 0.0 0.1 100.0 465 Nangarhar 93.7 5.8 0.4 0.0 0.1 100.0 769 Laghman 93.4 5.7 0.4 0.1 0.4 100.0 567 Panjsher 94.5 3.4 0.5 0.8 0.8 100.0 53 Baghlan 94.5 3.8 0.0 0.9 0.9 100.0 835 Bamyan 90.7 8.5 0.6 0.2 0.0 100.0 295 Ghazni 94.4 4.6 0.3 0.5 0.2 100.0 1,319 Paktika 91.5 8.1 0.0 0.0 0.4 100.0 779 Paktya 94.3 4.4 0.1 0.1 1.1 100.0 529 Khost 95.3 4.1 0.1 0.5 0.0 100.0 845 Kunarha 87.5 8.6 3.9 0.0 0.0 100.0 549 Nooristan 88.8 9.5 1.3 0.1 0.3 100.0 209 Badakhshan 96.2 3.7 0.0 0.0 0.2 100.0 968 Takhar 90.2 8.7 0.6 0.4 0.0 100.0 1,070 Kunduz 95.4 2.4 0.4 1.2 0.7 100.0 1,214 Samangan 95.7 4.1 0.1 0.0 0.1 100.0 319 Balkh 92.1 7.4 0.5 0.0 0.0 100.0 1,742 Sar-E-Pul 93.6 6.3 0.1 0.0 0.0 100.0 644 Ghor 91.4 8.3 0.3 0.0 0.0 100.0 708 Daykundi 91.4 7.9 0.5 0.1 0.0 100.0 319 Urozgan 93.0 6.4 0.1 0.4 0.2 100.0 229 Kandahar 93.6 5.8 0.3 0.1 0.1 100.0 2,193 Jawzjan 96.9 2.8 0.3 0.0 0.0 100.0 603 Faryab 92.0 7.4 0.6 0.0 0.0 100.0 2,030 Helmand 94.2 4.9 0.1 0.1 0.7 100.0 874 Badghis 89.7 10.1 0.2 0.0 0.0 100.0 640 Herat 90.5 8.7 0.5 0.0 0.3 100.0 2,166 Farah 88.1 10.9 0.7 0.4 0.0 100.0 717 Nimroz 89.0 10.4 0.6 0.0 0.0 100.0 264 Education No education 92.6 6.4 0.4 0.3 0.2 100.0 23,921 Primary 95.3 3.7 0.3 0.5 0.1 100.0 2,257 Secondary 96.2 3.6 0.0 0.0 0.2 100.0 1,951 More than secondary 93.3 5.5 0.2 1.0 0.0 100.0 542 Wealth quintile Lowest 91.3 7.8 0.5 0.3 0.2 100.0 5,757 Second 92.4 6.6 0.4 0.4 0.2 100.0 5,823 Middle 93.1 5.9 0.2 0.4 0.4 100.0 5,736 Fourth 94.1 4.8 0.6 0.4 0.1 100.0 5,846 Highest 94.5 4.8 0.3 0.3 0.1 100.0 5,509 Total 93.1 6.0 0.4 0.3 0.2 100.0 28,671 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 68 • Marriage and Sexual Activity Table 4.2.2 Number of men's wives Percent distribution of currently married men age 15-49 by number of wives, according to background characteristics, Afghanistan 2015 Number of wives Background characteristic 1 2+ Missing Total Number of men Age 15-19 99.5 0.0 0.5 100.0 142 20-24 99.7 0.1 0.2 100.0 1,160 25-29 99.2 0.6 0.2 100.0 2,410 30-34 98.0 1.8 0.2 100.0 1,992 35-39 96.5 3.5 0.0 100.0 1,925 40-44 94.6 5.3 0.1 100.0 1,385 45-49 92.7 6.8 0.5 100.0 1,664 Residence Urban 97.4 2.5 0.0 100.0 2,452 Rural 96.8 2.9 0.3 100.0 8,227 Province1 Kabul 97.4 2.6 0.0 100.0 1,332 Kapisa 98.0 1.7 0.3 100.0 63 Parwan 97.1 2.0 0.9 100.0 218 Wardak 99.1 0.9 0.0 100.0 170 Logar 97.5 1.5 1.0 100.0 203 Nangarhar 97.8 1.8 0.4 100.0 272 Laghman 97.9 0.9 1.2 100.0 226 Panjsher 97.9 1.2 0.9 100.0 18 Baghlan 99.4 0.6 0.0 100.0 281 Bamyan 94.4 5.6 0.0 100.0 93 Ghazni 97.8 1.7 0.5 100.0 617 Paktika 95.8 4.2 0.0 100.0 318 Paktya 97.4 1.9 0.7 100.0 202 Khost 98.0 2.0 0.0 100.0 334 Kunarha 96.3 3.7 0.0 100.0 149 Nooristan 93.8 6.2 0.0 100.0 66 Badakhshan 98.8 1.2 0.0 100.0 311 Takhar 94.6 5.4 0.0 100.0 296 Kunduz 97.1 1.8 1.1 100.0 472 Samangan 98.8 1.2 0.0 100.0 125 Balkh 96.7 2.9 0.4 100.0 613 Sar-E-Pul 96.6 3.4 0.0 100.0 192 Ghor 94.3 5.7 0.0 100.0 315 Daykundi 97.1 2.7 0.2 100.0 77 Urozgan 96.1 3.7 0.2 100.0 92 Kandahar 98.0 1.9 0.1 100.0 870 Jawzjan 98.2 1.8 0.0 100.0 218 Faryab 95.0 4.9 0.1 100.0 704 Helmand 97.2 2.6 0.2 100.0 355 Badghis 94.7 5.3 0.0 100.0 230 Herat 96.8 3.2 0.0 100.0 852 Farah 94.4 5.6 0.0 100.0 294 Nimroz 94.7 5.3 0.0 100.0 93 Education No education 96.3 3.5 0.2 100.0 5,411 Primary 97.8 2.0 0.2 100.0 1,969 Secondary 97.3 2.5 0.2 100.0 2,615 More than secondary 98.2 1.6 0.2 100.0 685 Wealth quintile Lowest 95.7 3.9 0.4 100.0 2,018 Second 97.4 2.4 0.2 100.0 2,211 Middle 97.1 2.6 0.4 100.0 2,145 Fourth 97.2 2.7 0.1 100.0 2,253 Highest 97.2 2.8 0.0 100.0 2,052 Total 96.9 2.9 0.2 100.0 10,679 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Marriage and Sexual Activity • 69 Table 4.3 Age at first marriage Percentage of women and men age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Afghanistan 2015 Current age Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage 15 18 20 22 25 WOMEN 15-19 2.7 na na na na 83.0 10,747 a 20-24 8.8 34.8 54.6 na na 33.1 9,103 19.5 25-29 14.2 45.1 64.4 77.8 87.0 9.6 6,967 18.5 30-34 16.5 49.8 69.5 82.7 91.4 2.5 4,411 18.0 35-39 13.8 45.7 64.8 79.4 90.3 0.9 4,503 18.4 40-44 13.5 44.8 66.9 82.5 93.1 0.2 3,120 18.4 45-49 9.6 36.5 59.0 74.0 88.9 0.0 3,369 19.0 20-49 12.3 41.9 62.0 na na 12.2 31,473 18.8 25-49 13.8 44.8 65.0 79.2 89.7 3.7 22,371 18.5 MEN 15-19 0.3 na na na na 96.9 4,618 a 20-24 0.8 7.3 16.7 na na 69.5 3,804 a 25-29 2.0 10.7 23.6 41.8 68.2 20.0 3,027 22.8 30-34 3.0 12.3 27.1 47.1 71.3 5.9 2,134 22.3 35-39 3.2 11.5 22.5 38.2 65.4 1.4 1,962 23.0 40-44 2.3 10.8 27.7 45.1 69.5 0.9 1,415 22.6 45-49 1.5 8.9 19.7 33.9 65.4 0.4 1,696 23.6 20-49 2.0 9.9 22.0 na na 24.4 14,038 a 25-49 2.4 10.9 24.0 41.4 68.0 7.6 10,234 22.9 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse. na = Not applicable due to censoring a = Omitted because less than 50% of the women or men began living with their spouse for the first time before reaching the beginning of the age group 70 • Marriage and Sexual Activity Table 4.4 Median age at first marriage by background characteristics Median age at first marriage among women age 20-49 and age 25-49, and median age at first marriage among men age 25-49, according to background characteristics, Afghanistan 2015 Background characteristic Women age Men age 20-49 25-49 25-49 Residence Urban 18.8 18.3 23.6 Rural 18.7 18.5 22.7 Province1 Kabul 19.6 19.2 23.8 Kapisa 18.8 18.2 22.5 Parwan 19.7 19.0 22.7 Wardak 19.9 19.5 23.2 Logar a 20.7 23.0 Nangarhar 18.6 18.1 22.5 Laghman 19.1 19.1 22.2 Panjsher a 18.9 a Baghlan 18.8 18.6 24.2 Bamyan 18.1 17.7 22.4 Ghazni 19.8 19.4 22.5 Paktika a 20.5 23.5 Paktya 19.6 19.7 22.9 Khost 18.3 18.3 21.9 Kunarha 18.1 17.6 21.5 Nooristan 18.6 18.7 23.2 Badakhshan 17.7 17.3 23.1 Takhar 18.2 17.2 23.1 Kunduz 19.3 18.6 22.8 Samangan 18.7 18.3 22.8 Balkh 19.2 18.6 24.1 Sar-E-Pul 19.0 18.7 24.0 Ghor 17.1 17.0 20.9 Daykundi 18.0 17.5 22.3 Urozgan 18.6 18.4 22.4 Kandahar 17.8 17.7 22.1 Jawzjan 19.8 19.3 22.4 Faryab 19.5 19.2 23.4 Helmand 17.9 17.9 21.5 Badghis 16.6 16.7 23.2 Herat 18.0 17.8 22.4 Farah 17.3 17.2 21.3 Nimroz 16.2 15.9 21.7 Education No education 18.5 18.3 22.5 Primary 18.7 18.6 22.9 Secondary a 19.9 23.4 More than secondary a 22.5 23.9 Wealth quintile Lowest 18.3 18.1 22.5 Second 18.8 18.6 22.8 Middle 19.0 18.8 22.5 Fourth 18.6 18.4 22.6 Highest 19.2 18.6 24.1 Total 18.8 18.5 22.9 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. a = Omitted because less than 50% of the respondents began living with their spouse for the first time before reaching the beginning of the age group Marriage and Sexual Activity • 71 Table 4.5 Age at first sexual intercourse Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Afghanistan 2015 Current age Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse 15 18 20 22 25 Number Median age at first intercourse WOMEN 15-19 1.8 na na na na 83.0 10,747 a 20-24 6.7 31.1 51.3 na na 33.1 9,103 19.9 25-29 10.5 41.6 61.0 74.7 84.3 9.6 6,967 18.8 30-34 11.9 45.6 64.9 78.4 87.4 2.5 4,411 18.4 35-39 12.6 44.2 63.7 77.5 87.4 0.9 4,503 18.6 40-44 12.3 42.8 64.1 80.0 88.7 0.2 3,120 18.6 45-49 9.3 36.5 56.9 72.4 85.5 0.0 3,369 19.2 20-49 9.9 39.1 59.0 na na 12.2 31,473 19.0 25-49 11.3 42.3 62.2 na na 3.7 22,371 18.7 15-24 4.0 na na na na 60.1 19,850 a MEN 15-19 0.2 na na na na 96.9 4,618 a 20-24 0.5 6.0 15.3 na na 69.5 3,804 a 25-29 1.6 8.3 21.5 40.3 65.5 20.0 3,027 23.0 30-34 1.7 10.7 24.1 43.8 68.1 5.9 2,134 22.6 35-39 1.2 8.1 20.1 36.1 63.3 1.4 1,962 23.4 40-44 1.4 7.9 22.9 41.0 65.0 0.9 1,415 23.2 45-49 0.9 7.8 17.9 30.0 59.7 0.4 1,696 23.9 20-49 1.1 7.9 19.7 na na 24.4 14,038 24.1 25-49 1.4 8.6 21.4 na na 7.6 10,234 23.2 15-24 0.3 na na na na 84.5 8,422 a na = Not applicable due to censoring a = Omitted because less than 50% of the respondents had sexual intercourse for the first time before reaching the beginning of the age group 72 • Marriage and Sexual Activity Table 4.6 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 20-49 and age 25-49, and median age at first sexual intercourse among men age 25-49, according to background characteristics, Afghanistan 2015 Background characteristic Women age Men age 20-49 25-49 25-49 Residence Urban 19.1 18.5 24.0 Rural 19.0 18.8 23.0 Province1 Kabul 19.8 19.3 24.2 Kapisa 18.9 18.3 22.3 Parwan 19.9 19.2 23.2 Wardak a 20.0 23.5 Logar a 20.8 23.3 Nangarhar 19.0 18.5 23.0 Laghman 19.3 19.3 22.7 Panjsher a 19.4 a Baghlan 19.0 18.6 a Bamyan 18.2 17.8 22.9 Ghazni a 19.8 22.8 Paktika a 20.8 23.7 Paktya a 20.3 23.3 Khost 18.8 18.8 22.4 Kunarha 18.3 17.8 22.2 Nooristan 18.7 18.8 23.3 Badakhshan 18.1 17.7 23.7 Takhar 18.2 17.2 23.3 Kunduz 19.6 18.9 23.4 Samangan 18.9 18.4 22.9 Balkh 19.3 18.7 24.4 Sar-E-Pul 19.2 18.7 23.8 Ghor 17.5 17.4 21.3 Daykundi 19.1 18.9 22.3 Urozgan 18.7 18.6 22.7 Kandahar 18.1 17.9 22.4 Jawzjan a 19.7 22.7 Faryab 19.6 19.4 23.8 Helmand 18.4 18.5 21.9 Badghis 16.9 17.0 23.7 Herat 18.2 18.0 22.5 Farah 17.6 17.4 21.3 Nimroz 16.5 16.3 21.9 Education No education 18.8 18.6 22.8 Primary 19.0 18.9 23.2 Secondary a 19.9 23.7 More than secondary a 22.8 24.2 Wealth quintile Lowest 18.6 18.3 22.7 Second 19.0 18.9 23.1 Middle 19.3 18.9 22.9 Fourth 19.0 18.7 22.9 Highest 19.5 18.8 24.4 Total 19.0 18.7 23.2 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. a = Omitted because less than 50% of the respondents had intercourse for the first time before reaching the beginning of the age group Marriage and Sexual Activity • 73 Table 4.7.1 Recent sexual activity: Women Percent distribution of ever-married women age 15-49 by timing of last sexual intercourse, according to background characteristics, Afghanistan 2015 Background characteristic Timing of last sexual intercourse Total Number of women Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 89.0 8.7 1.9 0.4 100.0 1,825 20-24 88.0 9.9 1.8 0.4 100.0 6,089 25-29 89.8 6.7 2.6 0.9 100.0 6,299 30-34 90.1 7.0 2.4 0.5 100.0 4,302 35-39 87.7 7.4 4.5 0.4 100.0 4,463 40-44 83.5 10.3 5.6 0.6 100.0 3,113 45-49 73.3 13.8 12.3 0.6 100.0 3,369 Marital status Married 88.8 8.8 1.9 0.5 100.0 28,671 Divorced/separated/ widowed 3.7 10.7 83.4 2.2 100.0 790 Marital duration2 0-4 years 89.8 8.7 1.1 0.3 100.0 6,473 5-9 years 90.5 7.3 1.7 0.5 100.0 5,807 10-14 years 91.1 6.9 1.4 0.5 100.0 5,075 15-19 years 88.4 8.4 2.3 0.8 100.0 4,194 20-24 years 89.1 8.1 2.4 0.4 100.0 3,555 25+ years 80.3 15.6 3.5 0.5 100.0 3,215 Married more than once 88.4 8.7 1.4 1.5 100.0 352 Residence Urban 84.4 10.3 4.5 0.8 100.0 6,870 Rural 87.2 8.4 4.0 0.5 100.0 22,591 Province3 Kabul 83.8 11.4 4.5 0.3 100.0 3,658 Kapisa 88.5 6.9 4.5 0.1 100.0 205 Parwan 90.5 4.9 4.3 0.3 100.0 625 Wardak 89.1 8.0 1.9 1.0 100.0 382 Logar 93.9 4.6 1.5 0.0 100.0 472 Nangarhar 88.5 8.0 3.2 0.2 100.0 794 Laghman 91.1 6.8 2.0 0.2 100.0 583 Panjsher 86.3 10.2 3.4 0.1 100.0 54 Baghlan 91.2 6.9 0.9 1.0 100.0 839 Bamyan 81.2 11.5 6.8 0.5 100.0 303 Ghazni 89.3 7.9 1.6 1.2 100.0 1,328 Paktika 86.3 10.2 2.7 0.8 100.0 792 Paktya 89.3 5.9 2.7 2.1 100.0 542 Khost 92.6 4.1 3.2 0.1 100.0 851 Kunarha 85.0 6.4 1.5 7.1 100.0 559 Nooristan 83.4 10.8 5.3 0.6 100.0 222 Badakhshan 85.9 9.3 4.8 0.0 100.0 1,004 Takhar 75.4 18.4 6.3 0.0 100.0 1,105 Kunduz 91.9 5.9 2.0 0.2 100.0 1,232 Samangan 88.7 7.0 4.2 0.0 100.0 330 Balkh 87.9 9.5 2.4 0.3 100.0 1,781 Sar-E-Pul 78.1 15.9 5.9 0.1 100.0 654 Ghor 93.6 4.2 2.3 0.0 100.0 715 Daykundi 75.1 16.6 8.0 0.3 100.0 329 Urozgan 97.0 1.7 0.8 0.5 100.0 230 Kandahar 86.2 10.0 2.7 1.0 100.0 2,227 Jawzjan 91.0 7.3 1.6 0.0 100.0 614 Faryab 78.7 11.2 10.0 0.2 100.0 2,114 Helmand 91.4 5.8 0.5 2.4 100.0 875 Badghis 90.0 7.8 2.2 0.0 100.0 650 Herat 89.5 3.8 6.7 0.0 100.0 2,316 Farah 80.1 11.0 8.7 0.1 100.0 777 Nimroz 82.7 12.0 4.6 0.6 100.0 278 Education No education 86.3 8.8 4.3 0.6 100.0 24,604 Primary 86.0 9.7 4.1 0.3 100.0 2,330 Secondary 89.0 8.7 2.0 0.3 100.0 1,971 More than secondary 91.2 5.5 2.9 0.5 100.0 556 (Continued…) 74 • Marriage and Sexual Activity Table 4.7.1—Continued Background characteristic Timing of last sexual intercourse Total Number of women Within the past 4 weeks Within 1 year1 One or more years Missing Wealth quintile Lowest 87.9 8.3 3.5 0.3 100.0 5,904 Second 86.9 8.6 3.9 0.6 100.0 6,001 Middle 85.8 9.2 4.3 0.7 100.0 5,888 Fourth 86.1 8.7 4.6 0.6 100.0 6,010 Highest 85.9 9.4 4.1 0.7 100.0 5,657 Total 86.5 8.8 4.1 0.6 100.0 29,461 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Marriage and Sexual Activity • 75 Table 4.7.2 Recent sexual activity: Men Percent distribution of ever-married men age 15-49 by timing of last sexual intercourse, according to background characteristics, Afghanistan 2015 Background characteristic Timing of last sexual intercourse Total Number of men Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 96.4 3.1 0.1 0.4 100.0 142 20-24 93.3 5.8 0.1 0.7 100.0 1,162 25-29 94.7 2.8 1.3 1.1 100.0 2,422 30-34 93.9 4.4 0.6 1.1 100.0 2,008 35-39 93.8 4.5 0.5 1.1 100.0 1,935 40-44 91.1 4.3 2.7 1.8 100.0 1,402 45-49 92.7 4.3 2.3 0.7 100.0 1,688 Marital status Married 94.2 4.2 0.6 1.1 100.0 10,679 Divorced/separated/ widowed 1.5 7.6 88.0 2.9 100.0 81 Marital duration2 0-4 years 94.6 3.9 0.8 0.7 100.0 2,605 5-9 years 95.1 3.4 0.1 1.5 100.0 2,310 10-14 years 95.4 3.7 0.0 0.9 100.0 2,088 15-19 years 91.7 6.6 0.0 1.6 100.0 1,364 20-24 years 93.6 3.2 1.8 1.4 100.0 1,225 25+ years 90.9 6.5 2.1 0.5 100.0 675 Married more than once 95.4 3.8 0.4 0.4 100.0 412 Residence Urban 90.8 5.1 2.4 1.8 100.0 2,479 Rural 94.3 3.9 0.9 0.9 100.0 8,281 Province3 Kabul 89.5 5.4 3.5 1.6 100.0 1,350 Kapisa 96.3 3.7 0.0 0.0 100.0 63 Parwan 97.3 1.2 0.9 0.6 100.0 220 Wardak 91.4 7.4 0.7 0.5 100.0 171 Logar 94.5 5.2 0.3 0.0 100.0 204 Nangarhar 89.6 5.1 0.4 4.9 100.0 273 Laghman 95.6 4.4 0.0 0.0 100.0 227 Panjsher 97.0 2.1 0.8 0.0 100.0 18 Baghlan 95.3 1.8 0.0 2.9 100.0 281 Bamyan 80.4 14.2 2.5 2.8 100.0 94 Ghazni 95.6 3.2 0.0 1.1 100.0 619 Paktika 94.2 4.3 1.4 0.1 100.0 322 Paktya 94.9 3.0 2.1 0.0 100.0 206 Khost 98.1 1.7 0.1 0.1 100.0 334 Kunarha 93.9 0.8 0.3 5.0 100.0 151 Nooristan 89.5 7.9 0.8 1.7 100.0 66 Badakhshan 96.9 1.7 1.4 0.0 100.0 316 Takhar 93.0 7.0 0.0 0.0 100.0 296 Kunduz 95.0 3.5 1.2 0.3 100.0 479 Samangan 97.9 1.9 0.0 0.2 100.0 125 Balkh 93.1 4.3 0.4 2.2 100.0 616 Sar-E-Pul 95.6 2.7 1.5 0.2 100.0 195 Ghor 93.5 4.0 2.5 0.0 100.0 322 Daykundi 93.7 5.5 0.8 0.0 100.0 77 Urozgan 98.9 1.1 0.0 0.0 100.0 92 Kandahar 88.4 8.0 0.8 2.9 100.0 874 Jawzjan 96.2 3.6 0.2 0.0 100.0 218 Faryab 95.4 1.5 3.1 0.0 100.0 706 Helmand 96.0 2.3 0.0 1.7 100.0 355 Badghis 95.4 4.2 0.4 0.0 100.0 231 Herat 96.6 1.9 1.2 0.3 100.0 863 Farah 87.4 11.1 1.3 0.2 100.0 295 Nimroz 93.0 4.6 0.2 2.1 100.0 93 Education No education 93.2 4.3 1.2 1.3 100.0 5,447 Primary 92.8 4.2 1.9 1.1 100.0 1,987 Secondary 94.9 3.8 0.6 0.7 100.0 2,632 More than secondary 92.1 5.3 1.7 0.9 100.0 695 (Continued…) 76 • Marriage and Sexual Activity Table 4.7.2—Continued Background characteristic Timing of last sexual intercourse Total Number of men Within the past 4 weeks Within 1 year1 One or more years Missing Wealth quintile Lowest 95.2 3.5 0.6 0.6 100.0 2,029 Second 94.6 3.7 0.9 0.8 100.0 2,233 Middle 93.8 5.2 0.7 0.3 100.0 2,160 Fourth 92.9 3.9 1.2 2.0 100.0 2,260 Highest 90.7 4.7 2.9 1.7 100.0 2,078 Total 93.5 4.2 1.2 1.1 100.0 10,760 1 Excludes men who had sexual intercourse within the last 4 weeks 2 Excludes men who are not currently married 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Fertility • 77 FERTILITY 5 Key Findings  Total fertility rate: The current total fertility rate in Afghanistan is 5.3 children per woman.  Patterns of fertility: Fertility levels are slightly lower among urban women, and they are much lower among highly educated women and women in wealthy households than among their peers.  Birth intervals: The median birth interval in Afghanistan is 28.4 months.  Age at first birth: The median age at first birth among women is 20.1 years.  Teenage pregnancy: Twelve percent of women age 15- 19 have already begun childbearing. he number of children that a woman bears depends on many factors, including the age she begins childbearing, how long she waits between births, and her fecundity. Postponing first births and extending the interval between births have played roles in reducing fertility levels in many countries. These factors also have positive health consequences. In contrast, short birth intervals (of less than 24 months) can lead to harmful outcomes for both newborns and their mothers, such as preterm birth, low birth weight, and death. Childbearing at a very young age is associated with an increased risk of complications during pregnancy and childbirth and higher rates of neonatal mortality. This chapter describes the current level of fertility in Afghanistan and some of its proximate determinants. It presents information on the total fertility rate, birth intervals, insusceptibility to pregnancy (due to postpartum amenorrhea, postpartum abstinence, or menopause), age at first birth, and teenage childbearing. 5.1 CURRENT FERTILITY Total fertility rate The average number of children a woman would have by the end of her childbearing years if she bore children at the current age-specific fertility rates. Age-specific fertility rates are calculated for the 3 years before the survey, based on detailed birth histories provided by women. Sample: Women age 15-49 T 78 • Fertility The total fertility rate (TFR) in Afghanistan is 5.3 children per woman. Childbearing peaks at age 20-29 and drops sharply thereafter (Table 5.1, Figure 5.1). Patterns by background characteristics  As expected, rural women have slightly more children on average than urban women (5.4 versus 4.8 children per woman). Rural fertility is higher than urban fertility in every age group (Table 5.1).  On average, women with no education have two more children than women with more than a secondary education (Table 5.2, Figure 5.2).  Although the total fertility rate is not uniformly associated with wealth, the rate is lowest among women in the highest wealth quintile (4.6 children) (Table 5.2).  The fertility rate is highest among women living in Nooristan and Urozgan (8.9 children and 8.8 children, respectively) and lowest among women in Ghazni (2.8 children) (Figure 5.3). Figure 5.3 Fertility by province Total fertility rate for the 3 years before the survey Figure 5.1 Age-specific fertility rates by residence Figure 5.2 Total fertility by education 0 50 100 150 200 250 300 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Births per 1,000 women Urban Rural Total 5.5 4.7 4.3 3.6 5.3 No education Primary Secondary More than secondary Total TFR for the 3 years before the survey Fertility • 79 5.2 CHILDREN EVER BORN AND LIVING The survey also collected data on the number of children ever born to women and those still living. On average, of the 7.1 children ever born to women age 45-49, 6.3 survived to the time of the survey. In Afghanistan, 3% of older, currently married women have never given birth; since voluntary childlessness is rare, this is often viewed as a measure of primary sterility. For complete information on children ever born by mother’s age, see Table 5.4. 5.3 BIRTH INTERVALS Median birth interval Number of months since the preceding birth by which half of children are born. Sample: Non-first births in the 5 years before the survey A birth interval is the length of time between two successive live births. Information on birth intervals provides insight into birth spacing patterns, which affect fertility as well as maternal, infant, and child mortality. Studies have shown that short birth intervals are associated with an increased risk of death for both the mother and the baby, particularly when the birth interval is less than 24 months. The median birth interval in Afghanistan is 28.4 months. One-third of children (32%) are born less than 24 months after a previous birth (Table 5.5, Figure 5.4). Patterns by background characteristics  Older women have longer birth intervals than younger women. The median birth interval is 10 months longer among women age 40-49 than among women age 20-29 (36.3 months versus 26.5 months) (Table 5.5).  Birth intervals are shorter, by about 6 months, among women with no education, a primary education, or a secondary education than among women with more than a secondary education.  The median birth interval ranges from 25 months in Laghman, Paktya, Nooristan, and Kandahaar to 37 months in Daykundi (Table 5.5). Figure 5.4 Birth intervals 7-17 months 12% 18-23 months 21% 24-35 months 36% 36-47 months 16% 48-59 months 8% 60+ months 8% Percent distribution of non-first births by number of months preceding birth 80 • Fertility 5.4 INSUSCEPTIBILITY TO PREGNANCY Median duration of postpartum amenorrhea Number of months after childbirth by which time half of women have begun menstruating. Sample: Women who gave birth in the 3 years before the survey Median duration of postpartum insusceptibility Number of months after childbirth by which time half of women are no longer protected against pregnancy by either postpartum amenorrhea or abstinence from sex. Sample: Women who gave birth in the 3 years before the survey Most women are insusceptible to pregnancy during the first 2 months after a birth, and continued postpartum amenorrhea and abstinence from sexual intercourse may protect them from pregnancy for longer. In Afghanistan, the median duration of postpartum amenorrhea is 3.3 months, and women abstain from sexual intercourse for a median duration of 1.3 months after giving birth. Women are insusceptible to pregnancy after childbirth (either because they are amenorrheic or because they are still abstaining from sex after birth) for a median duration of 3.9 months (Table 5.6). Patterns by background characteristics  Rural women remain amenorrheic longer than do urban women (3.8 months versus 2.5 months), but durations of sexual abstinence are similar in the two groups (1.2 months versus 1.6 months) (Table 5.7).  The median duration of postpartum amenorrhea decreases as wealth increases, falling from 5.2 months in the lowest quintile to 2.4 months in the highest quintile. Differences in postpartum abstinence are small. Menopause Women are considered to have reached menopause if they are neither pregnant nor postpartum amenorrheic and have not had a menstrual period in the 6 months before the survey, or if they report being menopausal. Sample: Ever-married women age 30-49 Once women reach menopause, they are no longer able to become pregnant. Overall, 13% of women age 30-49 in Afghanistan are menopausal. This proportion increases with age, rising from 2% among women age 30-34 to 50% among women age 48-49 (Table 5.8). 5.5 AGE AT FIRST BIRTH Median age at first birth Age by which half of women have had their first child. Sample: Women age 20-49 and 25-49 The median age at first birth in Afghanistan is 20.1 years among women age 25-49 (Table 5.9). Fertility • 81 Patterns by background characteristics  Highly educated women have their first child much later than other women. Women with more than a secondary education begin childbearing 4 years later than women with no education or only a primary education (24 years versus 20 years) (Table 5.10, Figure 5.5).  Childbearing starts at about the same age among women in the various wealth quintiles. 5.6 TEENAGE CHILDBEARING Teenage childbearing Percentage of women age 15-19 who have given birth or are pregnant with their first child. Sample: Women age 15-19 In Afghanistan, 12% of women age 15-19 have begun childbearing: 8% have given birth, and an additional 4% are pregnant with their first child (Table 5.11). Patterns by background characteristics  Teenagers in rural areas are more likely to begin childbearing than their urban peers: 14% of rural teenagers have a child or are pregnant, as compared with 8% of urban teenagers.  Teenagers with a secondary education are less likely to have a child or be pregnant than those with no education or only a primary education. Less than half as many teenagers with a secondary education have begun childbearing as those with no education (7% versus 16%).  Teenage childbearing is less common in the wealthiest households; 9% of women age 15-19 from the highest wealth quintile have begun childbearing, compared with 15% of young women in the lowest wealth quintile (Table 5.11). Figure 5.5 Median age at first birth by education 19.9 19.9 21.3 24.3 20.1 No education Primary Secondary More than secondary Total Median age at first birth among women age 25-49 82 • Fertility LIST OF TABLES For more information on fertility levels and some of the determinants of fertility, see the following tables:  Table 5.1 Current fertility  Table 5.2 Fertility by background characteristics  Table 5.3 Trends in age-specific fertility rates  Table 5.4 Children ever born and living  Table 5.5 Birth intervals  Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility  Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility  Table 5.8 Menopause  Table 5.9 Age at first birth  Table 5.10 Median age at first birth  Table 5.11 Teenage pregnancy and motherhood Fertility • 83 Table 5.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the 3 years preceding the survey, by residence, Afghanistan 2015 Residence Age group Urban Rural Total 15-19 62 83 78 20-24 255 264 261 25-29 251 277 271 30-34 204 214 212 35-39 124 151 144 40-44 43 70 64 45-49 26 28 28 TFR (15-49) 4.8 5.4 5.3 GFR 158 181 175 CBR 36 37 37 Note: Age-specific fertility rates are per 1,000 women. Rates for the 45-49 age group may be slightly biased due to truncation. Rates are for the period 1-36 months prior to the interview. As the survey was based on an ever-married sample, the number of women was increased using a factor based on all de facto women listed in the household who had never been married. The “all women” factors were based on age in the household and background information available at the household level. Women who have never been married are presumed not to have given birth. TFR: Total fertility rate, expressed per woman GFR: General fertility rate, expressed per 1,000 women age 15-44 CBR: Crude birth rate, expressed per 1,000 population 84 • Fertility Table 5.2 Fertility by background characteristics Total fertility rate for the 3 years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49, by background characteristics, Afghanistan 2015 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 4.8 9.0 6.7 Rural 5.4 17.3 7.0 Province1 Kabul 4.6 7.7 6.7 Kapisa 4.8 9.2 7.5 Parwan 5.7 10.4 7.7 Wardak 4.2 10.4 6.2 Logar 4.2 16.5 7.1 Nangarhar 6.4 11.2 8.2 Laghman 7.3 19.2 7.9 Panjsher 3.2 11.9 7.0 Baghlan 4.4 16.9 6.2 Bamyan 5.4 11.0 7.1 Ghazni 2.8 22.0 5.7 Paktika 5.3 25.9 7.0 Paktya 5.2 13.3 5.7 Khost 5.6 18.8 6.9 Kunarha 6.8 15.9 8.2 Nooristan 8.9 26.0 8.1 Badakhshan 5.3 11.8 7.0 Takhar 5.7 13.6 7.8 Kunduz 4.4 19.8 6.4 Samangan 5.1 14.8 6.4 Balkh 5.5 13.7 7.0 Sar-E-Pul 4.8 15.3 6.1 Ghor 5.8 23.8 8.4 Daykundi 5.2 9.4 6.6 Urozgan 8.8 15.7 8.8 Kandahar 6.5 19.2 7.5 Jawzjan 3.9 17.7 7.4 Faryab 6.2 13.8 6.6 Helmand 4.7 14.8 5.7 Badghis 6.6 17.8 7.4 Herat 4.8 14.6 6.8 Farah 5.4 28.8 7.9 Nimroz 5.4 16.2 7.6 Education No education 5.5 17.7 7.0 Primary 4.7 10.7 6.8 Secondary 4.3 6.9 5.9 More than secondary 3.6 7.0 4.4 Wealth quintile Lowest 5.3 17.4 7.0 Second 5.4 18.9 7.0 Middle 5.8 16.8 7.1 Fourth 5.3 14.2 6.9 Highest 4.6 9.3 6.6 Total 5.3 15.2 7.0 Note: Total fertility rates are for the period 1-36 months prior to the interview. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Fertility • 85 Table 5.3 Trends in age-specific fertility rates Age-specific fertility rates for 5-year periods preceding the survey, by mother's age at the time of the birth, Afghanistan 2015 Mother's age at birth Number of years preceding survey 0-4 5-9 10-14 15-19 15-19 87 150 174 166 20-24 269 337 335 342 25-29 280 331 360 358 30-34 222 294 311 [345] 35-39 146 196 [250] 40-44 69 [109] 45-49 [28] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of the interview. Table 5.4 Children ever born and living Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever born, and mean number of living children, according to age group, Afghanistan 2015 Age Number of children ever born Total Number of women Mean number of children ever born Mean number of living children 0 1 2 3 4 5 6 7 8 9 10+ ALL WOMEN 15-19 92.0 6.2 1.6 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 10,747 0.10 0.09 20-24 44.5 18.8 20.2 11.7 3.4 1.1 0.3 0.0 0.0 0.0 0.0 100.0 9,103 1.15 1.10 25-29 13.7 8.2 16.2 21.5 20.7 10.7 5.8 2.3 0.7 0.1 0.0 100.0 6,967 2.99 2.82 30-34 7.1 2.0 5.6 10.7 19.1 20.1 17.9 9.5 4.9 2.2 1.1 100.0 4,411 4.66 4.32 35-39 3.7 2.5 3.1 5.4 11.3 16.5 16.1 16.5 11.4 8.2 5.2 100.0 4,503 5.86 5.40 40-44 3.0 1.8 2.1 3.6 6.3 9.6 16.2 17.3 15.7 11.0 13.3 100.0 3,120 6.76 6.07 45-49 2.8 1.2 2.7 3.5 7.1 9.1 12.9 13.8 14.7 10.4 21.7 100.0 3,369 7.13 6.28 Total 36.9 7.7 8.7 8.4 8.4 7.3 6.8 5.5 4.2 2.8 3.4 100.0 42,221 2.95 2.70 CURRENTLY MARRIED WOMEN 15-19 53.1 36.1 9.3 1.2 0.3 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,812 0.59 0.55 20-24 16.9 28.1 30.2 17.6 5.0 1.6 0.5 0.1 0.0 0.0 0.0 100.0 6,028 1.73 1.64 25-29 4.4 8.9 18.0 23.6 23.1 12.0 6.5 2.6 0.8 0.1 0.0 100.0 6,193 3.33 3.14 30-34 4.5 1.9 5.5 10.8 19.6 20.7 18.6 9.8 5.1 2.3 1.2 100.0 4,226 4.81 4.46 35-39 2.7 2.6 3.1 5.3 11.4 16.5 16.3 16.7 11.6 8.4 5.3 100.0 4,375 5.92 5.47 40-44 2.9 1.7 2.0 3.5 6.0 9.6 15.7 17.6 16.0 11.3 13.8 100.0 2,977 6.83 6.13 45-49 2.8 0.9 1.7 3.5 7.3 8.4 13.3 13.8 15.0 11.1 22.3 100.0 3,060 7.25 6.40 Total 9.5 11.1 12.5 12.0 12.1 10.4 9.8 7.9 6.0 4.0 4.8 100.0 28,671 4.22 3.87 86 • Fertility Table 5.5 Birth intervals Percent distribution of non-first births in the 5 years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Afghanistan 2015 Background characteristic Months since preceding birth Total Number of non-first births Median number of months since preceding birth 7-17 18-23 24-35 36-47 48-59 60+ Age 15-19 37.1 30.6 22.3 8.4 0.4 1.2 100.0 222 20.4 20-29 14.3 24.1 38.3 14.7 5.6 3.1 100.0 13,134 26.5 30-39 9.1 17.7 33.6 18.3 9.9 11.3 100.0 9,940 31.2 40-49 6.0 13.7 29.7 18.6 12.3 19.6 100.0 2,398 36.3 Sex of preceding birth Male 10.9 20.6 35.9 16.4 8.4 7.9 100.0 13,102 28.7 Female 12.5 20.9 35.1 16.3 7.3 7.8 100.0 12,591 28.1 Survival of preceding birth Living 11.0 20.6 35.9 16.7 8.0 7.9 100.0 24,277 28.6 Dead 23.5 23.0 29.8 11.2 5.8 6.7 100.0 1,416 25.2 Birth order 2-3 13.8 23.6 37.5 15.1 5.5 4.4 100.0 10,349 26.8 4-6 10.1 19.1 35.0 16.7 9.5 9.5 100.0 10,022 29.8 7+ 10.6 18.2 32.7 18.2 9.2 11.1 100.0 5,322 30.6 Residence Urban 13.8 17.1 30.7 17.0 10.5 10.9 100.0 5,722 30.8 Rural 11.1 21.8 36.9 16.2 7.1 6.9 100.0 19,971 27.9 Province1 Kabul 14.5 16.9 32.0 15.3 10.8 10.5 100.0 2,907 30.2 Kapisa 19.6 15.7 33.7 17.6 6.0 7.5 100.0 179 27.7 Parwan 13.9 18.0 36.7 15.7 10.1 5.6 100.0 588 28.9 Wardak 6.3 19.0 39.8 22.8 6.2 5.9 100.0 254 31.3 Logar 6.5 19.6 42.9 21.2 5.9 3.8 100.0 383 28.8 Nangarhar 16.1 21.6 33.9 18.1 5.9 4.5 100.0 864 27.8 Laghman 25.4 19.4 33.2 13.0 5.2 3.8 100.0 678 25.0 Panjsher 26.8 16.0 27.6 10.8 8.9 9.9 100.0 32 27.1 Baghlan 8.5 19.4 31.1 18.8 10.1 12.1 100.0 634 32.2 Bamyan 7.6 18.6 35.0 18.8 9.5 10.5 100.0 269 31.3 Ghazni 4.6 23.3 33.2 15.0 10.2 13.7 100.0 603 32.1 Paktika 5.0 26.1 45.7 17.1 4.5 1.7 100.0 682 27.0 Paktya 18.3 25.9 36.9 11.1 3.8 4.0 100.0 486 25.4 Khost 14.4 25.8 36.3 15.3 4.9 3.2 100.0 847 25.8 Kunarha 11.2 19.0 40.4 18.7 5.6 5.1 100.0 608 28.3 Nooristan 6.3 37.6 46.1 7.5 1.9 0.5 100.0 294 25.4 Badakhshan 6.9 16.5 27.8 21.1 12.1 15.7 100.0 750 35.5 Takhar 11.1 16.7 35.8 18.7 10.1 7.6 100.0 1,015 29.8 Kunduz 10.7 20.4 34.8 20.0 6.7 7.4 100.0 997 29.9 Samangan 8.4 19.3 37.1 23.2 5.9 6.0 100.0 300 30.1 Balkh 10.3 21.5 32.2 18.0 7.9 10.2 100.0 1,517 30.2 Sar-E-Pul 3.8 15.0 33.6 25.8 11.2 10.6 100.0 482 35.1 Ghor 5.9 24.3 46.6 15.3 5.4 2.5 100.0 762 28.1 Daykundi 7.3 12.4 28.7 19.5 13.0 19.1 100.0 257 36.5 Urozgan 4.7 32.1 55.5 6.1 1.2 0.3 100.0 355 25.9 Kandahar 17.9 25.4 35.3 10.5 6.0 4.9 100.0 2,511 25.4 Jawzjan 8.1 22.0 37.9 19.6 6.7 5.6 100.0 515 29.1 Faryab 14.5 20.5 29.9 15.4 9.5 10.2 100.0 1,897 29.3 Helmand 11.6 19.0 42.1 15.2 5.5 6.8 100.0 760 27.7 Badghis 10.5 16.4 34.4 21.2 9.3 8.2 100.0 631 31.2 Herat 6.7 16.9 33.8 18.7 10.7 13.2 100.0 1,748 32.6 Farah 9.9 28.9 45.1 10.5 3.8 1.9 100.0 636 26.5 Nimroz 7.7 13.9 34.3 23.9 8.7 11.5 100.0 231 33.6 Education No education 11.5 20.8 35.7 16.6 7.9 7.6 100.0 22,159 28.3 Primary 12.0 19.7 35.4 16.3 7.1 9.4 100.0 1,847 28.8 Secondary 14.7 21.6 34.2 14.3 7.7 7.6 100.0 1,377 27.1 More than secondary 10.1 16.6 31.1 12.9 13.1 16.2 100.0 310 34.3 Wealth quintile Lowest 7.2 20.3 38.7 18.1 8.3 7.4 100.0 5,066 29.5 Second 10.0 23.9 37.6 15.6 6.9 5.9 100.0 5,301 27.5 Middle 13.3 23.0 36.7 14.6 6.3 6.0 100.0 5,518 26.9 Fourth 13.9 20.0 33.5 16.2 8.1 8.3 100.0 5,315 28.2 Highest 14.3 15.5 30.4 17.7 10.0 12.1 100.0 4,493 31.7 Total 11.7 20.7 35.5 16.4 7.9 7.8 100.0 25,693 28.4 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Fertility • 87 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility Percentage of births in the 3 years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Afghanistan 2015 Months since birth Percentage of births for which the mother is: Number of births Amenorrheic Abstaining Insusceptible1 <2 72.7 65.0 85.0 795 2-3 53.1 8.2 55.2 1,272 4-5 41.5 3.5 43.3 1,115 6-7 37.9 2.7 39.5 1,081 8-9 32.6 3.6 34.1 1,011 10-11 21.9 1.2 22.5 758 12-13 11.8 2.5 13.4 1,166 14-15 13.8 2.7 14.9 1,422 16-17 8.0 1.8 9.7 1,236 18-19 9.5 3.5 13.0 973 20-21 5.4 1.3 6.8 582 22-23 4.4 1.3 5.0 542 24-25 4.0 1.4 5.0 1,357 26-27 1.9 1.7 3.6 1,574 28-29 2.0 1.2 2.8 1,464 30-31 1.6 0.8 2.4 1,113 32-33 1.3 1.0 2.1 803 34-35 2.8 1.9 4.5 574 Total 17.8 5.1 19.7 18,838 Median 3.3 1.3 3.9 na Mean 6.9 2.5 7.6 na Note: Estimates are based on status at the time of the survey. na = Not applicable 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the 3 years preceding the survey, by background characteristics, Afghanistan 2015 Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility1 Mother's age 15-29 3.3 1.4 3.9 30-49 3.6 1.2 4.0 Residence Urban 2.5 1.6 3.2 Rural 3.8 1.2 4.3 Education No education 3.4 1.3 3.9 Primary a 1.6 5.4 Secondary 2.2 1.6 2.7 More than secondary a a a Wealth quintile Lowest 5.2 1.5 5.7 Second 3.4 1.3 4.0 Middle 3.2 0.9 3.8 Fourth 3.0 1.1 3.6 Highest 2.4 1.7 3.3 Total 3.3 1.3 3.9 Note: Medians are based on status at the time of the survey (current status). As there are too few cases, this information could not be presented for provinces. 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth a = Not calculated because of censoring 88 • Fertility Table 5.8 Menopause Percentage of ever-married women age 30-49 who are menopausal, by age, Afghanistan 2015 Age Percentage menopausal1 Number of women 30-34 2.0 4,302 35-39 4.9 4,463 40-41 14.0 1,783 42-43 16.5 1,011 44-45 26.8 1,465 46-47 28.8 976 48-49 50.1 1,247 Total 13.3 15,247 1 Percentage of women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred 6 or more months preceding the survey Table 5.9 Age at first birth Percentage of women age 15-49 who gave birth by specific exact ages, percentage who have never given birth, and median age at first birth, according to current age, Afghanistan 2015 Percentage who gave birth by exact age Percentage who have never given birth Current age 15 18 20 22 25 Number of women Median age at first birth 15-19 0.5 na na na na 92.0 10,747 a 20-24 3.3 20.4 38.5 na na 44.5 9,103 a 25-29 5.2 29.1 50.9 67.6 81.8 13.7 6,967 19.9 30-34 5.9 33.0 53.8 71.3 84.9 7.1 4,411 19.6 35-39 4.5 27.7 49.8 67.8 83.1 3.7 4,503 20.0 40-44 5.7 29.7 48.8 67.7 85.9 3.0 3,120 20.1 45-49 4.7 22.9 41.0 57.5 78.0 2.8 3,369 21.0 20-49 4.7 26.3 46.3 na na 18.0 31,473 a 25-49 5.2 28.7 49.5 66.9 82.7 7.3 22,371 20.1 na = Not applicable due to censoring a = Omitted because less than 50% of women had a birth before reaching the beginning of the age group Fertility • 89 Table 5.10 Median age at first birth Median age at first birth among women age 25-49, according to background characteristics, Afghanistan 2015 Background characteristic Women age 25-49 Residence Urban 20.1 Rural 20.0 Province1 Kabul 20.6 Kapisa 19.9 Parwan 21.2 Wardak 21.2 Logar 21.4 Nangarhar 19.7 Laghman 20.3 Panjsher 20.6 Baghlan 19.9 Bamyan 19.3 Ghazni 21.1 Paktika 21.6 Paktya 21.1 Khost 19.7 Kunarha 19.7 Nooristan 20.0 Badakhshan 19.1 Takhar 18.8 Kunduz 20.3 Samangan 20.0 Balkh 20.6 Sar-E-Pul 20.3 Ghor 19.2 Daykundi 19.5 Urozgan 19.4 Kandahar 19.1 Jawzjan 20.7 Faryab 20.7 Helmand 19.3 Badghis 18.2 Herat 19.5 Farah 18.1 Nimroz 18.0 Education No education 19.9 Primary 19.9 Secondary 21.3 More than secondary 24.3 Wealth quintile Lowest 19.7 Second 20.2 Middle 20.3 Fourth 19.9 Highest 20.3 Total 20.1 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 90 • Fertility Table 5.11 Teenage pregnancy and motherhood Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child, and percentage who have begun childbearing, by background characteristics, Afghanistan 2015 Background characteristic Percentage of women age 15-19 who: Percentage who have begun childbearing Number of women Have had a live birth Are pregnant with first child Age 15 0.2 0.5 0.7 1,809 16 1.3 1.1 2.4 2,648 17 4.3 3.6 7.9 1,931 18 13.3 7.2 20.5 2,729 19 22.9 8.4 31.3 1,630 Residence Urban 6.1 2.0 8.2 3,087 Rural 8.7 4.9 13.6 7,684 Education No education 10.4 6.0 16.4 5,572 Primary 6.9 2.4 9.3 1,743 Secondary 4.9 1.8 6.7 3,091 More than secondary * * * 166 Wealth quintile Lowest 8.9 5.7 14.6 1,979 Second 8.1 4.8 12.9 2,096 Middle 9.7 3.7 13.4 1,982 Fourth 7.1 3.9 11.1 2,225 Highest 6.4 2.6 9.1 2,508 Total 8.0 4.1 12.1 10,747 Note: As the survey was based on an ever-married sample, the number of women was increased using a factor based on all de facto women listed in the household who had never been married. The “all women” factors were based on age in the household and background information available at the household level. Women who have never been married are assumed to have never been pregnant. Because the number of all women is not normalized, the weighted numbers will not necessarily sum to the “total.” An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility Preferences • 91 FERTILITY PREFERENCES 6 Key Findings  Desire for another child: While 14% of currently married women age 15-49 want to have another child soon, 24% want to wait at least 2 years.  Limiting childbearing: Women are more likely than men to want no more children, no matter how many children they already have. Overall, 26% of women and 20% of men want to limit childbearing. Among married respondents with four children, 24% of women and 20% of men say they do not want another child (including those who have been sterilized).  Ideal family size: Ever-married women want 5.6 children, on average, while men want 6.2 children.  Unwanted births: Of all births and current pregnancies in the past 5 years, 89% were wanted at the time of conception, 6% were mistimed, and 4% were unwanted. nformation on fertility preferences can help family planning program planners assess the desire for children, the extent of mistimed and unwanted pregnancies, and the demand for contraception to space or limit births. This information may suggest the direction that fertility patterns will take in the future. This chapter presents information on whether and when married women and men want more children, ideal family size, whether the last birth was wanted at that time, and the theoretical fertility rate if all unwanted births were prevented. 6.1 DESIRE FOR ANOTHER CHILD Desire for another child Women and men were asked whether they wanted more children and, if so, how long they would prefer to wait before the next child. Women and men who are sterilized are assumed not to want any more children. Sample: Currently married women and men age 15-49 Fourteen percent of currently married women age 15-49 want to have another child soon. Half of women either want to wait at least 2 years before having another child (24%) or want no more children (26%, including sterilized women) (Table 6.1). Almost one-quarter of married women are undecided as to whether they want another child (23%). Patterns by background characteristics  The more children a woman already has, the less likely she is to want another. One in two married women with no children want to have a child within the next 2 years, as compared with one in four I 92 • Fertility Preferences (26%) women with one child and fewer than one in 10 women with four or more children (Table 6.1).  Men are more likely than women to want another child, no matter how many children they already have. For example, 36% of married men with one child want another, compared with 26% of married women with one child (Table 6.1). The desire to limit childbearing is higher among women than men, regardless of the number of living children (Figure 6.1).  There is a considerable difference between urban and rural women in the desire to limit childbearing. Married women living in urban areas are almost twice as likely to want to limit childbearing as those in rural areas (39% and 21%, respectively) (Table 6.2.1).  Wealthy women are more likely than other women to want to limit childbearing, no matter how many children they already have. Women in the highest wealth quintile who have three children are almost four times as likely as their peers in the lowest quintile to want no more children (Table 6.2.1). For additional information on men’s desire to limit childbearing, see Table 6.2.2. 6.2 IDEAL FAMILY SIZE Ideal family size Respondents with no children were asked “If you could choose exactly the number of children to have in your whole life, how many would that be?” Respondents who had children were asked “If you could go back to the time when you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?” Sample: Ever-married women and men age 15-49 If women could choose their family size, they would choose to have 5.6 children, on average, while men would choose to have 6.2 children (Table 6.3, Figure 6.2). Patterns by background characteristics  The more children women already have, the more children they consider ideal. For example, on average, women who have no children or one child consider 4.9 children to be ideal. In contrast, women who have six or more children consider 6.4 children to be ideal (Figure 6.3).  Older women want larger families. Ideal family size rises from 4.9 children among women age 15-19 to 6.2 children among women age 45-49 (Table 6.4). Figure 6.1 Desire to limit childbearing Figure 6.2 Ideal family size 1 1 8 13 24 35 51 1 1 4 10 20 28 43 0 1 2 3 4 5 6+ Number of living children Percentage of currently married women and men age 15-49 who want no more children Women Men 5.6 5.6 6.2 6.2 Ever-married Currently married Mean ideal number of children among women and men age 15-49 Women Men Fertility Preferences • 93  Ideal family size decreases with increasing education. Women with no education consider 5.8 children as their ideal family size, compared with 4.8 children and fewer among educated women. Women with more than a secondary education want 1.6 fewer children than women with no education (Table 6.4).  Women in wealthy households want smaller families. The average ideal family size is smaller, by more than one child, among women in the highest wealth quintile than among those in the lowest quintile (Table 6.4).  Family size norms vary across provinces. Women in Jawzjan and Daykundi want 3.8 children on average, while women in Nooristan and Farah want 10.0 and 7.4 children, respectively (Table 6.4). 6.3 FERTILITY PLANNING STATUS Planning status of birth Women reported whether their most recent birth was wanted at that time (planned birth), at a later time (mistimed birth), or not at all (unwanted birth). Sample: Current pregnancies and births in the 5 years before the survey to women age 15-49 According to mothers’ reports, a large majority of births were wanted at the time of conception (89%), while 6% were mistimed (that is, wanted at a later date). Only 4% of births were not wanted at all (Figure 6.4). Patterns by background characteristics  The more children a woman has, the more likely it is that her most recent birth was unwanted. Less than 1% of first births were unwanted, as compared with 8% of fourth- or higher-order births (Table 6.5).  The likelihood of unwanted births increases with age. One percent of births to women less than age 25 were unwanted, compared with 24% of births to women age 45-49 (Table 6.5). Figure 6.3 Ideal family size by number of living children Figure 6.4 Fertility planning status 4.9 4.9 5.0 5.4 5.5 6.0 6.4 4.8 5.1 5.7 5.8 6.1 6.6 7.5 0 1 2 3 4 5 6+ Number of living children Mean ideal number of children Women Men Wanted then 89% Mistimed 6% Unwanted 4% Percent distribution of births to women age 15-49 in the 5 years preceding the survey 94 • Fertility Preferences 6.4 WANTED FERTILITY RATES Wanted fertility rate The number of children the average woman would have over the course of her lifetime if she bore children at current age-specific fertility rates, excluding unwanted births. A birth is considered wanted if the number of living children at the time of conception is lower than the ideal number of children currently reported by the respondent. Sample: Births to women age 15-49 during the 3 years before the survey The wanted fertility rate reflects the level of fertility that would result if all unwanted births were prevented. The wanted fertility rate in Afghanistan is 4.4 children (Figure 6.5), as compared with the actual total fertility rate of 5.3 children. In other words, Afghan women are currently having 0.9 children more than they want, on average. Patterns by background characteristics The wanted fertility rate is consistently lower than the actual total fertility rate, but the size of the gap varies by women’s background characteristics (Table 6.6).  The gap between wanted and actual fertility is slightly larger among urban women than rural women (a difference of 1.1 children versus a difference of 0.8 children).  The gap between wanted and actual fertility is smaller among women with more than a secondary education (0.6 children) than among women with a primary education or no education (0.9 children each).  The gap between wanted and actual fertility steadily widens with increasing wealth, rising from 0.8 children in the lowest wealth quintile to 1.2 children in the highest quintile.  Women in Daykundi and Badghis have the largest gap between actual and wanted fertility (2.3 children each). The gap is smallest in Nooristan (0.1 children). LIST OF TABLES For more information on fertility preferences, see the following tables:  Table 6.1 Fertility preferences by number of living children  Table 6.2.1 Desire to limit childbearing: Women  Table 6.2.2 Desire to limit childbearing: Men  Table 6.3 Ideal number of children by number of living children  Table 6.4 Mean ideal number of children by background characteristics  Table 6.5 Fertility planning status  Table 6.6 Wanted fertility rates Figure 6.5 Wanted and Actual Fertility 3.7 4.6 4.4 1.1 0.8 0.9 Urban Rural Total 5.4 5.3 Total wanted fertility Difference TFR4.8 Wanted and actual number of children per woman Fertility Preferences • 95 Table 6.1 Fertility preferences by number of living children Percent distribution of currently married women and currently married men age 15-49 by desire for children, according to number of living children, Afghanistan 2015 Number of living children Desire for children 0 1 2 3 4 5 6+ Total 15-49 WOMEN1 Have another soon2 54.0 25.6 17.8 15.6 9.4 7.6 4.2 14.3 Have another later3 5.4 44.5 43.7 34.3 25.7 19.5 8.2 24.4 Have another, undecided when 3.4 5.7 3.2 4.1 2.6 2.9 1.4 3.0 Undecided 9.6 18.1 23.4 27.8 29.3 25.5 22.0 23.1 Want no more 0.5 1.3 7.5 11.6 22.8 32.8 46.8 23.6 Sterilized4 0.2 0.1 0.2 1.2 1.2 2.3 4.1 1.9 Declared infecund 26.7 3.9 3.6 4.9 8.5 8.5 12.7 9.2 Missing 0.3 0.8 0.5 0.5 0.5 0.9 0.6 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,767 3,575 3,749 3,716 3,826 3,653 8,385 28,671 MEN5 Have another soon2 66.5 36.4 22.8 25.7 17.2 13.5 9.4 22.1 Have another later3 7.2 44.5 49.6 39.3 32.9 28.4 12.3 29.7 Have another, undecided when 6.3 6.3 3.6 6.4 4.1 3.7 3.2 4.5 Undecided 8.1 11.1 17.4 15.0 19.9 21.1 20.7 17.4 Want no more 0.4 0.7 4.2 9.6 18.9 28.0 42.2 19.7 Sterilized4 0.4 0.1 0.1 0.5 0.8 0.2 1.2 0.6 Declared infecund 9.2 0.2 1.1 0.9 2.0 2.0 3.9 2.5 Missing 2.0 0.7 1.1 2.6 4.1 3.1 7.0 3.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 679 1,342 1,459 1,507 1,377 1,417 2,899 10,679 1 The number of living children includes the current pregnancy. 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years 4 Includes both female and male sterilization 5 The number of living children includes one additional child if respondent's wife is pregnant (or if any wife is pregnant for men with more than one current wife). 96 • Fertility Preferences Table 6.2.1 Desire to limit childbearing: Women Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background characteristics, Afghanistan 2015 Number of living children1 Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 1.3 2.2 19.5 23.2 40.6 55.6 71.7 39.1 Rural 0.4 1.2 4.1 9.5 18.3 28.5 45.1 21.3 Province2 Kabul 1.5 2.6 23.2 31.1 44.4 63.9 79.1 43.2 Kapisa 1.0 0.0 10.4 13.8 34.2 51.4 80.9 44.2 Parwan (0.0) 0.3 7.0 21.8 16.3 47.3 67.1 33.2 Wardak 0.0 0.1 6.2 2.8 21.8 37.4 57.5 19.3 Logar (2.7) 2.1 3.2 8.4 25.6 40.1 59.8 36.6 Nangarhar 1.2 1.5 4.5 10.9 16.1 27.5 54.3 25.5 Laghman (0.0) 1.0 1.6 4.5 17.0 20.6 52.4 25.4 Panjsher * 3.8 2.7 16.1 10.4 33.3 26.9 19.7 Baghlan (2.7) 3.0 3.9 9.6 19.5 30.4 54.7 25.1 Bamyan (0.0) 3.6 5.7 16.0 34.0 49.8 62.1 33.6 Ghazni 0.0 0.8 5.3 10.4 31.2 42.5 48.8 22.0 Paktika 1.8 1.0 0.7 7.1 21.8 18.7 38.5 14.5 Paktya 0.0 1.8 1.3 7.4 10.0 24.1 39.4 15.9 Khost 0.0 0.2 1.4 4.3 5.7 25.1 35.5 15.1 Kunarha (0.0) 0.4 0.8 0.3 7.4 3.5 22.8 10.9 Nooristan (0.0) 0.0 1.0 2.0 3.1 1.4 14.9 4.9 Badakhshan 0.0 1.1 5.9 6.8 20.5 29.0 46.1 20.2 Takhar 0.0 1.1 5.7 10.4 36.4 34.5 58.9 28.5 Kunduz 0.0 2.8 0.3 9.7 10.3 17.4 24.8 13.2 Samangan (0.0) 2.1 3.1 8.6 14.5 32.5 51.6 23.5 Balkh 0.0 0.0 3.8 12.2 31.6 34.3 54.4 25.4 Sar-E-Pul (0.0) 1.0 6.5 11.2 31.8 37.4 61.2 26.6 Ghor (0.0) 0.2 4.2 3.6 9.1 18.2 38.1 16.4 Daykundi (0.0) 5.8 8.8 15.5 20.7 33.9 37.6 21.2 Urozgan (0.0) 0.0 0.8 3.6 1.6 3.2 14.3 6.2 Kandahar (0.0) 0.8 11.1 9.2 17.7 24.9 41.6 22.9 Jawzjan (0.0) 1.3 3.0 12.4 27.9 35.5 50.4 31.0 Faryab 2.3 1.7 9.4 15.5 11.7 39.9 38.3 20.2 Helmand 0.0 6.6 13.0 20.7 20.8 28.4 39.9 23.9 Badghis 0.0 0.0 8.1 12.5 35.1 51.7 64.2 29.6 Herat (0.0) 1.3 6.3 12.1 31.6 34.1 66.2 30.4 Farah (0.0) 1.1 1.9 3.0 15.0 21.5 33.0 14.3 Nimroz 1.3 1.1 5.2 15.9 17.9 44.5 66.0 28.4 Education No education 0.5 1.5 6.4 11.2 22.5 33.2 49.8 26.0 Primary 0.2 1.2 13.4 12.1 33.3 39.0 60.8 24.0 Secondary 0.0 1.3 11.8 24.3 32.2 60.8 67.1 21.1 More than secondary 5.8 0.2 3.4 40.5 31.6 (54.3) 83.6 23.6 Wealth quintile Lowest 0.0 1.0 3.7 5.9 17.3 28.4 43.6 20.7 Second 0.9 1.9 2.4 8.8 18.4 27.0 41.7 20.1 Middle 0.7 0.9 6.1 11.8 17.7 28.8 45.0 22.1 Fourth 0.3 2.4 7.8 14.3 25.0 35.4 55.5 26.9 Highest 1.3 0.9 17.8 23.4 39.9 57.2 72.9 38.1 Total 0.6 1.4 7.8 12.8 24.0 35.1 50.9 25.5 Note: Women who have been sterilized or whose husband has been sterilized are considered to want no more children. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 The number of living children includes the current pregnancy. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Fertility Preferences • 97 Table 6.2.2 Desire to limit childbearing: Men Percentage of currently married men age 15-49 who want no more children, by number of living children, according to background characteristics, Afghanistan 2015 Number of living children1 Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 0.2 0.2 11.7 23.0 26.3 37.1 56.1 26.5 Rural 0.9 0.9 2.1 6.1 17.5 26.0 40.3 18.4 Education No education 0.7 1.4 3.7 8.7 17.0 29.5 40.9 21.2 Primary 2.4 0.1 0.6 11.3 18.0 35.7 43.3 20.3 Secondary 0.2 0.4 8.1 13.6 26.2 20.3 49.4 18.7 More than secondary 0.2 0.4 5.9 2.6 25.3 33.7 54.3 18.1 Wealth quintile Lowest 0.0 0.0 1.4 3.6 12.5 26.2 40.8 17.5 Second 1.8 0.0 3.5 10.6 19.4 27.6 37.7 18.7 Middle 0.6 2.1 3.3 5.7 21.9 29.5 36.0 18.9 Fourth 1.1 0.8 1.0 8.2 17.4 25.7 48.6 20.4 Highest 0.1 0.7 12.3 22.5 27.4 33.4 57.9 25.8 Total 0.7 0.8 4.3 10.1 19.8 28.2 43.4 20.2 Note: Men who have been sterilized or who state in response to the question about desire for children that their wife has been sterilized are considered to want no more children. As there are too few cases, provincial-level estimates are not shown. 1 The number of living children includes one additional child if respondent's wife is pregnant (or if any wife is pregnant for men with more than one current wife). 98 • Fertility Preferences Table 6.3 Ideal number of children by number of living children Percent distribution of ever-married women and ever-married men age 15-49 by ideal number of children, and mean ideal number of children for all ever-married respondents and for currently married respondents, according to number of living children, Afghanistan 2015 Number of living children Ideal number of children 0 1 2 3 4 5 6+ Total WOMEN1 0 3.3 1.4 0.7 1.8 1.5 1.9 2.7 1.9 1 0.3 1.0 0.4 0.5 0.2 0.3 0.1 0.4 2 8.3 3.0 4.7 2.1 3.9 2.6 1.9 3.2 3 5.3 6.6 3.9 5.8 2.1 1.8 1.7 3.4 4 30.6 34.6 33.9 22.6 23.3 14.7 11.8 22.0 5 10.4 11.2 11.4 12.2 9.9 13.1 5.9 9.8 6+ 26.8 29.2 32.7 40.9 42.9 50.4 53.3 42.6 Non-numeric responses 15.0 13.1 12.3 14.0 16.1 15.3 22.6 16.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,836 3,660 3,855 3,806 3,921 3,753 8,628 29,461 Mean ideal number of children for:2 Ever-married women 4.9 4.9 5.0 5.4 5.5 6.0 6.4 5.6 Number of ever-married women 1,560 3,181 3,380 3,274 3,288 3,179 6,675 24,538 Currently married women 4.9 4.9 5.0 5.4 5.5 5.9 6.4 5.6 Number of currently married women 1,509 3,112 3,306 3,206 3,209 3,102 6,504 23,948 MEN3 0 2.0 0.6 0.7 0.5 1.0 0.3 1.0 0.8 1 0.0 0.2 0.1 0.4 0.0 0.1 0.0 0.1 2 4.7 3.0 2.7 3.0 0.6 1.0 0.6 1.8 3 6.5 8.0 1.9 4.6 1.6 2.2 0.7 3.0 4 28.7 28.1 22.1 17.0 17.0 9.8 7.5 16.3 5 16.4 12.4 14.1 10.2 10.1 12.0 3.0 9.7 6+ 27.4 31.4 42.4 45.9 51.5 53.1 58.9 47.6 Non-numeric responses 14.3 16.4 16.0 18.4 18.1 21.6 28.3 20.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 706 1,347 1,465 1,515 1,380 1,420 2,926 10,760 Mean ideal number of children for:2 Ever-married men 4.8 5.1 5.7 5.8 6.1 6.6 7.5 6.2 Number of ever-married men 605 1,126 1,230 1,236 1,130 1,113 2,099 8,539 Currently married men 4.9 5.1 5.7 5.8 6.1 6.6 7.5 6.2 Number of currently married men 582 1,121 1,229 1,227 1,127 1,110 2,077 8,473 1 The number of living children includes the current pregnancy for women. 2 Means are calculated excluding respondents who gave non-numeric responses. 3 The number of living children includes one additional child if respondent's wife is pregnant (or if any wife is pregnant for men with more than one current wife). Fertility Preferences • 99 Table 6.4 Mean ideal number of children by background characteristics Mean ideal number of children for ever-married women and ever-married men age 15-49 by background characteristics, Afghanistan 2015 Background characteristic Mean Number of women1 Mean Number of men1 Age 15-19 4.9 1,600 5.3 128 20-24 5.1 5,289 5.6 952 25-29 5.5 5,422 5.8 1,996 30-34 5.8 3,677 6.0 1,635 35-39 5.8 3,595 6.2 1,541 40-44 6.1 2,464 6.9 1,058 45-49 6.2 2,491 7.0 1,227 Residence Urban 4.8 6,160 5.4 2,144 Rural 5.9 18,377 6.5 6,394 Province2 Kabul 4.6 3,444 5.4 1,230 Kapisa 4.9 139 5.3 44 Parwan 5.3 537 6.7 151 Wardak 6.2 303 6.4 128 Logar 5.9 472 6.7 201 Nangarhar 5.8 325 7.7 173 Laghman 7.0 465 7.4 190 Panjsher 6.6 49 7.3 17 Baghlan 6.2 839 6.7 270 Bamyan 5.3 301 5.0 65 Ghazni 5.1 1,231 5.5 616 Paktika 5.6 780 6.5 246 Paktya 6.8 507 6.3 200 Khost 5.7 645 6.6 300 Kunarha 7.0 79 7.6 51 Nooristan 10.0 110 11.1 41 Badakhshan 5.2 537 5.2 252 Takhar 5.1 576 5.7 159 Kunduz 6.3 763 5.3 321 Samangan 5.6 330 6.3 122 Balkh 5.6 1,437 5.2 391 Sar-E-Pul 5.7 624 5.5 167 Ghor 5.8 641 7.5 278 Daykundi 3.8 327 5.2 47 Urozgan 4.8 148 8.9 27 Kandahar 7.3 2,038 7.4 605 Jawzjan 3.8 496 6.8 155 Faryab 5.5 1,684 5.7 491 Helmand 5.1 728 6.4 347 Badghis 5.5 650 6.8 231 Herat 5.1 2,304 5.9 688 Farah 7.4 771 7.5 274 Nimroz 5.0 241 6.0 55 Education No education 5.8 20,155 6.5 4,128 Primary 4.8 2,047 6.1 1,586 Secondary 4.4 1,798 5.9 2,210 More than secondary 4.2 538 5.5 614 Wealth quintile Lowest 5.9 4,822 6.7 1,554 Second 5.9 4,801 6.4 1,709 Middle 6.1 4,807 6.6 1,666 Fourth 5.6 4,945 6.0 1,797 Highest 4.7 5,162 5.4 1,812 Total 5.6 24,538 6.2 8,539 1 Number of women who gave a numeric response 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 100 • Fertility Preferences Table 6.5 Fertility planning status Percent distribution of births to women age 15-49 in the 5 years preceding the survey (including current pregnancies), by planning status of the birth, according to birth order and mother's age at birth, Afghanistan 2015 Planning status of birth Birth order and mother's age at birth Wanted then Wanted later Wanted no more Missing Total Number of births Birth order 1 97.2 1.8 0.4 0.6 100.0 7,169 2 93.1 5.6 0.7 0.6 100.0 6,429 3 91.9 6.2 1.2 0.7 100.0 5,700 4+ 84.3 7.5 7.6 0.6 100.0 18,915 Mother's age at birth <20 95.1 3.6 0.6 0.7 100.0 5,091 20-24 92.2 6.5 0.8 0.6 100.0 12,408 25-29 89.6 6.3 3.5 0.6 100.0 9,753 30-34 86.0 6.8 6.6 0.6 100.0 5,714 35-39 80.4 5.9 13.1 0.6 100.0 3,653 40-44 80.3 4.3 14.5 0.9 100.0 1,291 45-49 73.1 2.3 23.8 0.8 100.0 304 Total 89.3 5.9 4.1 0.6 100.0 38,214 Fertility Preferences • 101 Table 6.6 Wanted fertility rates Total wanted fertility rates and total fertility rates for the 3 years preceding the survey, by background characteristics, Afghanistan 2015 Background characteristic Total wanted fertility rate Total fertility rate Residence Urban 3.7 4.8 Rural 4.6 5.4 Province1 Kabul 3.5 4.6 Kapisa 4.1 4.8 Parwan 4.5 5.7 Wardak 3.7 4.2 Logar 3.2 4.2 Nangarhar 5.6 6.4 Laghman 6.3 7.3 Panjsher 2.6 3.2 Baghlan 3.6 4.4 Bamyan 4.7 5.4 Ghazni 2.5 2.8 Paktika 4.7 5.3 Paktya 4.4 5.2 Khost 4.8 5.6 Kunarha 6.6 6.8 Nooristan 8.8 8.9 Badakhshan 4.8 5.3 Takhar 4.8 5.7 Kunduz 4.0 4.4 Samangan 4.0 5.1 Balkh 4.8 5.5 Sar-E-Pul 4.6 4.8 Ghor 5.1 5.8 Daykundi 2.9 5.2 Urozgan 6.6 8.8 Kandahar 5.1 6.5 Jawzjan 2.6 3.9 Faryab 5.2 6.2 Helmand 4.1 4.7 Badghis 4.3 6.6 Herat 3.6 4.8 Farah 4.6 5.4 Nimroz 4.1 5.4 Education No education 4.6 5.5 Primary 3.8 4.7 Secondary 3.6 4.3 More than secondary 3.0 3.6 Wealth quintile Lowest 4.5 5.3 Second 4.6 5.4 Middle 4.9 5.8 Fourth 4.4 5.3 Highest 3.4 4.6 Total 4.4 5.3 Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 5.2. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Family Planning • 103 FAMILY PLANNING 7 Key Findings  Contraceptive use: Twenty-three percent of currently married women use a method of family planning, with 20% using a modern method. The most popular methods are the pill (7%) and injectables (5%).  Source of modern methods: The public and private health sectors are equally popular as sources of modern contraception in Afghanistan. Most users get pills and condoms from the private medical sector (mainly pharmacies), while the public sector is more often the source for female sterilization, IUDs, and injectables.  Contraceptive discontinuation: One out of every four times (26%) that women began using a contraceptive method in the 5 years before the survey, they discontinued the method in less than 12 months. The most common reason for discontinuation was the desire to become pregnant (54%), followed by method-related side effects and health concerns (13%).  Unmet need for family planning: Overall, 25% of currently married women have an unmet need for family planning.  Demand for family planning: Total demand for family planning satisfied by use of modern methods is 42% among currently married women. ouples can use contraceptive methods to limit or space the number of children they have. This chapter presents information on the use and sources of contraceptive methods, informed choice of methods, and rates and reasons for discontinuing contraceptives. It also examines the potential demand for family planning and how much contact nonusers have with family planning providers. Afghanistan is a “Focus FP2020 Country,” meaning that it is part of a global movement to provide an additional 120 million women in the poorest countries of the world with access to voluntary family planning by the year 2020. The Ministry of Public Health is especially committed to achieving reductions in unmet need for family planning (Ministry of Public Health 2015a). C 104 • Family Planning 7.1 CONTRACEPTIVE KNOWLEDGE AND USE Knowledge of contraceptive methods is high in Afghanistan, with 95% of currently married women and 92% of married men knowing at least one method of contraception. Pills, injectables, and male condoms are the most widely known methods among both women and men. For more information on contraceptive knowledge by method, see Table 7.1 and Figure 7.1. Awareness of contraceptive methods is very poor among currently married women and men in Nooristan relative to those in other provinces, with only 32% of women and 59% of men having ever heard of any modern methods (Table 7.2). Contraceptive prevalence rate Percentage who use any contraceptive method. Sample: Currently married women age 15-49 Table 7.3.shows the percent distribution of currently married women by the contraceptive method they currently use. Overall, 23% of currently married women use a method of family planning, with 20% using a modern method and 3% using a traditional method (Figure 7.2). Figure 7.1 Knowledge of contraceptive methods Figure 7.2 Contraceptive use 95 94 89 87 65 49 23 62 32 48 15 50 92 91 84 79 72 53 34 33 22 34 17 65 Any method Any modern method Pill Injectables Male condom Female sterilization Male sterilization IUD Implants LAM Emergency contraception Traditional method Percentage of currently married women and men age 15-49 who have heard of specific contraceptive methods Women Men 23 20 7 5 3 2 1 <1 3 Any method Any modern method Pill Injectables Male condom Female sterilization IUD Implants Traditional method Percentage of currently married women age 15-49 currently using a contraceptive method Family Planning • 105 Modern methods Include male and female sterilization, injectables, intrauterine devices (IUDs), contraceptive pills, implants, male condoms, and the lactational amenorrhea method (LAM). Among currently married women, the most popular methods are the pill (7%), injectables (5%), and the male condom (3%). Patterns by background characteristics  The contraceptive prevalence rate (CPR) among married women age 15-49 is higher among those living in urban areas than among those living in rural areas (35% versus 19%) (Table 7.4).  Modern contraceptive use increases with increasing education. Women age 15-49 who have more than a secondary education (30%) are more likely to use modern methods of contraception than those with no education (19%) (Figure 7.3).  Wealth is directly related to use of modern contraception. For instance, women in the highest wealth quintile are twice as likely to use modern contraception as those in the lowest quintile (31% versus 15%).  Use of modern contraceptive methods varies by province, from a high of 58% in Herat to a low of 1% in Nooristan (Figure 7.4). Figure 7.3 Use of modern methods by education 19 22 26 30 20 No education Primary Secondary More than secondary Total Percentage of currently married women age 15-49 currently using a modern contraceptive method 106 • Family Planning Figure 7.4 Modern contraceptive use by province Percentage of currently married women age 15-49 currently using a modern contraceptive method 7.2 SOURCE OF MODERN CONTRACEPTIVE METHODS Source of modern contraceptives Place where the modern method currently being used was obtained the last time it was acquired. Sample: Women age 15-49 currently using a modern contraceptive method (excluding LAM) The public and private health sectors are equally popular as sources of contraception in Afghanistan (Figure 7.5). Most current users obtain pills (59%) and condoms (55%) from the private medical sector, while the public sector is more often the source for female sterilization (68%), IUDs (59%), and injectables (62%) (Table 7.6).  Female sterilization: Sterilized women were much more likely to have had the procedure at a government hospital (67%) than at a private hospital (18%).  Male condoms: Private pharmacies are the predominant sources for male condoms (50%), followed by government hospitals (13%). Figure 7.5 Source of modern contraceptive methods Public sector, 47% Private medical sector, 47% Non- government sector, 1% Other source, 4% Percent distribution of current users of modern methods by most recent source of method Family Planning • 107  Pills: The most commonly used method, the pill, is also widely obtained through private pharmacies (45%), although one-third of pill users obtain the method from government sources. A large majority of pill users say they use brands that are socially marketed (Table 7.7). 7.3 INFORMED CHOICE Informed choice Informed choice consists of women being informed at the time they started the current episode of method use about side effects of the method, what to do if they experience side effects, and other methods they could use. Sample: Women age 15-49 who are currently using selected modern contraceptive methods and who started the most recent episode of use within the 5 years before the survey More than half of all ever-married women using modern contraceptives were informed about side effects or other problems with the method they used (53%) and what to do if they experienced side effects (42%). Sixty-four percent of women were informed of other methods they could use (Table 7.8). Women receiving services from a public sector source are more likely to be informed about the possible side effects of the method (60%), what to do if they experienced side effects (51%), and other methods that they could use (70%) than those receiving services from a source in the private medical sector (41%, 30%, and 55%, respectively). 7.4 DISCONTINUATION OF CONTRACEPTIVES Contraceptive discontinuation rate Percentage of contraceptive initiation episodes discontinued within 12 months. Sample: Episodes of contraceptive use initiated in the 5 years before the survey for women who are currently age 15-49 One out of every four times (26%) that women began using a contraceptive method in the 5 years before the survey, they discontinued the method in less than 12 months. Discontinuation rates were highest for the pill, withdrawal, and condoms (Table 7.9). The most common reason reported for discontinuation was the desire to become pregnant, followed by method-related side effects and health concerns (Table 7.10). Method-related concerns were reported mostly for injectables (28%), IUDs (24%), and the pill (14%). Knowledge of the Fertile Period The survey also collected information on women and men’s knowledge of the fertile period. Only 8% of ever-married women and 7% of ever-married men know that a woman is most likely to conceive halfway between two periods (Table 7.11). 108 • Family Planning 7.5 DEMAND FOR FAMILY PLANNING Unmet need for family planning Proportion of women who (1) are not pregnant and not postpartum amenorrheic and are considered fecund and want to postpone their next birth for 2 or more years or stop childbearing altogether but are not using a contraceptive method, or (2) have a mistimed or unwanted current pregnancy, or (3) are postpartum amenorrheic and their most recent birth in the last 2 years was mistimed or unwanted. Sample: Currently married and ever-married women age 15-49 Demand for family planning: Unmet need for family planning + current contraceptive use (any method) Proportion of demand satisfied: Current contraceptive use (any method) Unmet need + current contraceptive use (any method) Proportion of demand satisfied by modern methods: Current contraceptive use (any modern method) Unmet need + current contraceptive use (any method) Overall, 25% of currently married women have an unmet need for family planning, 18% for spacing and 7% for limiting (Figure 7.6). Twenty-three percent of women have a met need for family planning or are using a contraceptive method. If all currently married women who say they want to space or limit their children were to use a family planning method, the contraceptive prevalence rate would increase to 47% (total demand). Of the total demand for family planning methods, 48% is met through use of any method and 42% through use of modern methods (Table 7.12.1). Patterns by background characteristics  Unmet need for family planning is lower among women with more than a secondary education (16%) than among women with no education (25%).  Twenty-seven percent of married women in the lowest wealth quintile have an unmet need for family planning, as compared with 21% in the wealthiest quintile.  Unmet need for family planning is lowest in Herat (6%) and highest in Badakhshan (39%) (Figure 7.7).  Total demand for family planning methods is 26% in Nooristan, while the percentage of demand satisified by modern methods is only 2%, the lowest among all provinces (Table 7.12.1). Figure 7.6 Demand for family planning Unmet need for spacing 18% Unmet need for limiting 7% Met need for spacing 11% Met need for limiting 11% No need for family planning 53% Percent distribution of currently married women age 15-49 by need for family planning Family Planning • 109 Figure 7.7 Unmet need for family planning by province Percentage of currently married women age 15-49 by unmet need for family planning Future Use of Contraception The survey also collected information on nonusers’ intentions to use contraception in the future. Twenty- two percent of currently married women age 15-49 who were not using contraception at the time of the survey said that they intended to use family planning in the future, while 42% said that they did not intend to do so (Table 7.13). Exposure to Family Planning Messages in the Media Table 7.14.1 offers information on women’s exposure to family planning messages in the media. About one in five ever-married women age 15-49 reported hearing a family planning message in the past few months on the radio (22%). Similarly, 29% of women heard a message on television, while only 2% read a family planning message in a newspaper or magazine. Overall, 61% of women had no exposure to family planning messages in any of the three main mass media (radio, television, or newspaper/magazine). Other sources play important roles in Afghanistan with respect to providing knowledge on family planning, with health professionals (21%) and local community leaders (25%) being prominent sources. Two in five women are not exposed to family planning messages from any source (including media). Patterns by background characteristics  Women in urban areas are more likely to be exposed to family planning messages through the media than those in rural areas. For instance, while 38% of urban women had no exposure to messages on the radio, on television, or in newspapers/magazines, 68% of rural women had no such exposure (Table 7.14.1). 110 • Family Planning  Women in rural areas are more likely than urban women to be exposed to family planning messages through local community leaders (27% versus 18%).  Education and wealth are strongly related to increased exposure to family planning messages through the various sources among women.  Table 7.14.2 offers similar information on men’s exposure to family planning messages. About one in three ever-married men age 15-49 reported hearing or seeing a family planning message in the past few months on radio (35%) and television (34%). Exposure to family planning messages through newspapers and magazines (9%) is less common. Overall, men are more exposed to family planning messages than women. 7.6 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS Contact of nonusers with family planning providers Respondent discussed family planning in the 12 months before the survey with a community health worker or during a visit to a health facility. Sample: Ever-married women age 15-49 who are not currently using any contraceptive methods The vast majority (82%) of women age 15-49 who were not using a contraceptive method said they had not discussed family planning with a community health worker or health facility staff member in the 12 months before the survey (Table 7.15). Fifteen percent reported discussing family planning with a community health worker and 10% with a provider at a health facility. Patterns by background characteristics  Among nonusers, those who are age 20-39 are more likely to have discussed family planning during a visit with a community health worker than younger (age 15-19) or older (age 40-49) women (Table 7.15).  Women with no education are less likely to have discussed family planning while visiting a health facility (9%) than women with more than a secondary education (19%).  Women in Bamyan (29%), Logar (27%), and Faryab (27%) are most likely to have discussed family planning while visiting a health facility, while women in Nooristan are least likely to have done so. LIST OF TABLES For more information on family planning, see the following tables:  Table 7.1 Knowledge of contraceptive methods  Table 7.2 Knowledge of contraceptive methods by background characteristics  Table 7.3 Current use of contraception by age  Table 7.4 Current use of contraception by background characteristics  Table 7.5 Timing of sterilization  Table 7.6 Source of modern contraception methods  Table 7.7 Use of social marketing brand pills and condoms  Table 7.8 Informed choice  Table 7.9 Twelve-month contraceptive discontinuation rates  Table 7.10 Reasons for discontinuation Family Planning • 111  Table 7.11 Knowledge of fertile period  Table 7.12.1 Need and demand for family planning among currently married women  Table 7.12.2 Need and demand for family planning among ever-married women  Table 7.13 Future use of contraception  Table 7.14.1 Exposure to family planning messages: Women  Table 7.14.2 Exposure to family planning messages: Men  Table 7.15 Contact of nonusers with family planning providers 112 • Family Planning Table 7.1 Knowledge of contraceptive methods Percentage of ever-married respondents and currently married respondents age 15-49 who have heard of any contraceptive method, by specific method, Afghanistan 2015 Women Men Method Ever-married women Currently married women Ever-married men Currently married men Any method 94.5 94.5 92.1 92.1 Any modern method 94.2 94.2 91.0 91.0 Female sterilization 49.4 49.4 53.3 53.3 Male sterilization 22.7 22.7 33.8 33.8 Pill 89.1 89.1 84.4 84.4 IUD 61.3 61.5 33.2 33.2 Injectables 87.2 87.3 79.1 79.1 Implants 32.1 32.0 22.2 22.2 Condom 64.5 64.6 72.4 72.4 Lactational amenorrhea method (LAM) 47.7 47.7 34.2 34.2 Emergency contraception 14.8 14.7 16.6 16.5 Any traditional method 50.4 50.3 64.8 64.8 Rhythm 19.5 19.5 22.9 22.9 Withdrawal 45.9 45.9 60.9 61.0 Other 1.4 1.5 0.4 0.4 Mean number of methods known by respondents age 15- 49 5.4 5.4 5.1 5.1 Number of respondents 29,461 28,671 10,760 10,679 Family Planning • 113 Table 7.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and currently married men age 15-49 who have heard of at least one contraceptive method and who have heard of at least one modern method, by background characteristics, Afghanistan 2015 Women Men Background characteristic Heard of any method Heard of any modern method1 Number Heard of any method Heard of any modern method1 Number Age 15-19 92.1 91.4 1,812 93.8 93.8 142 20-24 93.0 92.7 6,028 91.7 89.4 1,160 25-29 95.3 95.0 6,193 90.1 88.1 2,410 30-34 95.2 94.9 4,226 91.9 91.5 1,992 35-39 95.6 95.3 4,375 94.1 93.7 1,925 40-44 94.2 94.0 2,977 92.1 91.2 1,385 45-49 95.4 94.8 3,060 93.1 92.2 1,664 Residence Urban 95.6 95.3 6,673 89.7 89.6 2,452 Rural 94.2 93.8 21,998 92.9 91.4 8,227 Province2 Kabul 92.3 91.8 3,571 83.7 83.0 1,332 Kapisa 92.9 92.9 197 99.4 99.4 63 Parwan 99.5 99.4 592 100.0 99.6 218 Wardak 91.8 91.8 378 65.5 65.5 170 Logar 97.6 96.8 465 94.6 91.9 203 Nangarhar 99.2 97.2 769 89.8 89.8 272 Laghman 99.6 99.5 567 99.7 99.7 226 Panjsher 68.6 68.6 53 91.1 89.5 18 Baghlan 97.4 97.1 835 93.8 85.6 281 Bamyan 95.4 95.4 295 77.8 76.9 93 Ghazni 78.3 77.9 1,319 98.5 97.2 617 Paktika 86.8 86.3 779 78.8 78.1 318 Paktya 97.7 97.1 529 99.4 99.4 202 Khost 99.8 99.7 845 100.0 100.0 334 Kunarha 97.2 97.2 549 83.4 83.0 149 Nooristan 32.4 32.3 209 60.7 59.2 66 Badakhshan 82.3 81.8 968 76.9 74.9 311 Takhar 95.6 94.6 1,070 86.3 86.3 296 Kunduz 93.3 93.3 1,214 79.9 78.6 472 Samangan 86.8 82.2 319 87.0 87.0 125 Balkh 97.1 97.1 1,742 97.1 96.3 613 Sar-E-Pul 94.6 94.3 644 82.5 82.3 192 Ghor 99.7 99.7 708 99.9 99.8 315 Daykundi 78.8 78.8 319 72.3 72.3 77 Urozgan 83.2 83.2 229 99.4 99.4 92 Kandahar 99.8 99.8 2,193 99.7 94.7 870 Jawzjan 99.0 98.9 603 93.6 93.6 218 Faryab 98.3 98.3 2,030 98.6 98.6 704 Helmand 100.0 100.0 874 95.2 95.2 355 Badghis 99.6 99.6 640 99.8 99.7 230 Herat 100.0 100.0 2,166 100.0 100.0 852 Farah 96.7 94.3 717 95.6 94.0 294 Nimroz 98.7 98.7 264 96.0 94.2 93 Education No education 94.1 93.7 23,921 90.6 88.7 5,411 Primary 96.9 96.8 2,257 93.5 93.0 1,969 Secondary 96.1 95.9 1,951 93.5 93.3 2,615 More than secondary 97.2 97.2 542 94.9 94.8 685 Wealth quintile Lowest 94.3 93.9 5,757 90.1 88.2 2,018 Second 92.7 92.0 5,823 91.5 90.1 2,211 Middle 94.1 93.9 5,736 93.9 92.1 2,145 Fourth 95.5 95.2 5,846 94.6 93.9 2,253 Highest 96.2 96.0 5,509 90.3 90.3 2,052 Total 94.5 94.2 28,671 92.1 91.0 10,679 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, condom, lactational amenorrhea method (LAM), emergency contraception, and other modern methods 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 114 • Family Planning Table 7.3 Current use of contraception by age Percent distribution of ever-married women and currently married women age 15-49 by contraceptive method currently used, according to age, Afghanistan 2015 Age Any method Any modern method Modern method Any tradi- tional method Traditional method Not current- ly using Total Num- ber of women Female sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Con- dom LAM Rhythm With- drawal Other EVER-MARRIED WOMEN 15-19 7.7 5.9 0.0 0.0 2.7 0.7 0.5 0.0 1.4 0.7 1.8 0.1 1.7 0.0 92.3 100.0 1,825 20-24 17.5 15.1 0.0 0.0 6.5 1.0 1.7 0.5 3.5 1.8 2.3 0.1 2.1 0.1 82.5 100.0 6,089 25-29 20.6 18.5 0.2 0.0 7.5 1.5 3.7 0.0 3.5 2.1 2.1 0.0 2.0 0.0 79.4 100.0 6,299 30-34 26.0 22.2 1.1 0.1 8.6 1.4 5.7 0.1 4.0 1.4 3.8 0.0 3.7 0.0 74.0 100.0 4,302 35-39 28.4 25.0 2.8 0.0 6.7 1.9 8.7 0.2 3.8 0.8 3.5 0.0 3.3 0.1 71.6 100.0 4,463 40-44 27.2 24.2 4.2 0.0 6.6 2.0 8.6 0.0 2.5 0.2 3.0 0.0 2.8 0.2 72.8 100.0 3,113 45-49 21.2 19.6 6.4 0.1 4.9 1.1 4.7 0.1 2.0 0.3 1.5 0.0 1.5 0.0 78.8 100.0 3,369 Total 21.9 19.3 1.8 0.0 6.6 1.4 4.8 0.2 3.2 1.2 2.6 0.0 2.5 0.1 78.1 100.0 29,461 CURRENTLY MARRIED WOMEN 15-19 7.8 6.0 0.0 0.0 2.7 0.7 0.5 0.0 1.4 0.7 1.8 0.1 1.7 0.0 92.2 100.0 1,812 20-24 17.6 15.3 0.0 0.0 6.5 1.0 1.7 0.5 3.6 1.9 2.4 0.1 2.2 0.1 82.4 100.0 6,028 25-29 20.9 18.8 0.2 0.0 7.6 1.5 3.8 0.1 3.5 2.1 2.1 0.0 2.1 0.0 79.1 100.0 6,193 30-34 26.4 22.6 1.1 0.1 8.8 1.4 5.8 0.1 4.0 1.4 3.8 0.0 3.8 0.0 73.6 100.0 4,226 35-39 29.0 25.5 2.9 0.0 6.9 2.0 8.9 0.2 3.9 0.8 3.6 0.0 3.4 0.1 71.0 100.0 4,375 40-44 28.4 25.3 4.4 0.0 6.9 2.1 9.0 0.0 2.6 0.2 3.2 0.0 2.9 0.2 71.6 100.0 2,977 45-49 23.2 21.5 6.9 0.1 5.4 1.2 5.2 0.1 2.2 0.3 1.7 0.0 1.7 0.0 76.8 100.0 3,060 Total 22.5 19.8 1.8 0.0 6.8 1.4 4.9 0.2 3.3 1.3 2.7 0.0 2.6 0.1 77.5 100.0 28,671 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method Family Planning • 115 Table 7.4 Current use of contraception by background characteristics Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Afghanistan 2015 Modern method Traditional method Background characteristic Any meth- od Any mo- dern meth- od Femal e sterili- zation Male sterili- zation Pill IUD Inject- ables Im- plants Con- dom LAM Other Any tradi- tional meth- od Rhy- thm With- drawal Other Not current ly using Total Num- ber of wo- men Number of living children 0 0.9 0.6 0.1 0.0 0.2 0.0 0.0 0.0 0.2 0.0 0.0 0.3 0.0 0.3 0.0 99.1 100.0 2,875 1-2 17.8 15.4 0.2 0.0 6.2 1.1 1.5 0.4 3.8 2.1 0.0 2.5 0.1 2.3 0.0 82.2 100.0 7,165 3-4 23.5 20.7 1.1 0.1 7.7 2.0 4.4 0.1 3.9 1.4 0.0 2.8 0.0 2.6 0.1 76.5 100.0 7,505 5+ 30.3 26.9 3.8 0.0 8.3 1.6 8.7 0.1 3.4 1.0 0.0 3.4 0.0 3.3 0.1 69.7 100.0 11,126 Residence Urban 34.9 29.0 3.4 0.1 9.3 2.7 5.0 0.2 7.2 1.1 0.0 5.9 0.1 5.7 0.1 65.1 100.0 6,673 Rural 18.7 17.0 1.4 0.0 6.1 1.0 4.9 0.2 2.1 1.3 0.0 1.7 0.0 1.6 0.0 81.3 100.0 21,998 Province1 Kabul 32.1 26.5 4.4 0.0 5.5 3.5 3.5 0.3 8.1 1.3 0.0 5.6 0.1 5.2 0.3 67.9 100.0 3,571 Kapisa 20.1 19.1 3.1 0.0 2.2 2.9 8.4 0.2 2.2 0.0 0.1 1.1 0.2 0.9 0.0 79.9 100.0 197 Parwan 27.3 23.8 2.0 0.0 3.9 1.8 10.0 0.4 3.8 1.9 0.0 3.5 0.0 3.5 0.0 72.7 100.0 592 Wardak 31.9 30.1 3.6 0.0 8.6 0.9 10.8 0.0 5.9 0.3 0.0 1.7 0.0 1.7 0.0 68.1 100.0 378 Logar 32.8 24.7 0.5 0.0 5.8 6.1 7.7 0.0 4.4 0.3 0.0 8.0 0.0 8.0 0.0 67.2 100.0 465 Nangarhar 21.4 13.3 1.1 0.0 3.4 1.1 4.1 0.1 1.7 1.6 0.1 8.1 0.5 7.5 0.0 78.6 100.0 769 Laghman 14.4 13.6 1.4 0.0 6.2 0.6 3.2 0.0 2.2 0.0 0.0 0.9 0.0 0.9 0.0 85.6 100.0 567 Panjsher 12.2 11.6 1.1 0.0 2.5 1.4 4.8 0.2 1.3 0.5 0.0 0.5 0.0 0.5 0.0 87.8 100.0 53 Baghlan 15.6 14.0 2.5 0.0 2.5 1.0 6.0 0.0 2.0 0.0 0.0 1.6 0.0 1.2 0.4 84.4 100.0 835 Bamyan 21.9 21.5 0.9 0.0 4.5 0.5 11.8 0.0 3.7 0.0 0.0 0.4 0.0 0.2 0.2 78.1 100.0 295 Ghazni 13.4 12.4 2.3 0.4 3.0 1.6 3.6 0.1 1.1 0.2 0.0 1.1 0.1 0.9 0.1 86.6 100.0 1,319 Paktika 28.9 26.1 1.2 0.0 1.4 0.8 2.7 0.1 4.4 15.5 0.0 2.8 0.0 2.8 0.0 71.1 100.0 779 Paktya 14.5 11.1 0.5 0.0 2.0 0.9 2.1 0.2 3.6 1.7 0.0 3.5 0.0 3.4 0.1 85.5 100.0 529 Khost 16.2 12.0 1.6 0.0 5.4 0.0 3.3 0.0 1.3 0.4 0.0 4.2 0.2 4.0 0.0 83.8 100.0 845 Kunarha 6.0 5.5 0.6 0.0 1.8 0.4 2.5 0.0 0.1 0.0 0.0 0.5 0.1 0.4 0.1 94.0 100.0 549 Nooristan 0.5 0.5 0.1 0.0 0.3 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 99.5 100.0 209 Badakhshan 7.8 7.2 0.8 0.0 2.0 0.4 3.8 0.0 0.2 0.0 0.0 0.6 0.0 0.6 0.0 92.2 100.0 968 Takhar 9.4 7.7 0.9 0.0 1.4 0.3 3.7 0.0 1.0 0.3 0.1 1.7 0.0 1.7 0.0 90.6 100.0 1,070 Kunduz 12.9 12.4 0.7 0.0 3.2 2.4 5.2 0.0 1.0 0.0 0.0 0.5 0.0 0.4 0.0 87.1 100.0 1,214 Samangan 4.6 4.3 0.2 0.0 1.2 0.4 2.3 0.0 0.2 0.0 0.0 0.3 0.0 0.2 0.0 95.4 100.0 319 Balkh 20.6 13.1 2.2 0.1 2.8 1.1 3.2 0.1 3.2 0.3 0.0 7.5 0.0 7.5 0.0 79.4 100.0 1,742 Sar-E-Pul 11.8 10.1 0.0 0.0 4.6 0.4 4.5 0.0 0.6 0.0 0.0 1.7 0.0 1.7 0.0 88.2 100.0 644 Ghor 14.6 14.5 0.0 0.0 2.5 0.2 11.1 0.0 0.6 0.0 0.1 0.0 0.0 0.0 0.0 85.4 100.0 708 Daykundi 11.0 11.0 0.0 0.0 5.2 0.1 3.7 0.0 2.0 0.0 0.0 0.0 0.0 0.0 0.0 89.0 100.0 319 Urozgan 11.8 11.8 0.2 0.0 8.4 0.0 3.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 88.2 100.0 229 Kandahar 28.6 25.7 0.6 0.0 16.0 1.1 3.6 0.0 3.7 0.7 0.0 2.8 0.0 2.8 0.0 71.4 100.0 2,193 Jawzjan 14.6 11.8 1.8 0.0 3.8 0.2 3.1 0.2 2.2 0.6 0.0 2.7 0.0 2.7 0.0 85.4 100.0 603 Faryab 12.4 12.2 0.6 0.0 3.3 1.3 3.7 1.1 0.9 1.2 0.0 0.2 0.0 0.2 0.0 87.6 100.0 2,030 Helmand 15.5 14.9 1.7 0.1 5.2 2.6 3.6 0.1 1.5 0.0 0.0 0.7 0.0 0.6 0.1 84.5 100.0 874 Badghis 13.4 13.4 1.7 0.0 7.1 0.3 3.6 0.1 0.2 0.3 0.0 0.0 0.0 0.0 0.0 86.6 100.0 640 Herat 60.5 58.2 4.4 0.1 26.9 1.4 12.2 0.2 9.2 4.0 0.0 2.3 0.0 2.2 0.1 39.5 100.0 2,166 Farah 27.3 26.2 1.6 0.0 13.9 1.2 4.2 0.1 3.2 2.0 0.0 1.1 0.1 1.0 0.0 72.7 100.0 717 Nimroz 29.5 26.3 0.9 0.0 14.5 0.4 6.9 0.0 3.2 0.4 0.0 3.1 0.0 3.1 0.0 70.5 100.0 264 Education No education 20.9 18.9 1.9 0.0 6.8 1.1 5.1 0.1 2.6 1.3 0.0 2.1 0.0 2.0 0.1 79.1 100.0 23,921 Primary 27.0 21.8 1.7 0.1 6.7 1.8 4.3 0.2 5.3 1.9 0.0 5.2 0.0 4.9 0.2 73.0 100.0 2,257 Secondary 31.4 26.0 1.1 0.0 8.7 4.0 2.3 1.5 7.7 0.6 0.0 5.5 0.1 5.3 0.0 68.6 100.0 1,951 More than secondary 39.6 29.7 0.5 0.0 3.5 6.9 7.2 0.0 10.8 1.0 0.0 9.9 0.7 9.2 0.0 60.4 100.0 542 Wealth quintile Lowest 15.8 15.0 1.1 0.0 5.8 0.4 5.8 0.0 1.4 0.4 0.0 0.7 0.0 0.6 0.1 84.2 100.0 5,757 Second 17.4 16.1 1.4 0.0 5.7 1.1 4.5 0.0 1.7 1.6 0.0 1.3 0.0 1.2 0.1 82.6 100.0 5,823 Middle 17.5 15.7 1.3 0.0 5.6 0.8 4.3 0.0 2.0 1.7 0.0 1.8 0.0 1.8 0.0 82.5 100.0 5,736 Fourth 25.6 22.0 1.8 0.1 7.2 1.7 5.1 0.5 3.9 1.7 0.0 3.7 0.0 3.6 0.0 74.4 100.0 5,846 Highest 36.6 30.5 3.7 0.0 10.0 3.2 4.7 0.2 7.7 0.9 0.0 6.1 0.2 5.8 0.1 63.4 100.0 5,509 Total 22.5 19.8 1.8 0.0 6.8 1.4 4.9 0.2 3.3 1.3 0.0 2.7 0.0 2.6 0.1 77.5 100.0 28,671 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 116 • Family Planning Table 7.5 Timing of sterilization Percent distribution of sterilized women age 15-49 by age at the time of sterilization and median age at sterilization, according to the number of years since the operation, Afghanistan 2015 Years since operation Age at time of sterilization Total Number of women Median age1 <25 25-29 30-34 35-39 40-44 45-49 <2 1.6 19.9 19.9 27.0 14.3 17.3 100.0 86 34.1 2-3 3.4 9.3 35.7 36.7 13.0 1.9 100.0 93 34.7 4-5 1.0 5.9 20.9 34.3 38.0 0.0 100.0 98 35.4 6-7 2.5 14.0 30.2 29.4 23.9 0.0 100.0 81 33.9 8-9 (1.1) (28.4) (24.2) (36.3) (10.0) (0.0) 100.0 56 (33.8) 10+ 8.9 22.7 54.9 13.5 0.0 0.0 100.0 119 a Total 3.5 16.1 32.7 28.3 16.2 3.1 100.0 534 33.8 Note: Figures in parentheses are based on 25-49 unweighted cases. a = Not calculated due to censoring 1 Median age at sterilization is calculated only for women sterilized before age 40 to avoid problems of censoring. Table 7.6 Source of modern contraception methods Percent distribution of users of modern contraceptive methods age 15-49 by most recent source of method, according to method, Afghanistan 2015 Source Female sterilization Pill IUD Injectables Male condom Total Public sector 67.5 36.1 59.0 62.0 31.1 47.2 Government hospital 66.7 11.0 31.9 25.5 13.3 22.9 CHC/polyclinic 0.0 14.3 16.0 22.8 9.0 14.2 Basic health center 0.0 5.7 7.3 6.0 3.3 4.8 Health sub-center 0.0 3.0 1.8 3.4 1.2 2.4 Health post/sub-health post 0.0 0.0 0.0 0.7 0.5 0.3 Community health worker 0.0 0.7 0.0 0.8 1.6 0.8 Mobile clinic 0.0 1.3 1.9 2.4 2.2 1.6 Other public sector 0.8 0.1 0.1 0.5 0.0 0.3 Non-government sector 0.0 0.7 1.1 0.7 0.7 0.7 Marie Stopes 0.0 0.1 0.9 0.2 0.0 0.2 Red Cross Society 0.0 0.0 0.0 0.5 0.2 0.2 AFGA 0.0 0.3 0.0 0.0 0.0 0.1 Other NGO sector 0.0 0.3 0.1 0.0 0.5 0.2 Private medical sector 24.4 59.0 36.6 35.3 55.0 46.6 Private hospital/clinic 18.3 7.4 20.1 7.5 2.4 8.6 Pharmacy 0.0 45.0 1.0 20.2 49.6 31.0 Private doctor 5.3 6.1 15.6 7.4 3.0 6.6 Fieldworker 0.0 0.5 0.0 0.2 0.0 0.2 Other private medical sector 0.8 0.0 0.0 0.1 0.0 0.1 Other source 3.3 3.7 1.2 1.0 11.7 4.2 Charity foundation 0.0 0.1 0.0 0.0 0.0 0.0 Refugee camp 0.0 0.4 0.0 0.0 0.3 0.2 Shop 0.0 1.8 0.0 0.2 9.0 2.3 Friend/relative 0.0 0.6 0.0 0.5 1.0 0.5 Other 3.3 0.8 1.2 0.4 1.4 1.1 Don't know 1.7 0.0 0.0 0.0 0.0 0.2 Missing 3.0 0.5 2.1 1.0 1.5 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 534 1,958 409 1,406 950 5,313 Note: Total includes 9 women whose husbands are sterilized and 46 women who are using implants who are not shown separately because there are too few cases; total excludes women using the lactational amenorrhea method (LAM). CHC = comprehensive health center AFGA = Afghan Family Guidance Association Family Planning • 117 Table 7.7 Use of social marketing brand pills and condoms Percentage of current pill and condom users age 15-49 using a social marketing brand, by background characteristics, Afghanistan 2015 Among pill users Among condom users1 Background characteristic Percentage using Khoshi Number of women using the pill Percentage using Aramesh or Asodagi Number of women using condoms Age 15-19 (77.9) 45 * 13 20-24 75.4 376 92.2 150 25-29 70.2 454 71.4 165 30-34 71.8 345 86.3 105 35-39 73.1 289 88.1 118 40-44 76.9 192 (80.0) 38 45-49 57.7 136 (95.7) 59 Residence Urban 73.3 583 87.6 324 Rural 71.4 1,254 81.2 326 Education No education 73.0 1,516 81.6 401 Primary 73.1 145 88.0 88 Secondary 64.6 160 86.4 115 More than secondary * 16 (96.4) 46 Wealth quintile Lowest 73.3 308 76.1 66 Second 71.6 301 87.7 68 Middle 72.8 308 80.3 77 Fourth 71.5 394 81.2 147 Highest 71.3 526 88.1 291 Total 72.0 1,837 84.4 649 Note: Table excludes pill and condom users who do not know the brand name. Condom use is based on women's reports. Figures in parentheses are based on 25- 49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. As there are too few cases, provincial- level data are not shown separately. 1 Among condom users not also using the pill 118 • Family Planning Table 7.8 Informed choice Among current users of selected modern methods age 15-49 who started the last episode of use within the 5 years preceding the survey, the percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods they could use, by method and initial source, Afghanistan 2015 Among women who started last episode of modern contraceptive method within 5 years preceding the survey: Method/source Percentage who were informed about side effects or problems of method used Percentage who were informed about what to do if they experienced side effects Percentage who were informed by a health or family planning worker of other methods that could be used Number of women Method1 Female sterilization 51.2 41.7 50.5 234 Pill 43.7 33.0 56.6 1,776 IUD 66.4 56.0 73.9 315 Injectables 61.3 51.8 72.5 1,190 Initial source of method2 Public sector 60.4 50.7 70.3 2,076 Government hospital 58.5 47.3 68.8 933 CHC/polyclinic 61.0 51.1 68.1 678 Basic health center 58.9 49.3 75.8 240 Health sub-center 77.1 73.4 83.2 107 Mobile clinic 57.4 53.7 67.8 72 Private sector 41.3 30.4 54.9 1,376 Private hospital/clinic 43.3 35.5 58.7 314 Private doctor's office 48.3 35.5 57.6 276 Pharmacy 37.9 26.4 52.4 779 Other source (51.1) (36.8) (59.9) 38 Shop (35.3) (35.3) (49.0) 17 Other (53.7) (33.6) (38.0) 20 Total 52.6 42.4 63.5 3,560 Note: Table includes users of only the methods listed individually. Figures in parentheses are based on 25- 49 unweighted cases. CHC = comprehensive health center 1 Total includes users of implants as there are too few users to show separately. 2 Source at start of current episode of use; total includes sources with too few users to show separately. Table 7.9 Twelve-month contraceptive discontinuation rates Among women age 15-49 who started an episode of contraceptive use within the 5 years preceding the survey, the percentage of episodes discontinued within 12 months, by reason for discontinuation and specific method, Afghanistan 2015 Method Method failure Desire to become pregnant Other fertility- related reasons2 Side effects/ health concerns Wanted more effective method Other method- related reasons3 Other reasons Any reason4 Switched to another method5 Number of episodes of use6 Pill 2.5 11.7 0.3 3.7 0.5 0.7 1.2 20.7 2.3 3,467 IUD 0.0 1.6 0.0 6.9 0.2 0.0 1.7 10.3 0.9 461 Injectables 0.3 5.5 1.7 7.3 0.4 0.2 1.6 17.1 1.6 1,920 Condom 4.3 8.7 0.0 0.8 1.1 0.8 2.9 18.6 2.3 1,262 Withdrawal 3.8 10.3 0.1 0.2 1.2 1.7 2.8 20.0 3.1 1,017 Other1 1.1 8.2 0.4 0.9 10.1 1.2 72.9 94.7 16.0 1,038 All methods 2.1 8.6 0.5 3.5 1.6 0.8 9.2 26.2 3.6 9,527 Note: Figures are based on life table calculations using information on episodes of use that began 3-62 months preceding the survey. Female sterilization is excluded as there are no failure cases. 1 Includes LAM and implants, not shown separately 2 Includes infrequent sex/husband away, difficult to get pregnant/menopausal, and marital dissolution/separation 3 Includes lack of access/too far, costs too much, and inconvenient to use 4 Reasons for discontinuation are mutually exclusive and add to the total given in this column. 5 The episodes of use included in this column are a subset of the discontinued episodes included in the discontinuation rate. A woman is considered to have switched to another method if she used a different method in the month following discontinuation or if she gave "wanted a more effective method" as the reason for discontinuation and started another method within 2 months of discontinuation. 6 Number of episodes of use includes both episodes of use that were discontinued during the period of observation and episodes of use that were not discontinued during the period of observation. Family Planning • 119 Table 7.10 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the 5 years preceding the survey by main reason stated for discontinuation, according to specific method, Afghanistan 2015 Reason Pill IUD Inject- ables Male condom Lactation al amenor- rhea With- drawal Other1 All methods Became pregnant while using 7.8 3.5 4.9 18.1 0.4 18.3 (8.1) 8.0 Wanted to become pregnant 67.4 47.8 52.4 57.9 8.9 60.0 (64.8) 53.7 Husband disapproved 2.5 15.4 2.7 10.0 1.5 7.7 (11.1) 4.3 Wanted a more effective method 2.5 1.3 1.8 3.0 10.2 3.9 (1.7) 3.6 Side effects/health concerns 13.5 23.9 28.4 4.0 0.9 2.0 (5.4) 12.7 Lack of access/too far 0.5 0.0 0.9 0.2 0.1 0.0 (6.0) 0.5 Cost too much 0.2 0.0 0.0 0.9 1.0 0.0 (0.0) 0.3 Inconvenient to use 1.2 4.7 0.7 1.6 0.2 2.4 (0.0) 1.2 Up to God/fatalistic 0.1 0.0 1.0 1.4 10.9 1.2 (0.8) 2.1 Difficult to get pregnant/menopausal 0.1 0.0 2.2 0.0 0.0 0.5 (0.0) 0.5 Infrequent sex/husband away 0.8 0.0 1.1 1.1 0.4 0.0 (0.0) 0.7 Marital dissolution/separation 0.3 0.0 0.0 0.0 0.0 0.0 (0.0) 0.1 Other 1.5 2.9 2.1 1.3 55.3 1.2 (1.2) 9.4 Don't know 0.0 0.0 0.0 0.1 0.0 0.0 (0.0) 0.0 Missing 1.7 0.6 1.8 0.6 10.2 2.8 (0.8) 2.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 2,521 233 1,107 598 862 545 95 5,962 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Implants, rhythm method, and male sterilization are included in the discontinuation rate for other methods. Table 7.11 Knowledge of fertile period Percent distribution of ever-married women and ever- married men age 15-49 by knowledge of the fertile period during the ovulatory cycle, Afghanistan 2015 Perceived fertile period Ever-married women Ever-married men Just before her menstrual period begins 2.1 2.4 During her menstrual period 5.0 2.0 Right after her menstrual period has ended 12.7 20.3 Halfway between two menstrual periods 8.3 7.1 Other 0.0 0.2 No specific time 35.5 25.9 Don't know 35.5 42.1 Missing 0.8 0.0 Total 100.0 100.0 Number of women 29,461 10,760 120 • Family Planning Table 7.12.1 Need and demand for family planning among currently married women Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Afghanistan 2015 Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percent- age of demand satisfied2 Percentage of demand satisfied by modern methods3 Number of women Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Age 15-19 19.6 1.3 20.9 7.3 0.5 7.8 26.8 1.8 28.7 27.1 20.8 1,812 20-24 24.8 2.4 27.2 15.2 2.4 17.6 40.0 4.9 44.9 39.3 34.1 6,028 25-29 23.9 5.4 29.3 16.2 4.7 20.9 40.1 10.2 50.3 41.6 37.4 6,193 30-34 19.0 8.5 27.5 14.3 12.2 26.4 33.3 20.7 54.0 49.0 41.9 4,226 35-39 12.9 13.2 26.2 9.4 19.6 29.0 22.3 32.9 55.2 52.6 46.1 4,375 40-44 6.7 11.9 18.6 4.6 23.9 28.4 11.3 35.8 47.0 60.5 53.7 2,977 45-49 3.6 6.8 10.4 1.5 21.6 23.2 5.2 28.4 33.6 69.0 64.0 3,060 Residence Urban 14.7 9.5 24.2 15.6 19.2 34.9 30.3 28.8 59.1 59.0 49.0 6,673 Rural 18.3 6.2 24.5 10.0 8.7 18.7 28.3 14.9 43.2 43.3 39.3 21,998 Province4 Kabul 14.7 11.3 26.0 12.7 19.4 32.1 27.3 30.7 58.1 55.3 45.6 3,571 Kapisa 18.0 12.7 30.8 6.7 13.5 20.1 24.7 26.2 50.9 39.6 37.5 197 Parwan 17.3 9.1 26.4 10.5 16.8 27.3 27.8 25.8 53.7 50.9 44.3 592 Wardak 13.9 4.9 18.8 21.2 10.6 31.9 35.1 15.5 50.6 62.9 59.5 378 Logar 9.9 10.3 20.2 13.9 18.8 32.8 23.8 29.1 53.0 61.9 46.7 465 Nangarhar 18.9 7.7 26.6 11.1 10.3 21.4 29.9 18.0 48.0 44.5 27.7 769 Laghman 18.6 9.4 28.1 7.5 7.0 14.4 26.1 16.4 42.5 34.0 32.0 567 Panjsher 17.2 10.2 27.4 8.8 3.3 12.2 26.0 13.6 39.6 30.8 29.4 53 Baghlan 17.9 8.1 26.0 5.1 10.5 15.6 23.0 18.7 41.6 37.6 33.8 835 Bamyan 17.0 7.9 24.9 9.7 12.2 21.9 26.7 20.1 46.8 46.8 45.9 295 Ghazni 18.0 4.7 22.7 5.4 8.0 13.4 23.3 12.7 36.1 37.2 34.3 1,319 Paktika 18.7 1.6 20.3 21.2 7.7 28.9 39.9 9.3 49.2 58.7 52.9 779 Paktya 17.2 5.1 22.3 9.2 5.3 14.5 26.4 10.4 36.8 39.5 30.1 529 Khost 32.3 2.0 34.3 8.2 8.0 16.2 40.5 10.0 50.5 32.1 23.8 845 Kunarha 20.5 4.9 25.4 3.2 2.8 6.0 23.7 7.7 31.4 19.1 17.4 549 Nooristan 23.8 1.5 25.4 0.5 0.1 0.5 24.3 1.6 25.9 2.1 1.9 209 Badakhshan 32.0 7.1 39.1 3.8 4.0 7.8 35.7 11.2 46.9 16.6 15.3 968 Takhar 19.3 15.4 34.7 5.2 4.2 9.4 24.5 19.6 44.1 21.3 17.5 1,070 Kunduz 25.3 4.9 30.2 6.2 6.8 12.9 31.5 11.6 43.1 30.0 28.9 1,214 Samangan 15.5 9.0 24.4 2.6 1.9 4.6 18.1 10.9 29.0 15.7 14.8 319 Balkh 16.7 4.9 21.6 8.9 11.6 20.6 25.7 16.5 42.2 48.8 31.0 1,742 Sar-E-Pul 20.4 8.4 28.8 5.5 6.3 11.8 25.9 14.7 40.6 29.1 25.0 644 Ghor 31.8 4.9 36.6 6.2 8.4 14.6 38.0 13.2 51.2 28.4 28.4 708 Daykundi 27.3 8.9 36.2 6.0 5.1 11.0 33.3 13.9 47.2 23.4 23.4 319 Urozgan 26.4 1.7 28.0 9.5 2.3 11.8 35.8 3.9 39.8 29.6 29.6 229 Kandahar 9.1 5.0 14.0 16.5 12.1 28.6 25.5 17.1 42.6 67.0 60.4 2,193 Jawzjan 26.4 8.4 34.8 4.7 9.9 14.6 31.1 18.3 49.4 29.5 24.0 603 Faryab 19.0 8.7 27.6 6.5 5.8 12.4 25.5 14.5 40.0 30.9 30.4 2,030 Helmand 23.6 10.3 34.0 8.3 7.2 15.5 32.0 17.5 49.5 31.4 30.1 874 Badghis 9.3 9.4 18.7 5.0 8.4 13.4 14.3 17.8 32.1 41.7 41.7 640 Herat 4.0 2.3 6.3 34.5 26.0 60.5 38.5 28.3 66.8 90.6 87.1 2,166 Farah 10.2 1.8 12.0 17.2 10.1 27.3 27.4 11.9 39.3 69.5 66.6 717 Nimroz 15.2 8.6 23.8 17.3 12.1 29.5 32.6 20.7 53.2 55.3 49.4 264 Education No education 17.3 7.5 24.8 9.8 11.1 20.9 27.2 18.6 45.7 45.7 41.2 23,921 Primary 18.2 5.4 23.5 15.4 11.7 27.0 33.5 17.0 50.5 53.5 43.2 2,257 Secondary 19.2 4.4 23.6 22.0 9.4 31.4 41.2 13.8 55.1 57.1 47.1 1,951 More than secondary 13.4 2.5 16.0 22.9 16.7 39.6 36.3 19.3 55.6 71.3 53.5 542 Wealth quintile Lowest 20.0 6.9 26.8 7.6 8.1 15.8 27.6 15.0 42.6 37.0 35.3 5,757 Second 18.2 6.6 24.8 9.7 7.7 17.4 27.9 14.3 42.2 41.3 38.2 5,823 Middle 18.5 6.0 24.5 9.6 7.9 17.5 28.1 13.9 42.0 41.7 37.4 5,736 Fourth 18.1 6.7 24.8 12.5 13.1 25.6 30.6 19.8 50.4 50.9 43.6 5,846 Highest 12.3 9.0 21.3 17.4 19.2 36.6 29.7 28.2 57.9 63.2 52.7 5,509 Total 17.5 7.0 24.5 11.3 11.1 22.5 28.8 18.1 46.9 47.9 42.2 28,671 Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al. 2012. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, and lactational amenorrhea method (LAM). 4 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Family Planning • 121 Table 7.12.2 Need and demand for family planning among ever-married women Percentage of ever-married age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Afghanistan 2015 Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percentag e of demand satisfied2 Percentag e of demand satisfied by modern methods3 Number of women Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total EVER-MARRIED WOMEN Age 15-19 19.5 1.3 20.8 7.2 0.5 7.7 26.7 1.8 28.5 27.0 20.8 1,825 20-24 24.6 2.4 27.0 15.0 2.4 17.5 39.6 4.8 44.5 39.3 34.0 6,089 25-29 23.6 5.4 29.0 16.0 4.7 20.6 39.6 10.0 49.6 41.6 37.4 6,299 30-34 18.7 8.4 27.1 14.0 12.0 26.0 32.7 20.3 53.1 49.0 41.9 4,302 35-39 12.7 13.0 25.7 9.2 19.2 28.4 21.9 32.3 54.1 52.6 46.1 4,463 40-44 6.4 11.4 17.8 4.4 22.8 27.2 10.8 34.2 45.0 60.5 53.7 3,113 45-49 3.3 6.2 9.5 1.4 19.8 21.2 4.7 26.0 30.7 69.0 64.0 3,369 Residence Urban 14.3 9.3 23.6 15.2 18.7 33.9 29.6 28.0 57.5 59.0 49.0 6,870 Rural 17.9 6.1 23.9 9.8 8.5 18.2 27.6 14.6 42.2 43.2 39.3 22,591 Province4 Kabul 14.3 11.0 25.3 12.4 19.0 31.4 26.7 30.0 56.7 55.3 45.6 3,658 Kapisa 17.3 12.2 29.5 6.4 12.9 19.3 23.7 25.1 48.9 39.6 37.5 205 Parwan 16.8 9.2 25.9 10.0 15.9 25.9 26.7 25.1 51.8 49.9 43.4 625 Wardak 13.8 4.8 18.6 21.0 10.5 31.6 34.8 15.4 50.1 62.9 59.5 382 Logar 9.7 10.2 19.9 13.7 18.6 32.3 23.5 28.7 52.2 61.9 46.7 472 Nangarhar 18.3 7.5 25.7 10.7 10.0 20.7 29.0 17.4 46.4 44.5 27.7 794 Laghman 18.1 9.3 27.5 7.3 6.8 14.1 25.4 16.1 41.5 33.9 31.8 583 Panjsher 16.8 10.0 26.8 8.6 3.2 11.9 25.4 13.2 38.6 30.7 29.4 54 Baghlan 17.8 8.1 26.0 5.1 10.5 15.6 22.9 18.6 41.5 37.5 33.7 839 Bamyan 16.6 7.7 24.3 9.5 12.1 21.6 26.1 19.8 45.9 47.0 46.1 303 Ghazni 17.8 4.7 22.5 5.3 8.0 13.3 23.2 12.6 35.8 37.2 34.2 1,328 Paktika 18.4 1.6 20.0 20.9 7.6 28.5 39.4 9.1 48.5 58.7 53.0 792 Paktya 16.8 5.0 21.7 9.0 5.2 14.2 25.8 10.1 35.9 39.5 30.1 542 Khost 32.1 2.0 34.1 8.1 8.0 16.1 40.2 10.0 50.2 32.1 23.8 851 Kunarha 20.2 4.8 25.0 3.1 2.8 5.9 23.3 7.6 30.9 19.1 17.4 559 Nooristan 22.5 1.5 23.9 0.4 0.1 0.5 22.9 1.5 24.4 2.1 1.9 222 Badakhshan 30.8 7.0 37.8 3.6 3.9 7.5 34.5 10.9 45.3 16.6 15.3 1,004 Takhar 18.9 14.9 33.8 5.0 4.1 9.1 23.9 18.9 42.9 21.2 17.4 1,105 Kunduz 24.9 4.8 29.7 6.1 6.7 12.7 31.0 11.5 42.5 30.0 28.9 1,232 Samangan 14.9 8.7 23.6 2.6 1.8 4.4 17.5 10.5 28.0 15.7 14.8 330 Balkh 16.5 4.8 21.3 8.9 11.4 20.2 25.4 16.1 41.5 48.8 31.1 1,781 Sar-E-Pul 20.1 8.3 28.4 5.5 6.2 11.7 25.5 14.5 40.0 29.1 25.0 654 Ghor 31.5 4.8 36.3 6.1 8.3 14.4 37.6 13.1 50.7 28.4 28.4 715 Daykundi 26.8 8.8 35.6 5.8 4.9 10.7 32.6 13.7 46.3 23.1 23.1 329 Urozgan 26.2 1.6 27.8 9.4 2.3 11.7 35.6 3.9 39.5 29.6 29.6 230 Kandahar 8.9 4.9 13.8 16.3 11.9 28.2 25.2 16.8 42.0 67.1 60.4 2,227 Jawzjan 26.0 8.3 34.3 4.6 9.7 14.4 30.6 18.0 48.7 29.5 24.0 614 Faryab 18.2 8.4 26.6 6.3 5.6 11.9 24.5 14.0 38.4 30.9 30.4 2,114 Helmand 23.6 10.3 33.9 8.3 7.2 15.5 31.9 17.5 49.4 31.4 30.1 875 Badghis 9.2 9.2 18.4 4.9 8.3 13.2 14.1 17.5 31.6 41.7 41.7 650 Herat 3.7 2.2 5.9 32.3 24.5 56.7 36.0 26.6 62.6 90.6 87.1 2,316 Farah 9.4 1.7 11.0 15.9 9.3 25.2 25.3 11.0 36.3 69.5 66.6 777 Nimroz 14.4 8.1 22.5 16.5 11.5 28.0 31.0 19.6 50.6 55.4 49.5 278 Education No education 16.9 7.3 24.2 9.5 10.8 20.4 26.5 18.1 44.6 45.7 41.2 24,604 Primary 17.6 5.2 22.8 14.9 11.3 26.2 32.5 16.5 49.0 53.4 43.2 2,330 Secondary 19.1 4.3 23.4 21.8 9.3 31.1 40.8 13.7 54.5 57.1 47.1 1,971 More than secondary 13.1 2.5 15.5 22.7 16.3 39.1 35.8 18.8 54.6 71.5 53.8 556 Wealth quintile Lowest 19.5 6.7 26.2 7.4 7.9 15.4 26.9 14.6 41.5 37.0 35.3 5,904 Second 17.7 6.4 24.1 9.4 7.6 17.0 27.1 14.0 41.1 41.3 38.1 6,001 Middle 18.1 5.9 23.9 9.4 7.7 17.1 27.4 13.6 41.0 41.7 37.4 5,888 Fourth 17.6 6.5 24.1 12.2 12.8 25.0 29.8 19.3 49.1 50.9 43.6 6,010 Highest 12.0 8.8 20.8 17.0 18.7 35.7 29.0 27.5 56.5 63.1 52.7 5,657 Total 17.0 6.8 23.9 11.0 10.9 21.9 28.1 17.7 45.8 47.8 42.1 29,461 Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al. 2012. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, and lactational amenorrhea method (LAM). 4 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 122 • Family Planning Table 7.13 Future use of contraception Percent distribution of currently married women age 15-49 who are not using a contraceptive method by intention to use in the future, according to number of living children, Afghanistan 2015 Number of living children1 Intention 0 1 2 3 4+ Total Intends to use 8.7 22.6 28.1 23.6 22.5 22.3 Unsure 28.3 42.8 35.2 35.7 31.4 33.8 Does not intend to use 61.7 32.8 34.2 38.3 43.8 41.7 Missing 1.3 1.8 2.5 2.4 2.2 2.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,742 3,080 2,965 2,879 11,562 22,228 1 Includes current pregnancy Family Planning • 123 Table 7.14.1 Exposure to family planning messages: Women Percentage of ever-married women age 15-49 who heard or saw a family planning message on radio, on television, or in a newspaper or magazine; who saw such a message on a billboard or the internet; or who heard such a message from health professionals or local community leaders in the past few months, according to background characteristics, Afghanistan 2015 Media source Other source Background characteristic Radio Television News- paper/ magazine None of these three media sources1 Billboard Internet Health profes- sionals Local community leaders Percentage of women with no exposure to any of the sources2 Number of women Age 15-19 18.4 24.6 1.9 64.8 2.2 1.0 17.6 21.2 45.5 1,825 20-24 21.9 29.3 2.5 60.5 2.3 2.1 22.3 26.0 38.6 6,089 25-29 22.8 29.0 1.9 60.3 1.2 1.1 21.5 25.8 39.0 6,299 30-34 23.4 30.8 1.1 58.0 1.1 0.7 19.9 25.3 37.8 4,302 35-39 21.6 30.8 1.8 59.9 0.6 1.5 22.1 25.1 38.7 4,463 40-44 22.0 28.9 1.4 61.5 1.1 0.7 23.0 22.8 40.0 3,113 45-49 18.1 27.9 1.7 63.5 1.3 0.4 20.0 24.6 41.9 3,369 Residence Urban 23.4 56.1 5.3 38.2 3.2 4.0 20.9 17.9 27.6 6,870 Rural 21.1 21.0 0.8 67.6 0.8 0.3 21.4 27.1 43.2 22,591 Province3 Kabul 26.8 59.0 6.2 32.6 4.4 4.6 18.4 15.7 26.6 3,658 Kapisa 34.7 34.2 2.9 52.7 0.3 0.5 11.4 1.9 49.8 205 Parwan 62.6 36.5 2.4 31.1 4.1 0.7 47.6 38.9 7.2 625 Wardak 14.7 4.8 0.1 83.2 3.8 0.4 18.2 12.3 72.0 382 Logar 54.1 27.8 1.1 45.2 0.1 0.2 5.5 12.2 40.3 472 Nangarhar 23.4 31.3 1.6 60.0 1.2 0.3 36.5 65.8 19.8 794 Laghman 65.8 22.0 1.2 33.2 0.8 0.6 47.6 56.5 1.7 583 Panjsher 17.9 46.8 1.1 41.4 1.0 0.6 29.4 24.9 15.2 54 Baghlan 4.4 45.5 0.1 53.4 0.1 0.6 12.7 8.2 46.6 839 Bamyan 9.8 10.3 0.8 84.5 0.3 0.5 62.6 62.4 11.0 303 Ghazni 12.0 5.8 0.8 85.8 0.6 0.1 10.4 13.5 73.7 1,328 Paktika 17.1 1.7 0.1 82.8 0.1 0.1 15.4 16.0 66.0 792 Paktya 50.7 8.1 0.3 48.9 0.4 0.0 11.5 24.9 32.7 542 Khost 58.6 29.2 0.3 40.4 2.0 0.1 16.2 31.3 32.4 851 Kunarha 14.7 5.5 0.5 84.9 0.2 0.0 0.8 0.8 84.6 559 Nooristan 0.7 0.1 0.2 99.2 0.0 0.0 0.0 0.9 98.8 222 Badakhshan 12.0 10.6 1.2 84.2 0.7 0.1 37.6 27.4 42.8 1,004 Takhar 14.3 18.3 0.4 77.1 0.4 0.2 36.3 44.1 26.9 1,105 Kunduz 39.5 42.8 1.8 52.4 0.6 1.3 9.4 7.5 40.5 1,232 Samangan 4.9 15.9 0.6 82.8 0.9 0.2 22.2 27.7 61.2 330 Balkh 5.0 29.3 2.1 68.6 2.3 1.0 20.0 18.8 49.6 1,781 Sar-E-Pul 0.8 6.4 0.7 93.3 0.3 0.7 10.1 5.1 83.5 654 Ghor 11.5 44.2 1.4 54.6 0.9 0.3 12.9 61.8 3.1 715 Daykundi 1.8 7.2 0.6 91.7 0.1 0.1 3.8 1.4 87.9 329 Urozgan 2.4 0.3 0.0 97.4 0.0 0.0 5.8 3.1 91.0 230 Kandahar 21.0 10.9 0.6 76.3 0.1 0.8 15.8 36.4 36.1 2,227 Jawzjan 31.6 40.6 5.8 57.8 0.0 0.7 8.6 9.6 56.4 614 Faryab 0.8 25.4 0.5 74.3 2.2 1.7 16.3 34.5 40.5 2,114 Helmand 69.0 25.7 0.7 25.6 0.5 0.3 22.7 29.6 22.5 875 Badghis 1.6 3.1 0.0 95.6 0.1 0.1 35.1 13.1 60.9 650 Herat 18.4 63.7 3.4 33.7 1.2 2.1 41.7 31.3 11.2 2,316 Farah 16.5 16.7 0.1 71.1 0.1 0.1 19.7 10.2 52.3 777 Nimroz 0.4 33.5 0.3 66.5 1.1 0.4 8.3 24.8 55.6 278 Education No education 21.1 24.8 0.4 64.3 0.5 0.2 20.4 25.5 41.6 24,604 Primary 23.0 43.6 3.0 49.6 2.7 1.0 21.2 19.9 34.7 2,330 Secondary 21.4 53.4 11.8 40.4 6.5 6.9 29.2 23.4 27.1 1,971 More than secondary 39.9 77.1 27.0 21.1 14.5 22.7 29.7 26.7 12.0 556 Wealth quintile Lowest 10.0 18.2 0.3 77.8 0.4 0.1 22.3 26.0 47.8 5,904 Second 20.9 16.6 0.2 70.0 0.4 0.1 21.4 26.3 46.2 6,001 Middle 23.8 17.7 0.6 67.2 0.7 0.1 19.6 27.8 43.6 5,888 Fourth 27.3 33.3 1.5 54.7 1.6 0.7 21.1 25.4 35.8 6,010 Highest 26.3 61.5 6.7 32.7 3.9 4.9 22.0 18.9 23.5 5,657 Total 21.6 29.2 1.8 60.7 1.4 1.2 21.3 24.9 39.5 29,461 1 Radio, television, or newspaper/magazine 2 Includes those with no exposure to any source (radio, television, newspaper/magazine, billboard, internet, health professionals, or local community leaders) 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 124 • Family Planning Table 7.14.2 Exposure to family planning messages: Men Percentage of ever-married men age 15-49 who heard or saw a family planning message on radio, on television, or in a newspaper or magazine; who saw such a message on a billboard or the internet; or who heard such a message from health professionals or local community leaders in the past few months, according to background characteristics, Afghanistan 2015 Media source Other source Background characteristic Radio Television News- paper/ magazine None of these three media sources1 Billboard Internet Health profes- sionals Local community leaders Percentage of men with no exposure to any of the sources2 Number of men Age 15-19 31.8 14.6 7.8 64.2 7.7 5.7 33.0 33.9 30.3 142 20-24 33.0 28.4 6.7 53.6 5.1 4.2 28.9 30.1 33.8 1,162 25-29 33.6 34.4 9.3 47.3 6.8 5.8 28.3 29.8 30.9 2,422 30-34 35.9 31.2 6.3 50.1 5.3 5.3 26.0 30.8 31.2 2,008 35-39 35.2 38.6 8.9 46.0 6.2 4.3 31.4 28.3 28.4 1,935 40-44 39.2 33.8 9.8 47.4 5.3 4.0 23.4 28.9 32.0 1,402 45-49 31.9 35.0 9.6 48.4 3.9 2.5 27.2 33.9 29.5 1,688 Residence Urban 42.6 57.6 17.8 29.8 8.7 10.2 27.5 19.6 18.7 2,479 Rural 32.3 26.5 5.7 54.3 4.7 2.8 27.8 33.5 34.4 8,281 Province3 Kabul 44.5 62.8 21.1 28.2 11.6 10.0 25.3 16.0 23.0 1,350 Kapisa 71.1 60.3 17.6 26.2 8.2 4.2 46.3 50.0 18.5 63 Parwan 45.9 47.3 7.9 37.4 4.7 1.5 14.3 48.0 32.3 220 Wardak 30.1 18.3 7.5 61.9 0.7 1.7 22.0 26.4 47.5 171 Logar 51.8 12.3 11.2 46.6 3.3 3.9 5.4 12.1 43.2 204 Nangarhar 69.0 36.8 12.6 23.5 4.7 5.0 46.3 28.8 14.2 273 Laghman 65.2 30.4 11.6 31.9 13.1 3.0 40.3 57.6 1.4 227 Panjsher 34.6 44.8 10.3 46.9 6.1 3.6 34.8 60.0 21.6 18 Baghlan 4.2 18.8 4.1 78.4 0.9 1.6 10.3 34.7 41.7 281 Bamyan 16.3 17.4 9.0 74.8 4.3 3.5 19.1 12.8 56.8 94 Ghazni 57.4 36.8 3.4 39.1 5.6 2.4 26.5 18.3 31.2 619 Paktika 36.7 10.0 4.1 62.1 0.5 4.4 15.2 23.6 53.2 322 Paktya 77.8 14.1 8.3 20.2 0.3 9.8 73.4 73.7 1.0 206 Khost 34.8 15.0 5.4 60.9 2.0 7.0 47.0 2.5 34.9 334 Kunarha 37.3 17.8 13.9 59.3 10.9 5.1 37.0 24.5 32.1 151 Nooristan 9.3 1.5 5.4 87.0 0.8 2.4 6.2 21.2 68.1 66 Badakhshan 44.5 33.5 10.8 48.9 2.6 2.8 33.9 41.3 25.7 316 Takhar 14.4 24.8 3.3 68.9 1.7 1.8 24.3 20.9 44.4 296 Kunduz 42.9 45.1 3.6 34.8 2.5 2.5 27.5 41.4 25.6 479 Samangan 39.1 19.2 3.8 55.2 1.2 1.3 7.1 21.4 48.6 125 Balkh 26.8 40.0 8.0 52.9 8.8 5.0 23.4 9.8 36.4 616 Sar-E-Pul 9.6 17.5 1.3 80.9 2.4 0.5 11.8 16.8 68.3 195 Ghor 16.4 17.4 10.2 67.4 1.6 1.6 59.0 56.6 16.8 322 Daykundi 12.8 12.4 3.6 81.4 1.6 1.7 3.9 4.0 79.4 77 Urozgan 56.6 11.6 0.8 41.0 0.8 1.2 46.1 85.0 1.9 92 Kandahar 24.1 7.5 3.1 71.5 0.4 3.9 23.9 13.9 47.7 874 Jawzjan 17.1 9.8 4.0 75.2 0.3 4.6 20.1 24.7 56.6 218 Faryab 9.6 62.6 9.3 33.6 13.8 3.5 37.7 38.3 14.5 706 Helmand 45.6 18.9 7.9 48.1 26.6 7.1 37.2 55.9 18.5 355 Badghis 8.7 9.3 1.8 82.4 0.6 0.1 11.2 29.9 47.0 231 Herat 35.4 57.8 10.5 29.6 1.8 6.3 23.9 64.2 9.2 863 Farah 32.6 17.5 2.1 57.9 0.7 1.4 26.3 22.2 37.1 295 Nimroz 4.5 15.5 2.3 81.1 2.3 0.0 0.5 1.0 80.6 93 Education No education 27.9 22.8 0.8 60.5 1.7 0.6 21.6 30.7 39.9 5,447 Primary 35.7 40.3 4.1 44.3 4.7 2.5 27.7 29.8 26.9 1,987 Secondary 43.4 43.6 18.3 35.0 11.5 7.8 37.0 32.6 19.8 2,632 More than secondary 51.5 62.0 44.1 20.4 16.5 28.3 41.4 20.2 11.9 695 Wealth quintile Lowest 24.9 21.7 4.4 63.5 1.3 1.2 25.4 36.4 37.9 2,029 Second 33.1 22.0 4.6 55.7 6.0 2.4 27.4 37.6 33.2 2,233 Middle 32.2 21.1 4.6 57.7 3.3 1.8 24.6 30.1 39.1 2,160 Fourth 39.7 44.3 9.3 38.6 6.9 4.4 32.3 29.3 25.4 2,260 Highest 42.9 59.3 19.8 28.2 10.4 12.9 28.7 18.0 18.4 2,078 Total 34.7 33.7 8.5 48.7 5.6 4.5 27.8 30.3 30.8 10,760 1 Radio, television, or newspaper/magazine 2 Includes those with no exposure to any source (radio, television, newspaper/magazine, billboard, internet, health professionals, or local community leaders) 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Family Planning • 125 Table 7.15 Contact of nonusers with family planning providers Among ever-married women age 15-49 who are not using contraception, the percentage who during the past 12 months were visited by a community health worker who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who did not discuss family planning either with a community health worker or at a health facility, by background characteristics, Afghanistan 2015 Background characteristic Percentage of women who were visited by a community health worker who discussed family planning Percentage of women who visited a health facility in the past 12 months and who: Percentage of women who did not discuss family planning either with a community health worker or at a health facility Discussed family planning Did not discuss family planning Number of women Age 15-19 10.6 5.0 28.5 88.0 1,685 20-24 15.8 9.9 37.4 81.5 5,026 25-29 18.6 13.3 36.0 78.0 5,000 30-34 15.2 9.4 37.5 82.3 3,184 35-39 18.0 10.7 34.1 80.1 3,194 40-44 13.0 8.7 27.1 84.7 2,266 45-49 9.6 4.5 23.1 88.8 2,656 Residence Urban 16.0 10.3 33.5 80.1 4,539 Rural 15.0 9.4 33.3 82.8 18,471 Province1 Kabul 11.0 8.7 27.3 85.7 2,511 Kapisa 6.6 5.1 51.0 90.5 166 Parwan 20.1 8.1 26.3 77.9 464 Wardak 25.3 16.7 32.4 74.1 261 Logar 8.2 27.1 43.4 71.2 319 Nangarhar 4.5 7.5 77.7 89.5 630 Laghman 33.6 16.7 46.9 59.8 501 Panjsher 31.8 16.0 10.6 67.7 48 Baghlan 24.4 7.0 20.0 74.0 709 Bamyan 33.7 29.3 13.1 62.4 237 Ghazni 8.1 4.5 14.9 89.9 1,151 Paktika 13.3 6.6 26.1 86.1 566 Paktya 4.3 4.3 64.2 93.0 466 Khost 14.5 2.0 58.3 84.4 714 Kunarha 4.2 1.6 74.9 95.0 526 Nooristan 1.9 0.0 17.6 98.1 221 Badakhshan 8.6 5.1 18.6 89.8 928 Takhar 5.7 2.8 28.4 93.8 1,005 Kunduz 28.0 20.6 31.1 70.8 1,075 Samangan 7.0 1.2 17.7 92.6 315 Balkh 23.4 14.2 52.0 75.1 1,421 Sar-E-Pul 11.8 9.9 28.4 86.1 578 Ghor 2.5 1.8 61.7 96.5 612 Daykundi 5.4 1.4 8.7 93.9 294 Urozgan 3.4 1.6 3.4 95.5 203 Kandahar 7.9 8.0 31.2 87.4 1,600 Jawzjan 20.7 9.6 53.8 78.6 526 Faryab 32.7 26.5 37.1 63.3 1,862 Helmand 2.6 0.5 13.8 97.1 739 Badghis 2.3 2.0 11.4 96.8 564 Herat 35.3 9.3 29.1 63.6 1,002 Farah 19.6 11.2 10.8 78.9 581 Nimroz 3.8 0.7 12.7 95.7 200 Education No education 14.2 8.8 33.1 83.5 19,593 Primary 17.2 10.2 36.4 80.7 1,720 Secondary 24.4 18.5 34.2 71.7 1,358 More than secondary 27.6 19.4 29.4 65.9 339 Wealth quintile Lowest 13.9 7.8 29.8 85.1 4,996 Second 13.9 8.0 31.8 84.2 4,982 Middle 13.2 8.0 35.8 84.2 4,881 Fourth 19.0 12.9 36.7 78.3 4,511 Highest 17.0 12.2 32.7 78.2 3,639 Total 15.2 9.6 33.3 82.3 23,010 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Infant and Child Mortality • 127 INFANT AND CHILD MORTALITY 8 Key Findings  Current levels: For the 5-year period preceding the survey, the under-5 mortality rate is 55 deaths per 1,000 live births, and the infant mortality rate is 45 deaths per 1,000 live births. This means that one in 18 children in Afghanistan die before their fifth birthday, and approximately four-fifths of these deaths occur during infancy.  Residential differences: Neonatal, infant, and under-5 mortality rates are substantially higher in rural areas than in urban areas. For instance, the infant mortality rate is 35 deaths per 1,000 live births in urban areas, as compared with 54 deaths per 1,000 live births in rural areas.  Short birth intervals: Infants are more than twice as likely to die before their first birthday if they are born less than 2 years after an older sibling. Excess mortality associated with short birth intervals persists through age 5. nformation on infant and child mortality is relevant to a demographic assessment of a country’s population and is an important indicator of the country’s socioeconomic development and quality of life. It can also help identify children who may be at higher risk of death and lead to strategies to reduce this risk, such as promoting birth spacing. This chapter presents information on levels, trends, and differentials in perinatal, neonatal, infant, and under-5 mortality rates. It also examines biodemographic factors and fertility behaviors that affect mortality risks for infants and children. The information was collected as part of a retrospective birth history in which female respondents listed all of the children they had borne, along with each child’s date of birth, survivorship status, and current age or age at death. The quality of mortality estimates calculated from birth histories depends on the mother’s ability to recall all of the children she has given birth to, as well as their birth dates and ages at death. Potential data quality problems include: The selective omission from birth histories of those births that did not survive, which can result in underestimation of childhood mortality. The displacement of birth dates, which may distort mortality trends. This can occur if an interviewer knowingly records a birth as occurring in a different year than the one in which it occurred. This may happen if an interviewer is trying to cut down on his or her overall work load, because live births occurring during the 5 years before the interview are the subject of a lengthy set of additional questions. I 128 • Infant and Child Mortality The quality of reporting of age at death. Misreporting the child’s age at death may distort the age pattern of mortality, especially if the net effect of the age misreporting is to transfer deaths from one age bracket to another. Any method of measuring childhood mortality that relies on mothers’ reports (e.g., birth histories) assumes that female adult mortality is not high or, if it is high, that there is little or no correlation between the mortality risks of mothers and those of their children. In countries such as Afghanistan that have high rates of female adult mortality (Chapter 14), these assumptions may not hold, and the resulting childhood mortality rates will be understated to some degree (Sarah Saleem et al. 2014). Selected indicators of the quality of the mortality data on which the estimates of mortality in this chapter are based are presented in Appendix C, Tables C.4-C.6. 8.1 EARLY CHILDHOOD MORTALITY Neonatal mortality: the probability of dying within the first month of life. Postneonatal mortality: the probability of dying between the first month of life and first birthday (computed as the difference between infant and neonatal mortality). Infant mortality: the probability of dying between birth and the first birthday. Child mortality: the probability of dying between the first and the fifth birthday. Under-5 mortality: the probability of dying between birth and the fifth birthday. In the 5-year period before the 2015 AfDHS, the neonatal mortality rate was 22 deaths per 1,000 births, meaning that one of every 45 children died during the first month of life. The infant mortality rate was 45 deaths per 1,000 live births; that is, one in every 22 children died before their first birthday. The under-5 mortality rate was 55 deaths per 1,000 live births, meaning that one of every 18 children died before reaching their fifth birthday (Table 8.1). Four-fifths of all deaths in the first 5 years of life occurred during infancy, and two-fifths occurred during the first month of life. The data from the 2015 AfDHS show that there has been a decline in the under-5 mortality rate. The rate was 87 deaths per 1,000 live births in the 10-14 years prior to the survey, falling to 55 deaths per 1,000 live births in the 5 years preceding the survey. These mortality estimates should be used with caution. They appear to be lower than expected, given findings of other data sources from Afghanistan, as well as expert knowledge of the relationship of neonatal deaths to infant deaths. Neonatal death in particular appears to be under-reported. Further analyses are being conducted to better understand these estimates, and additional analyses are encouraged. Patterns by background characteristics  Mortality estimates by background characteristics are calculated for the 10-year period before the survey to ensure that there are sufficient cases to produce statistically reliable estimates (Table 8.2).  Urban areas have lower rates of childhood mortality than rural areas. For example, the infant mortality rate is 35 deaths per 1,000 live births in urban areas, as opposed to 54 deaths per 1,000 live births in rural areas. Similarly, the under-5 mortality rate is lower in urban areas than in rural areas (43 deaths per 1,000 live births and 67 deaths per 1,000 live births, respectively). Infant and Child Mortality • 129  Provincial differences in mortality persist throughout infancy and early childhood. Infant and under- 5 mortality rates are highest in Nooristan (123 and 170 deaths per 1,000 live births, respectively (Table 8.2).  The under-5 mortality rate declines with increasing mother’s education, from 65 deaths per 1,000 live births among children whose mothers have no education to 45 deaths per 1,000 live births among children whose mothers have a secondary education (Figure 8.1).  The under-5 mortality rate also declines with increasing household wealth, from 81 deaths per 1,000 live births in the lowest wealth quintile to 40 deaths per 1,000 live births in the highest quintile. 8.2 BIODEMOGRAPHIC RISK FACTORS Researchers have identified multiple risk factors for infant and child mortality based on the characteristics of the mother and child and on the circumstances of the birth. Table 8.3 illustrates the relationship between these risk factors and neonatal, infant, and under-5 mortality.  Boys are more likely than girls to die in childhood. The gender gap is most pronounced during the first month of life (28 deaths per 1,000 live births among boys and 21 deaths per 1,000 live births among girls).  Mortality throughout early childhood is higher following short birth intervals. For instance, the under-5 mortality rate is 86 deaths per 1,000 live births for births with less than a 2-year interval from the previous birth. An interval of at least 2 years reduces this rate to 55 deaths per 1,000 live births (Figure 8.2).  Size at birth has an influence on neonatal mortality. The neonatal mortality rate is 35 deaths per 1,000 live births among neonates reported to be smaller than average at birth, as compared with 16 deaths per 1,000 live births among those who were of average or larger size at birth. Figure 8.1 Under-5 mortality by mother’s education Figure 8.2 Under-5 mortality by birth interval 65 46 45 (20) No education Primary Secondary More than secondary Deaths per 1,000 live births for the 10-year period before the survey Note: Figures in parentheses are based on 250-499 unweighted person- years of exposure to the risk of death. 86 55 38 35 <2 years 2 years 3 years 4+ years Deaths per 1,000 live births for the 10-year period before the survey Previous birth interval 130 • Infant and Child Mortality 8.3 PERINATAL MORTALITY Perinatal mortality rate Perinatal deaths comprise stillbirths (pregnancy losses occurring after 7 months of gestation) and early neonatal deaths (deaths of live births within the first 7 days of life). The perinatal mortality rate is calculated as the number of perinatal deaths per 1,000 pregnancies of 7 or more months’ duration. Sample: Number of pregnancies of 7 or more months’ duration to women age 15-49 in the 5 years before the survey The causes of stillbirths and early neonatal deaths are closely linked, and it can be difficult to determine whether a death is one or the other. Because the perinatal mortality rate encompasses both stillbirths and early neonatal deaths, it offers a better measure of the level of mortality around delivery. During the 5 years before the survey, the perinatal mortality rate in Afghanistan was 36 deaths per 1,000 pregnancies (Table 8.4). Patterns by background characteristics  Perinatal mortality increases with mother’s age at birth, rising from 30 deaths per 1,000 pregnancies for women age 20-29 to 63 deaths per 1,000 pregnancies for women age 40-49.  Short birth intervals are associated with high levels of perinatal mortality. When the previous pregnancy interval is less than 15 months, the rate peaks at 45 deaths per 1,000 pregnancies (Table 8.4).  Perinatal mortality is twice as high in rural areas as in urban areas (41 deaths per 1,000 pregnancies and 20 deaths per 1,000 pregnancies, respectively).  Household wealth seems to have a direct impact on perinatal mortality. The perinatal mortality rate decreases from 44 deaths per 1,000 pregnancies in the lowest wealth quintile to 20 deaths per 1,000 pregnancies in the highest quintile. LIST OF TABLES For more information on infant and child mortality, see the following tables:  Table 8.1 Early childhood mortality rates  Table 8.2 Early childhood mortality rates by socioeconomic characteristics  Table 8.3 Early childhood mortality rates by demographic characteristics  Table 8.4 Perinatal mortality  Table 8.5 High-risk fertility behavior Infant and Child Mortality • 131 Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-5 mortality rates for 5-year periods preceding the survey, Afghanistan 2015 Years preceding the survey Neonatal mortality (NN) Post- neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) 0-4 22 23 45 11 55 5-9 28 27 54 16 69 10-14 31 36 66 23 87 1 Computed as the difference between the infant and neonatal mortality rates Table 8.2 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by background characteristics, Afghanistan 2015 Background characteristic Neonatal mortality (NN) Post- neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Residence Urban 17 17 35 9 43 Rural 27 27 54 14 67 Province2 Kabul 18 18 36 7 43 Kapisa 23 17 41 9 49 Parwan 42 21 63 14 76 Wardak 34 20 54 14 68 Logar 7 21 28 7 35 Nangarhar 29 22 51 14 64 Laghman 32 13 45 12 56 Panjsher 16 11 27 12 38 Baghlan 36 27 63 12 74 Bamyan 40 25 65 12 76 Ghazni 36 25 61 3 64 Paktika 6 7 13 8 21 Paktya 22 13 35 9 44 Khost 24 14 38 4 42 Kunarha 22 10 32 7 39 Nooristan 41 83 123 53 170 Badakhshan 38 30 68 42 107 Takhar 39 21 60 26 84 Kunduz 13 16 28 11 40 Samangan 21 32 53 15 67 Balkh 24 29 53 12 65 Sar-E-Pul 44 19 63 12 74 Ghor 32 55 87 19 104 Daykundi 15 14 28 13 41 Urozgan 55 34 89 12 99 Kandahar 32 35 67 19 84 Jawzjan 15 27 42 19 60 Faryab 22 40 61 20 80 Helmand 1 1 3 0 3 Badghis 35 32 67 10 77 Herat 20 30 49 9 58 Farah 13 15 28 11 39 Nimroz 12 8 21 9 30 Mother's education No education 26 26 52 14 65 Primary 18 16 34 13 46 Secondary 20 19 39 6 45 More than secondary 13 3 17 (3) (20) Wealth quintile Lowest 32 30 62 20 81 Second 26 26 51 14 64 Middle 28 28 57 16 71 Fourth 20 21 41 10 51 Highest 17 17 35 6 40 Note: Figures in parentheses are based on 250-499 unweighted person-years of exposure to the risk of death. 1 Computed as the difference between the infant and neonatal mortality rates 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 132 • Infant and Child Mortality Table 8.3 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by demographic characteristics, Afghanistan 2015 Demographic characteristic Neonatal mortality (NN) Post- neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Child's sex Male 28 24 52 14 66 Female 21 25 46 12 58 Mother's age at birth <20 28 25 53 10 63 20-29 22 25 47 12 58 30-39 29 23 52 18 68 40-49 35 29 64 18 80 Birth order 1 26 27 53 8 60 2-3 17 18 35 12 47 4-6 25 27 52 14 65 7+ 39 30 69 20 87 Previous birth interval2 <2 years 36 35 71 16 86 2 years 21 19 40 16 55 3 years 15 14 28 10 38 4+ years 14 15 28 7 35 Birth size3 Small/very small 35 33 67 na na Average or larger 16 19 35 na na Don’t know/missing 69 13 82 na na na = Not available 1 Computed as the difference between the infant and neonatal mortality rates 2 Excludes first-order births 3 Rates for the 5-year period before the survey Infant and Child Mortality • 133 Table 8.4 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the 5-year period preceding the survey, by background characteristics, Afghanistan 2015 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months’ duration Mother's age at birth <20 54 107 35 4,575 20-29 294 274 30 18,845 30-39 229 132 47 7,745 40-49 64 16 63 1,277 Previous pregnancy interval in months4 First pregnancy 66 95 28 5,797 <15 191 173 45 8,133 15-26 217 138 41 8,660 27-38 81 76 34 4,605 39+ 86 48 26 5,246 Residence Urban 49 97 20 7,295 Rural 592 432 41 25,148 Province5 Kabul 28 44 19 3,797 Kapisa 1 5 27 220 Parwan 9 27 48 737 Wardak 17 8 71 363 Logar 2 1 6 441 Nangarhar 17 23 38 1,045 Laghman 11 21 39 820 Panjsher 1 0 25 41 Baghlan 53 27 100 805 Bamyan 5 8 38 333 Ghazni 22 28 57 856 Paktika 0 5 6 875 Paktya 6 12 29 607 Khost 9 12 21 1,034 Kunarha 7 9 22 732 Nooristan 9 10 52 363 Badakhshan 6 19 26 945 Takhar 13 37 40 1,267 Kunduz 38 21 46 1,260 Samangan 11 2 35 370 Balkh 26 15 21 1,969 Sar-E-Pul 25 11 54 650 Ghor 32 13 48 945 Daykundi 4 2 18 318 Urozgan 13 5 43 420 Kandahar 140 94 75 3,129 Jawzjan 1 3 7 601 Faryab 36 15 21 2,434 Helmand 1 0 2 899 Badghis 4 22 33 778 Herat 62 26 40 2,211 Farah 31 7 44 857 Nimroz 1 0 6 297 Mother's education No education 590 462 39 27,156 Primary 31 17 19 2,535 Secondary 14 47 27 2,256 More than secondary 6 4 20 495 Wealth quintile Lowest 177 102 44 6,304 Second 155 119 41 6,660 Middle 187 138 47 6,966 Fourth 89 91 27 6,693 Highest 33 80 20 5,819 Total 641 529 36 32,443 1 Stillbirths are fetal deaths in pregnancies lasting 7 or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of 7 or more months' duration, expressed per 1,000 4 Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+ months. 5 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 134 • Infant and Child Mortality Table 8.5 High-risk fertility behavior Percent distribution of children born in the 5 years preceding the survey by category of elevated risk of mortality and the risk ratio, and percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Afghanistan 2015 Births in the 5 years preceding the survey Percentage of currently married women1 Risk category Percentage of births Risk ratio Not in any high-risk category 19.6 1.00 13.5a Unavoidable risk category First-order births between age 18 and age 34 15.3 1.77 7.7 Single high-risk category Mother's age <18 4.3 2.49 0.8 Mother's age >34 0.4 0.22 2.5 Birth interval <24 months 11.3 1.50 10.1 Birth order >3 24.4 1.72 19.5 Subtotal 40.4 1.73 32.9 Multiple high-risk category Age <18 and birth interval <24 months2 0.7 5.59 0.2 Age >34 and birth interval <24 months 0.2 * 0.1 Age >34 and birth order >3 9.8 1.72 28.5 Age >34 and birth interval <24 months and birth order >3 2.4 2.77 4.7 Birth interval <24 months and birth order >3 11.6 3.64 12.4 Subtotal 24.6 2.83 45.9 In any avoidable high-risk category 65.0 2.15 78.8 Total 100.0 na 100.0 Number of births/women 31,812 na 28,671 Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead among births not in any high-risk category. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes the category age <18 and birth order >3 a Includes sterilized women Maternal Health Care • 135 MATERNAL HEALTH CARE 9 Key Findings  Antenatal care coverage: Fifty-nine percent of women who gave birth in the 5 years before the survey received antenatal care from a skilled provider for their most recent birth. However, only 18% had the recommended four or more ANC visits.  Components of antenatal care: Pregnant women are more likely to have their blood pressure measured as part of antenatal care (79%) than to receive iron supplements (42%) or information about pregnancy complications (56%).  Protection against neonatal tetanus: More than half (53%) of births are protected against neonatal tetanus; the proportion varies widely among provinces, however, from a low of 3% in Nooristan to a high of 79% in Ghor.  Delivery: Slightly less than half of births are delivered in a health facility (48%). Home deliveries are more common in rural communities (59%) than in urban communities (23%). Seventy-seven percent of poor households deliver at home.  Postnatal checks: Forty percent of women and only 9% of newborns receive the recommended postnatal health check within 2 days of delivery.  Cesarean delivery: The overall rate of cesarean delivery in Afghanistan is 3%. ealth care services during pregnancy and childbirth and after delivery are important for the survival and well-being of both the mother and the infant. The Afghan Ministry of Public Health (MoPH), through its leadership and effective governance, is committed to reducing the country’s high levels of reproductive, maternal, neonatal, child, and adolescent (RMNCA) morbidity and mortality. These are the major causes of concern in the national public health agenda. It is the policy of the MoPH to have close oversight of the many different aspects of work that comprise RMNCA health. These include, but are not limited to, maternal and newborn death surveillance and response; collaboration and coordination with stakeholders and strengthening of human resources; improvements in the quality of health services; medical records and reporting for health information systems, program monitoring, and research; and innovation and new technology (MoPH 2015a). The first part of this chapter presents information on antenatal care (ANC) providers, the number and timing of ANC visits, and various components of care during ANC visits. The second focuses on childbirth and presents information on place of delivery, assistance during delivery, and cesarean deliveries. The third part focuses on postnatal care and presents information on postnatal health checks for mothers and H 136 • Maternal Health Care newborns. The final section examines barriers women may face when seeking care during pregnancy, delivery, and the postnatal period. 9.1 ANTENATAL CARE COVERAGE AND CONTENT 9.1.1 Skilled Providers Antenatal care (ANC) from a skilled provider Pregnancy care received from skilled providers, that is, doctors, nurses/midwives, and auxiliary nurse/midwives. Sample: Women age 15-49 who had a live birth in the 5 years before the survey In Afghanistan, 59% of women age 15-49 who gave birth in the 5 years preceding the survey received ANC from a skilled provider for their most recent birth (Table 9.1). Patterns by background characteristics  Women with higher-order births are less likely to receive ANC. Only 56% of women giving birth to their fourth or later child received ANC from a skilled provider, as compared with 67% of women giving birth to their first child.  Women in urban areas are more likely to receive ANC than women in rural areas (72% versus 55%). Also, urban women are more likely than rural women to receive ANC from a doctor (46% versus 26%).  ANC coverage differs substantially by province. Women in Parwan (88%) and Balkh (85%) are most likely to receive ANC services, and women in Kunarha (16%) and Nooristan (11%) are least likely to receive such services.  Ninety-four percent of women with more than a secondary education receive ANC services from skilled providers, compared with only 55% of women with no education.  Women in the highest wealth quintile (76%) are more likely to receive ANC services from skilled providers than those in the second and lowest wealth quintiles (50%). 9.1.2 Timing and Number of ANC Visits Eighteen percent of women in Afghanistan had at least four ANC visits during their last pregnancy, as recommended by WHO (Table 9.2, Figure 9.1). However, 38% of women did not have any ANC visits for their most recent live birth. Thirty percent of women had an ANC visit during the first trimester for their most recent live birth; however, 18% of women delayed their first ANC visit to the fourth or fifth month, and the remaining women delayed their first visit even longer. Rural women are more likely than urban women to have no ANC visits (41% versus 28%). Forty-two percent of women in urban areas had an ANC visit during the first trimester for their most recent live birth, as compared with only 27% of rural women. Figure 9.1 Antenatal care coverage 72 32 42 55 14 27 59 18 30 Received any ANC from a skilled provider Had 4+ ANC visits Had ANC in first trimester (<4 months) Percentage of women age 15-49 who had a live birth in the 5 years before the survey (for the most recent birth) Urban Rural Total Maternal Health Care • 137 9.2 COMPONENTS OF ANC VISITS Blood pressure measurements are an important component of antenatal care, as specified in the Basic Package of Health Services for Afghanistan 2010/1389 (MoPH 2010a). However, only about four- fifths of pregnant women (79%) had their blood pressure measured as part of an ANC visit. Similarly, only two in five women had a urine sample taken for testing, while 30% had a blood sample taken (Table 9.3, Figure 9.2). Only 56% of women were informed about signs of pregnancy complications during their ANC visit. Overall, only 42% of women took iron supplements during pregnancy and 3% received drugs for intestinal worms. For complete information on these components of ANC, see Table 9.3. Knowledge of Pregnancy Complications As noted, only 56% of women were informed about signs of pregnancy complications during ANC visits, and thus knowledge of such complications was relatively poor. Fifty-eight percent of women knew that vaginal bleeding is a symptom that requires immediate care during pregnancy, and 51% knew that severe lower abdominal pain requires immediate care (Table 9.4). Male Participation in ANC The 2015 AfDHS collected information on men’s participation in antenatal care visits for their wives. Sixty-three percent of men reported that their wife made ANC visits during the pregnancy for their last child in the 2 years prior to the survey (Table 9.5). Among those whose wives had an ANC visit, two- thirds mentioned that they accompanied their wives. This was mostly true for men in urban areas (75%), those with more than a secondary education (79%), and those in the highest wealth quintile (71%). 9.3 PROTECTION AGAINST NEONATAL TETANUS Protection against neonatal tetanus The number of tetanus toxoid injections needed to protect a baby from neonatal tetanus depends on the mother’s vaccinations. A birth is protected against neonatal tetanus if the mother has received any of the following:  Two tetanus toxoid injections during that pregnancy.  Two or more injections, the last one within 3 years of the birth.  Three or more injections, the last one within 5 years of the birth.  Four or more injections, the last one within 10 years of the birth.  Five or more injections at any time prior to the birth. Sample: Most recent live births in the 5 years before the survey to women age 15-49 Depending on whether and when a pregnant woman has been vaccinated against tetanus during previous pregnancies, she may need as many as two tetanus toxoid injections during her pregnancy to protect her baby against neonatal tetanus. In Afghanistan, 53% of women’s most recent births were protected against neonatal tetanus (Table 9.6). Only 34% of women with a live birth in the 5 years preceding the survey received two or more injections during their last pregnancy. Figure 9.2 Components of antenatal care 30 40 79 56 Blood sample taken Urine sample taken Blood pressure measured Informed of signs of pregnancy complications Among women who received ANC for their most recent birth, the percentage with selected services 138 • Maternal Health Care Patterns by background characteristics  First-order births are more likely to be protected against neonatal tetanus (59%) than higher-order births.  There are wide provincial differences in the percentage of births protected against neonatal tetanus; only 3% of births in Nooristan are protected against neonatal tetanus.  Women with a secondary education are more likely than those with no education to have their births protected against neonatal tetanus (76% versus 49%). 9.4 DELIVERY SERVICES 9.4.1 Institutional Deliveries Institutional deliveries Deliveries that take place in a health facility. Sample: All live births in the 5 years before the survey The survey data revealed that 51% of live births in the 5 years before the survey took place at home. Forty- eight percent of infants were delivered at a health facility, with 43% of these deliveries occurring at a public sector facility (Table 9.7). Patterns by background characteristics  There is a strong association between ANC visits and institutional deliveries; specifically, the more ANC visits, the better the chance of an institutional delivery. Seventy-eight percent of births among mothers with four or more ANC visits were delivered in a health facility, as compared with only 30% of births among mothers with no ANC visits (Table 9.7).  Institutional deliveries are less common in rural areas, where there are more likely to be topography and access barriers, than in urban areas (40% and 76%, respectively).  There is a strong relationship between institutional deliveries and mother’s level of education. Ninety-two percent of births among mothers with more than a secondary education were delivered in a health facility, as compared with only 43% of births among mothers with education (Figure 9.3).  Likewise, 83% of women in the highest wealth quintile delivered in a health facility, compared with only 22% of women in the lowest wealth quintile. Figure 9.3 Institutional deliveries by education 43 70 76 92 48 No education Primary Secondary More than secondary Total Percentage of live births in the 5 years preceding the survey that were delivered at a health facility Maternal Health Care • 139 Institutional deliveries are least common in Badghis (6%) and Nooristan (1%) (Figure 9.4). Figure 9.4 Institutional deliveries by province Percentage of live births in the 5 years preceding the survey that were delivered at a health facility 9.4.2 Skilled Assistance during Delivery Skilled assistance during delivery Births delivered with the assistance of doctors and nurse/midwives. Sample: All live births in the 5 years before the survey Half of all deliveries in Afghanistan are assisted by a skilled provider (51%), that is, a doctor, nurse, midwife, or auxiliary nurse/midwife (Table 9.8, Figure 9.5). One-third of births are assisted by traditional birth attendants, and 15% are assisted by relatives. Patterns by background characteristics  Skilled assistance during delivery declines sharply with increasing birth order: 61% of first births have skilled assistance, as compared with 44% of sixth- or higher-order births.  Urban deliveries are more likely to be assisted by a skilled provider. Seventy-nine percent of urban and 42% of rural deliveries are assisted by skilled providers. Figure 9.5 Delivery assistance Auxiliary nurse/mid-wife 34% Doctor 17% Relative/ friend 15% Traditional birth attendant 33% No one 1% Percent distribution of births in the 5 years before the survey 140 • Maternal Health Care  Only 6% of deliveries in Badghis and 1% in Nooristan are attended by a skilled provider. An overwhelming majority of births in Nooristan are assisted by relatives (84%).  The more education a woman has, the more likely it is that she will receive assistance from a skilled provider at delivery. Ninety-seven percent of births among women with more than a secondary education were assisted by a skilled provider, as compared with only 45% of births among women with no education.  Wealth affects whether or not a woman receives skilled assistance during delivery; the likelihood of assistance from a skilled provider is more than three times higher among births in the highest wealth quintile than among those in the lowest quintile (85% versus 24%) (Figure 9.6). 9.4.3 Delivery by Cesarean Provision of quality emergency obstetric care, including cesarean sections, reduces maternal and neonatal mortality and complications. However, use of cesarean sections without medical need can place women at risk of short-term and long-term health problems. WHO advises that cesarean sections be done only when medically necessary but does not recommend a specific rate for countries to achieve at the population level. Research conducted by WHO has shown that increases in countries’ cesarean section rates up to 10% are associated with declines in maternal and neonatal mortality. However, increases in cesarean sections beyond 10% are not associated with reductions in maternal and newborn mortality rates (WHO 2015a). In Afghanistan, cesarean deliveries accounted for only 3% of all births in the 5 years prior to the survey, indicating a missed opportunity to decrease maternal deaths (Table 9.8). Patterns by background characteristics  The likelihood of cesarean deliveries increases with number of ANC visits. Nine percent of births among mothers with four or more ANC visits were delivered via cesarean, as compared with 2% of births among mothers who received no ANC.  The cesarean delivery rate is higher in urban than rural areas (7% versus 2%).  Mothers with more than a secondary education are more likely than those with no education to undergo a cesarean section (11% versus 2%).  The cesarean rate is higher among births in the highest wealth quintile than among those in the lowest quintile (7% versus 1%). 9.5 POSTNATAL CARE 9.5.1 Postnatal Health Check for Mothers WHO recommends that women receive a postnatal health check within 24 hours after delivery (WHO 2015b). In Afghanistan, 38% of mothers with a live birth in the 2 years prior to the survey received a postnatal checkup within 24 hours after delivery. Overall, 40% of mothers received a postnatal checkup in the first 2 days after delivery, and 56% did not have any postnatal checkup (Table 9.9). Figure 9.6 Delivery assistance by wealth 24 37 44 65 85 50 Lowest Second Middle Fourth Highest Total Percentage of live births in the 5 years before the survey assisted by a skilled provider WealthiestPoorest Maternal Health Care • 141 Patterns by background characteristics  Women who delivered in a health facility were much more likely to receive a postnatal checkup within the first 2 days after giving birth than those delivering outside a health facility (63% versus 18%) (Table 9.9).  Eighty percent of mothers with more than a secondary education received a timely postnatal checkup, as compared with 35% of women with no education.  Women from the wealthiest households were almost twice as likely to receive timely postnatal care as women from the lowest wealth quintile (58% versus 31%).  There were large provincial differences in receipt of postnatal care in the first 2 days after delivery. Herat had the highest percentage of women with a postnatal checkup (78%), followed by Faryab (66%) and Panjsher (64%); women in Urozgan (5%) and Nooristan (1%) were least likely to receive a postnatal checkup. Type of Provider Thirty-three percent of women received a postnatal checkup from a doctor or nurse/midwife, while 3% received care from an auxiliary nurse/midwife. Overall, 36% of postnatal checkups in the 2 days after delivery were carried out by skilled providers (Table 9.10). 9.5.2 Postnatal Health Checks for Newborns According to WHO, postnatal care services for newborns should start as soon as possible after birth because many neonatal deaths occur within the first 48 hours of life (WHO 2015b). In Afghanistan, only 9% of last-born infants in the 2 years preceding the survey received a postnatal checkup in the first 2 days after birth (Table 9.11). Patterns by background characteristics  Newborns of birth order 6 or above (8%) are less likely to receive a timely postnatal checkup than newborns of birth order 1 (12%) (Table 9.11).  Infants delivered in a health facility are twice as likely to receive a postnatal check within 2 days after birth as infants delivered outside a health facility (13% versus 6%).  The percentage of newborns with a postnatal checkup is higher in urban areas than in rural areas (13% versus 8%) (Figure 9.7).  There is a strong association between mother’s education and timely newborn postnatal checkups. Only 9% of newborns whose mothers have no education receive a postnatal checkup, as compared with 22% of newborns whose mothers have more than a secondary education. Type of Provider Eight percent of newborns received a postnatal check within 2 days after birth from a skilled provider (doctor, nurse/midwife, or auxiliary nurse/midwife) (Table 9.12). Figure 9.7 Postnatal care by place of delivery 52 13 36 8 40 9 Women Newborns Percentage of last births in the 2 years before the survey for which women and newborns received a postnatal check within 2 days after birth Urban Rural Total 142 • Maternal Health Care 9.6 PROBLEMS IN ACCESSING HEALTH CARE Problems in accessing health care Women were asked whether each of the following factors is a big problem in seeking medical advice or treatment for themselves when they are sick:  getting permission to go to the doctor.  getting money for advice or treatment.  distance to a health facility.  not wanting to go alone. Sample: Women age 15-49 The MoPH has scaled up health service delivery in Afghanistan through its Basic Package of Health Services and Essential Hospital Services, which includes more than 2,200 health facilities in all 34 provinces (MoPH 2010). However, information on whether women can access these services is important. According to the 2015 AfDHS, 89% of Afghan women reported having one or more problems in accessing health care for themselves. The most commonly reported problem was not wanting to go alone (70%), followed by distance to a health facility (67%), getting money for treatment (67%), and getting permission to go for treatment (51%) (Table 9.13). Patterns by background characteristics  Problems in accessing health care services are more predominant in rural areas (92%) than in urban areas (78%).  There is a strong negative association between women’s level of education and problems in accessing health care. Ninety-one percent of women with no education reported at least one problem in accessing health care services, as compared with 54% of women with more than a secondary education (Figure 9.8).  Women in the lowest wealth quintile are more likely to face problems in accessing health care services (94%) than women in the highest quintile (77%). Figure 9.8 Women with at least one problem in accessing health care by education 91 80 75 54 89 No education Primary Secondary More than secondary Total Percentage of ever-married women age 15-49 Maternal Health Care • 143 LIST OF TABLES For more information on maternal health care, see the following tables:  Table 9.1 Antenatal care  Table 9.2 Number of antenatal care visits and timing of first visit  Table 9.3 Components of antenatal care  Table 9.4 Knowledge of symptoms of pregnancy complications  Table 9.5 Men’s participation during ANC visits  Table 9.6 Tetanus toxoid injections  Table 9.7 Place of delivery  Table 9.8 Assistance during delivery  Table 9.9 Timing of first postnatal checkup for the mother  Table 9.10 Type of provider of first postnatal checkup for the mother  Table 9.11 Timing of first postnatal checkup for the newborn  Table 9.12 Type of provider of first postnatal checkup for the newborn  Table 9.13 Problems in accessing health care 144 • Maternal Health Care Table 9.1 Antenatal care Percent distribution of women age 15-49 who had a live birth in the 5 years preceding the survey by antenatal care (ANC) provider during the pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Afghanistan 2015 Antenatal care provider Percentage receiving antenatal care from a skilled provider1 Background characteristic Doctor Nurse/ midwife Auxiliary nurse/ midwife Community health worker Traditional birth attendant Other Missing No ANC Total Number of women Mother's age at birth <20 31.7 23.5 3.5 0.1 2.5 0.2 0.1 38.4 100.0 58.7 2,218 20-34 30.5 24.2 3.1 0.1 3.3 0.0 0.2 38.4 100.0 57.9 14,245 35-49 31.1 28.4 2.1 0.1 2.3 0.0 0.3 35.7 100.0 61.6 3,169 Birth order 1 36.0 27.3 3.5 0.1 2.8 0.1 0.1 30.1 100.0 66.8 3,027 2-3 31.7 23.9 3.3 0.1 3.6 0.0 0.2 37.1 100.0 59.0 6,224 4-5 30.0 23.1 2.4 0.3 3.8 0.1 0.3 40.0 100.0 55.5 4,733 6+ 27.4 25.9 2.9 0.1 1.9 0.0 0.3 41.5 100.0 56.3 5,648 Residence Urban 46.1 24.8 0.9 0.1 0.6 0.1 0.1 27.4 100.0 71.7 4,559 Rural 26.1 24.8 3.7 0.1 3.8 0.0 0.3 41.2 100.0 54.6 15,073 Province2 Kabul 42.8 22.8 0.5 0.4 0.5 0.4 0.1 32.5 100.0 66.1 2,385 Kapisa 2.9 72.5 0.5 0.0 0.3 0.0 0.2 23.7 100.0 75.9 129 Parwan 18.5 58.8 10.3 0.0 0.0 0.0 0.0 12.4 100.0 87.5 437 Wardak 11.8 43.0 12.2 0.0 0.1 0.0 1.4 31.6 100.0 66.9 249 Logar 51.7 22.7 0.0 0.2 0.0 0.0 0.0 25.3 100.0 74.4 276 Nangarhar 71.6 5.4 0.1 0.0 0.5 0.0 0.3 22.1 100.0 77.2 576 Laghman 54.1 18.0 3.2 0.5 2.4 0.0 0.0 21.7 100.0 75.4 428 Panjsher 53.7 15.7 0.0 0.0 0.5 0.0 0.5 29.6 100.0 69.4 26 Baghlan 5.9 36.2 2.6 0.0 11.3 0.0 1.8 42.2 100.0 44.7 504 Bamyan 3.5 68.2 0.3 0.9 0.0 0.0 0.0 27.0 100.0 72.0 206 Ghazni 19.6 8.6 5.1 0.0 2.9 0.0 1.3 62.4 100.0 33.3 638 Paktika 11.2 8.0 18.3 0.1 1.4 0.0 0.2 60.7 100.0 37.5 525 Paktya 21.3 4.9 33.7 0.0 0.5 0.1 1.7 37.8 100.0 59.9 347 Khost 63.9 7.2 1.0 0.0 0.0 0.0 0.0 27.8 100.0 72.1 580 Kunarha 12.9 2.6 0.5 0.0 0.4 0.0 0.2 83.5 100.0 15.9 421 Nooristan 5.9 4.4 0.7 0.0 0.0 0.0 0.0 89.0 100.0 11.0 184 Badakhshan 26.3 10.4 1.7 0.0 0.4 0.0 0.0 61.1 100.0 38.4 650 Takhar 39.5 25.8 0.0 0.0 0.0 0.0 0.0 34.8 100.0 65.2 751 Kunduz 51.3 19.1 0.2 0.0 5.5 0.0 0.1 23.8 100.0 70.6 760 Samangan 1.2 43.9 1.7 0.0 0.6 0.0 0.9 51.7 100.0 46.8 225 Balkh 44.6 38.0 1.9 0.3 0.6 0.0 0.0 14.5 100.0 84.6 1,232 Sar-E-Pul 5.8 56.2 0.0 0.3 4.9 0.0 0.1 32.7 100.0 62.0 430 Ghor 20.7 30.9 7.3 0.0 0.7 0.0 0.0 40.4 100.0 58.8 542 Daykundi 4.9 36.3 1.4 0.0 0.2 0.0 0.7 56.4 100.0 42.7 216 Urozgan 4.5 8.6 6.0 0.0 0.3 0.0 0.3 80.3 100.0 19.1 200 Kandahar 28.0 14.1 6.1 0.0 0.6 0.0 0.2 51.0 100.0 48.2 1,631 Jawzjan 16.1 37.6 0.5 0.0 0.0 0.1 0.3 45.3 100.0 54.2 398 Faryab 23.7 49.7 0.1 0.2 6.2 0.0 0.0 20.0 100.0 73.5 1,451 Helmand 16.7 13.1 0.9 0.0 0.5 0.0 0.2 68.6 100.0 30.7 568 Badghis 4.2 14.6 1.6 0.0 3.9 0.0 0.4 75.3 100.0 20.4 499 Herat 49.3 20.3 0.2 0.0 18.2 0.0 0.0 11.9 100.0 69.8 1,465 Farah 16.1 23.7 1.3 0.0 2.7 0.0 0.0 56.3 100.0 41.0 493 Nimroz 9.2 27.3 0.3 0.0 0.9 0.0 0.0 62.2 100.0 36.9 195 Education No education 27.9 23.4 3.4 0.1 3.3 0.0 0.3 41.5 100.0 54.7 16,279 Primary 36.1 33.3 1.7 0.3 2.3 0.0 0.3 26.1 100.0 71.0 1,596 Secondary 48.6 30.8 1.0 0.0 0.9 0.3 0.1 18.5 100.0 80.3 1,432 More than secondary 65.7 27.5 0.8 0.0 0.0 0.0 0.0 5.9 100.0 94.1 325 Wealth quintile Lowest 19.9 28.0 2.6 0.2 4.6 0.0 0.3 44.5 100.0 50.4 3,914 Second 22.9 23.3 3.8 0.1 5.2 0.0 0.3 44.5 100.0 50.0 3,964 Middle 26.3 22.8 4.6 0.0 3.8 0.0 0.2 42.2 100.0 53.7 4,020 Fourth 35.0 25.8 2.9 0.3 1.1 0.1 0.2 34.6 100.0 63.7 4,056 Highest 50.9 24.2 1.0 0.1 0.3 0.2 0.1 23.2 100.0 76.1 3,679 Total 30.7 24.8 3.0 0.1 3.0 0.1 0.2 38.0 100.0 58.6 19,632 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife, and auxiliary nurse/midwife. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Maternal Health Care • 145 Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 who had a live birth in the 5 years preceding the survey by number of antenatal care (ANC) visits for the most recent live birth, and by the timing of the first visit, and among women with ANC, median months pregnant at first visit, according to residence, Afghanistan 2015 Number and timing of ANC visits Residence Urban Rural Total Number of ANC visits None 27.5 41.4 38.2 1 11.2 12.2 12.0 2-3 27.7 30.8 30.1 4+ 31.7 13.6 17.8 Don't know/missing 1.9 2.0 2.0 Total 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 27.5 41.4 38.2 <4 41.7 26.5 30.0 4-5 16.7 17.7 17.5 6-7 8.9 9.5 9.3 8+ 3.4 2.8 2.9 Don't know/missing 1.8 2.1 2.1 Total 100.0 100.0 100.0 Number of women 4,559 15,073 19,632 Median months pregnant at first visit (for those with ANC) 3.6 4.2 4.0 Number of women with ANC 3,306 8,834 12,141 146 • Maternal Health Care Table 9.3 Components of antenatal care Among women age 15-49 with a live birth in the 5 years preceding the survey, the percentage who took iron tablets or syrup and drugs for intestinal parasites during the pregnancy of the most recent birth, and among women receiving antenatal care (ANC) for the most recent live birth in the 5 years preceding the survey, the percentage receiving specific antenatal services, according to background characteristics, Afghanistan 2015 Among women with a live birth in the past 5 years, the percentage who during the pregnancy of their last birth: Among women who received antenatal care for their most recent birth in the past 5 years, the percentage with selected services Background characteristic Took iron tablets or syrup Took intestinal parasite drugs Number of women with a live birth in the past 5 years Informed of signs of pregnancy complicatio ns Blood pressure measured Urine sample taken Blood sample taken Number of women with ANC for their most recent birth Mother's age at birth <20 38.6 3.5 2,218 50.9 78.4 40.5 28.4 1,366 20-34 42.7 3.0 14,245 56.2 78.2 39.7 31.4 8,745 35-49 43.8 2.7 3,169 57.1 80.7 38.3 24.5 2,030 Birth order 1 44.1 3.0 3,027 55.0 79.2 47.0 35.8 2,113 2-3 43.6 3.3 6,224 56.5 78.9 38.1 30.0 3,908 4-5 42.1 2.5 4,733 57.3 76.2 38.2 27.7 2,826 6+ 40.4 3.1 5,648 54.1 80.2 37.6 27.8 3,294 Residence Urban 50.1 2.9 4,559 51.4 80.4 48.9 43.7 3,306 Rural 40.1 3.1 15,073 57.4 78.0 36.0 24.7 8,834 Province1 Kabul 56.6 4.0 2,385 58.8 75.0 59.3 54.8 1,608 Kapisa 48.5 1.2 129 38.6 18.1 26.2 19.6 99 Parwan 71.8 3.8 437 34.0 60.0 45.8 20.2 382 Wardak 64.7 0.8 249 30.0 97.4 59.1 29.1 170 Logar 57.8 2.5 276 70.4 73.3 65.2 50.1 206 Nangarhar 65.7 0.9 576 42.9 92.7 35.7 35.1 449 Laghman 60.1 5.4 428 81.5 88.2 56.6 40.8 335 Panjsher 57.4 15.1 26 45.2 90.6 79.5 70.5 18 Baghlan 43.9 0.9 504 61.6 42.8 53.1 25.0 283 Bamyan 62.8 4.8 206 73.6 84.6 48.4 36.7 150 Ghazni 18.2 11.9 638 55.4 84.2 53.8 41.6 231 Paktika 46.4 4.0 525 90.8 93.2 37.7 43.9 205 Paktya 34.9 1.8 347 41.7 76.8 33.2 25.3 211 Khost 32.6 4.8 580 30.9 97.0 65.1 75.0 419 Kunarha 22.5 1.9 421 11.2 70.7 40.7 45.0 70 Nooristan 3.4 0.0 184 32.8 92.4 22.0 26.2 20 Badakhshan 29.6 2.4 650 70.4 95.5 39.7 39.0 253 Takhar 24.2 0.2 751 21.6 19.7 14.9 17.4 490 Kunduz 42.3 2.9 760 56.9 88.7 27.8 24.3 578 Samangan 23.0 0.6 225 45.4 59.7 30.4 23.8 109 Balkh 50.3 0.3 1,232 65.2 97.9 34.1 28.6 1,053 Sar-E-Pul 34.0 0.5 430 57.9 90.5 36.8 20.6 289 Ghor 45.7 3.4 542 77.9 92.7 10.6 9.7 323 Daykundi 18.2 2.0 216 36.0 62.7 16.8 16.7 94 Urozgan 25.0 0.3 200 61.1 98.4 10.3 27.2 39 Kandahar 13.2 1.2 1,631 36.4 76.9 32.4 21.7 797 Jawzjan 16.2 1.1 398 31.9 18.3 40.3 12.2 216 Faryab 69.6 4.6 1,451 61.0 89.5 29.2 8.8 1,160 Helmand 9.0 3.8 568 83.4 92.5 70.2 67.3 178 Badghis 13.5 0.6 499 52.1 76.1 9.5 5.9 122 Herat 74.0 4.0 1,465 68.1 79.7 37.6 16.4 1,291 Farah 16.6 7.6 493 76.3 69.0 21.0 25.1 215 Nimroz 41.1 0.5 195 15.2 71.3 9.2 14.9 74 Education No education 38.6 2.9 16,279 54.2 78.6 38.1 27.8 9,491 Primary 55.8 1.4 1,596 57.2 78.7 42.2 32.1 1,176 Secondary 63.8 5.4 1,432 62.9 78.8 47.2 38.4 1,167 More than secondary 72.0 7.1 325 72.9 81.3 45.3 51.7 306 Wealth quintile Lowest 37.0 1.6 3,914 60.3 78.2 24.3 14.5 2,162 Second 35.9 3.2 3,964 58.0 73.5 30.0 21.8 2,190 Middle 39.8 3.3 4,020 55.3 77.3 41.1 27.4 2,315 Fourth 44.7 3.7 4,056 54.2 81.1 48.3 37.1 2,650 Highest 55.4 3.2 3,679 52.5 81.9 49.1 43.2 2,823 Total 42.4 3.0 19,632 55.8 78.7 39.5 29.9 12,141 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Maternal Health Care • 147 Table 9.4 Knowledge of symptoms of pregnancy complications Among women receiving antenatal care (ANC) for the most recent live birth in the 5 years preceding the survey, the percentage with knowledge of symptoms during pregnancy indicating the need to seek immediate care, according to background characteristics, Afghanistan 2015 Among women who received antenatal care for their most recent birth in the past five years, the percentage with specific knowledge regarding: Background characteristic Vaginal bleeding Severe lower abdomina l pain Severe headache Con- vulsions Blurred vision Swelling in face Swelling in hands and feet Other Don't know Missing Number of women with ANC for their most recent birth Mother's age at birth <20 62.6 46.1 40.4 22.6 17.6 21.7 22.4 3.6 8.7 0.9 1,366 20-34 57.4 51.8 40.1 25.4 21.2 24.7 24.2 2.9 6.4 0.8 8,745 35-49 57.2 51.4 40.0 24.2 20.2 23.6 23.9 1.9 6.4 0.7 2,030 Birth order 1 60.2 49.2 39.9 22.6 20.3 24.9 24.1 3.3 8.9 0.5 2,113 2-3 56.4 50.3 40.8 27.6 21.1 23.9 25.4 3.4 6.6 0.9 3,908 4-5 60.3 51.9 39.9 24.0 20.4 24.2 22.8 2.5 6.0 0.6 2,826 6+ 56.4 52.6 39.7 23.9 20.6 24.0 23.0 2.1 5.9 1.2 3,294 Residence Urban 55.7 52.6 43.0 23.3 23.5 31.9 29.3 4.1 8.4 0.3 3,306 Rural 58.8 50.5 39.1 25.5 19.6 21.3 21.9 2.3 6.0 1.0 8,834 Province1 Kabul 52.8 51.7 48.3 24.7 25.0 29.2 30.8 4.0 6.4 0.0 1,608 Kapisa 67.6 23.0 30.8 41.4 1.6 2.0 2.5 18.0 12.8 0.6 99 Parwan 58.5 42.9 20.8 13.0 9.4 8.8 4.9 11.5 19.4 0.9 382 Wardak 57.2 53.1 40.9 8.4 9.0 23.0 20.1 0.3 11.6 0.1 170 Logar 75.8 25.3 23.1 4.0 6.2 34.8 57.1 0.8 9.6 0.0 206 Nangarhar 52.4 60.3 21.3 5.4 4.9 32.5 13.9 3.6 5.9 0.5 449 Laghman 38.5 59.4 53.3 38.7 27.3 37.5 20.6 1.7 1.9 0.1 335 Panjsher 61.1 45.3 37.9 24.5 33.0 64.2 60.9 4.5 0.4 0.2 18 Baghlan 27.6 27.6 18.6 8.8 8.0 24.9 17.9 5.6 15.4 1.9 283 Bamyan 51.4 46.7 44.9 27.5 28.0 25.4 22.9 2.7 1.2 0.0 150 Ghazni 60.6 49.2 50.6 53.5 47.6 48.6 30.3 0.1 14.1 0.0 231 Paktika 57.1 44.8 18.4 12.0 14.4 11.1 4.7 0.3 4.6 0.0 205 Paktya 67.1 29.8 8.5 6.2 0.9 2.5 3.4 0.4 22.2 0.9 211 Khost 40.2 59.7 27.6 15.8 9.4 18.8 4.0 0.0 16.9 1.3 419 Kunarha 30.3 58.5 13.4 5.9 3.7 23.5 42.8 0.1 19.7 0.6 70 Nooristan 74.3 87.1 23.6 27.5 6.4 19.8 16.7 1.6 0.0 3.8 20 Badakhshan 74.0 73.4 42.4 35.8 27.2 36.7 34.6 0.0 1.5 0.6 253 Takhar 52.2 54.9 32.9 30.6 9.9 15.8 10.1 7.0 4.8 0.2 490 Kunduz 94.8 90.3 81.9 72.2 52.6 39.0 33.3 0.0 1.0 0.2 578 Samangan 22.8 39.9 25.0 13.3 8.1 23.4 34.4 0.0 0.4 38.3 109 Balkh 86.2 60.6 56.3 17.3 41.7 31.5 25.8 4.4 1.0 0.0 1,053 Sar-E-Pul 86.6 76.5 50.1 39.9 38.3 45.1 53.4 1.7 0.6 0.2 289 Ghor 80.6 75.4 57.8 40.9 18.1 12.4 11.4 0.4 1.2 0.0 323 Daykundi 49.8 43.7 37.4 11.0 1.6 0.5 8.4 3.9 1.9 0.0 94 Urozgan 41.1 69.4 56.3 25.4 4.4 16.3 5.8 0.0 2.2 2.8 39 Kandahar 51.7 33.7 18.8 7.9 5.0 34.3 33.6 0.6 19.8 1.9 797 Jawzjan 42.9 64.7 66.3 46.1 27.9 14.1 12.2 8.0 19.0 0.0 216 Faryab 30.1 41.5 37.7 24.2 10.4 10.5 21.7 3.2 0.6 0.3 1,160 Helmand 94.9 95.6 92.9 87.1 82.1 58.7 35.8 0.0 0.8 0.7 178 Badghis 70.2 52.2 46.0 36.0 42.1 26.6 59.6 2.4 8.9 5.7 122 Herat 57.7 33.6 32.0 17.1 13.4 11.2 21.3 0.2 3.1 0.1 1,291 Farah 53.7 31.6 20.6 30.6 15.7 19.7 32.6 3.2 7.7 0.2 215 Nimroz 59.7 29.0 9.1 0.8 4.1 6.2 4.7 9.6 3.2 3.0 74 Education No education 57.1 50.6 38.8 24.1 20.2 23.4 22.7 2.3 7.4 0.9 9,491 Primary 64.9 53.1 41.3 29.3 21.8 27.7 26.9 3.1 4.7 0.6 1,176 Secondary 57.5 51.3 46.0 24.7 22.0 27.3 27.7 7.4 3.1 0.3 1,167 More than secondary 60.2 59.2 54.0 34.5 26.4 23.2 34.8 1.3 4.9 0.0 306 Wealth quintile Lowest 66.3 53.6 43.1 25.4 21.5 19.4 20.4 1.3 3.2 1.7 2,162 Second 61.9 53.6 40.8 27.5 24.3 22.0 21.9 2.6 4.6 0.4 2,190 Middle 55.7 49.3 35.2 26.7 17.7 23.0 20.7 2.7 8.2 1.1 2,315 Fourth 53.5 46.9 39.4 24.0 17.8 25.0 24.9 3.1 8.1 0.8 2,650 Highest 54.5 52.6 42.0 21.9 22.3 29.8 29.9 3.9 8.4 0.2 2,823 Total 58.0 51.1 40.1 24.9 20.7 24.2 23.9 2.8 6.7 0.8 12,141 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 148 • Maternal Health Care Table 9.5 Men's participation during ANC visits Among ever-married men with a last live birth in the 2 years preceding the survey, the percentage whose wife received an ANC checkup, and among those whose wife received an ANC checkup, the percent distribution who were ever present during any of the ANC checkups, according to background characteristics, Afghanistan 2015 Men whose wife received: Among wives who received ANC: Background characteristic ANC checkup Number of men Husband present Husband not present Missing Total Number of men Residence Urban 79.1 1,449 74.6 25.3 0.2 100.0 1,145 Rural 58.4 4,786 62.2 37.6 0.2 100.0 2,795 Education No education 51.0 3,163 60.8 38.9 0.2 100.0 1,615 Primary 74.9 1,149 65.1 34.7 0.2 100.0 861 Secondary 72.9 1,502 69.2 30.6 0.2 100.0 1,094 More than secondary 88.2 420 79.1 20.9 0.0 100.0 370 Wealth quintile Lowest 51.2 1,127 65.2 34.4 0.4 100.0 577 Second 55.3 1,282 60.5 39.3 0.2 100.0 709 Middle 57.3 1,312 61.8 38.0 0.2 100.0 751 Fourth 67.3 1,291 67.6 32.3 0.1 100.0 869 Highest 84.6 1,222 71.2 28.7 0.2 100.0 1,034 Total 63.2 6,234 65.8 34.0 0.2 100.0 3,940 Maternal Health Care • 149 Table 9.6 Tetanus toxoid injections Among mothers age 15-49 with a live birth in the 5 years preceding the survey, the percentage receiving two or more tetanus toxoid injections during the pregnancy for the last live birth and the percentage whose last live birth was protected against neonatal tetanus, according to background characteristics, Afghanistan 2015 Background characteristic Percentage receiving two or more injections during last pregnancy Percentage whose last birth was protected against neonatal tetanus1 Number of mothers Mother's age at birth <20 38.5 54.4 2,218 20-34 33.6 53.1 14,245 35-49 29.5 51.8 3,169 Birth order 1 41.5 59.4 3,027 2-3 35.7 54.8 6,224 4-5 31.6 51.5 4,733 6+ 28.5 48.8 5,648 Residence Urban 30.6 54.8 4,559 Rural 34.4 52.5 15,073 Province2 Kabul 28.9 51.7 2,385 Kapisa 59.3 70.4 129 Parwan 39.3 61.7 437 Wardak 45.7 57.0 249 Logar 35.1 68.6 276 Nangarhar 24.9 60.9 576 Laghman 48.8 67.9 428 Panjsher 32.4 54.6 26 Baghlan 37.2 49.5 504 Bamyan 46.0 69.7 206 Ghazni 23.5 41.2 638 Paktika 42.8 71.0 525 Paktya 57.9 66.2 347 Khost 28.5 40.4 580 Kunarha 28.4 37.2 421 Nooristan 2.4 2.8 184 Badakhshan 48.3 68.2 650 Takhar 35.0 58.8 751 Kunduz 33.1 46.4 760 Samangan 16.1 27.0 225 Balkh 33.7 62.8 1,232 Sar-E-Pul 14.0 59.5 430 Ghor 56.4 79.1 542 Daykundi 17.0 26.2 216 Urozgan 2.9 24.7 200 Kandahar 10.6 28.3 1,631 Jawzjan 40.5 55.5 398 Faryab 42.4 74.1 1,451 Helmand 21.7 21.8 568 Badghis 37.2 51.8 499 Herat 52.1 62.3 1,465 Farah 23.6 27.7 493 Nimroz 48.0 58.4 195 Education No education 31.4 49.2 16,279 Primary 40.1 66.5 1,596 Secondary 46.2 76.4 1,432 More than secondary 49.8 72.3 325 Wealth quintile Lowest 32.9 52.8 3,914 Second 33.1 49.9 3,964 Middle 32.5 48.0 4,020 Fourth 35.1 56.3 4,056 Highest 33.9 58.5 3,679 Total 33.5 53.0 19,632 1 Includes mothers with two injections during the pregnancy of their last birth, or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within 5 years of the last birth), or four or more injections (the last within 10 years of the last live birth), or five or more injections at any time prior to the last birth 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 150 • Maternal Health Care Table 9.7 Place of delivery Percent distribution of live births in the 5 years preceding the survey by place of delivery and percentage delivered in a health facility, according to background characteristics, Afghanistan 2015 Background characteristic Health facility Home Other Missing Total Percentage delivered in a health facility Number of births Public sector Private/ NGO sector Mother's age at birth <20 43.0 5.4 50.4 0.5 0.7 100.0 48.3 4,521 20-34 43.3 5.2 50.6 0.6 0.4 100.0 48.5 23,246 35-49 41.2 4.6 53.4 0.4 0.3 100.0 45.8 4,035 Birth order 1 52.5 6.3 40.0 0.7 0.6 100.0 58.8 6,119 2-3 43.7 5.6 49.6 0.6 0.4 100.0 49.3 10,348 4-5 40.2 4.1 54.9 0.4 0.4 100.0 44.3 7,357 6+ 37.3 4.5 57.3 0.6 0.3 100.0 41.8 7,978 Antenatal care visits1 None 27.1 2.6 69.5 0.5 0.4 100.0 29.7 7,492 1-3 51.7 6.8 40.8 0.8 0.0 100.0 58.4 8,260 4+ 69.6 8.7 21.0 0.7 0.0 100.0 78.3 3,494 Don't know/missing 49.2 9.9 39.7 1.0 0.3 100.0 59.1 386 Residence Urban 63.0 12.9 23.3 0.3 0.5 100.0 75.8 7,246 Rural 37.1 2.8 59.0 0.6 0.4 100.0 39.9 24,555 Province2 Kabul 73.2 9.2 16.3 0.5 0.8 100.0 82.4 3,769 Kapisa 48.4 0.4 49.9 0.0 1.4 100.0 48.7 219 Parwan 46.3 2.3 50.7 0.0 0.7 100.0 48.7 728 Wardak 53.4 4.4 23.3 18.8 0.1 100.0 57.8 345 Logar 60.9 6.0 32.4 0.1 0.6 100.0 66.9 439 Nangarhar 60.1 4.5 34.8 0.6 0.1 100.0 64.6 1,028 Laghman 57.6 0.8 41.6 0.0 0.0 100.0 58.4 809 Panjsher 64.0 0.1 34.9 0.0 1.0 100.0 64.1 40 Baghlan 29.1 0.2 69.6 0.0 1.1 100.0 29.4 751 Bamyan 45.2 1.0 53.1 0.2 0.6 100.0 46.2 328 Ghazni 56.7 7.8 33.7 0.0 1.8 100.0 64.4 834 Paktika 34.5 1.3 63.3 0.0 0.9 100.0 35.8 874 Paktya 57.1 3.2 36.2 1.5 2.0 100.0 60.3 601 Khost 49.6 8.0 35.9 6.4 0.1 100.0 57.6 1,024 Kunarha 42.4 0.6 57.0 0.0 0.0 100.0 43.0 725 Nooristan 0.8 0.0 98.8 0.0 0.4 100.0 0.8 355 Badakhshan 22.0 0.4 75.9 1.7 0.0 100.0 22.4 939 Takhar 43.7 5.5 50.7 0.0 0.0 100.0 49.3 1,254 Kunduz 47.8 8.2 43.9 0.0 0.2 100.0 55.9 1,222 Samangan 29.2 2.2 68.6 0.0 0.0 100.0 31.4 359 Balkh 40.2 7.8 51.6 0.0 0.4 100.0 48.0 1,943 Sar-E-Pul 39.8 1.3 58.1 0.0 0.8 100.0 41.1 625 Ghor 14.8 0.0 85.2 0.0 0.0 100.0 14.8 913 Daykundi 22.3 0.4 77.2 0.0 0.2 100.0 22.7 315 Urozgan 11.6 0.8 86.6 0.0 0.9 100.0 12.5 407 Kandahar 22.1 13.4 64.3 0.0 0.2 100.0 35.5 2,989 Jawzjan 57.2 14.2 27.6 0.2 0.7 100.0 71.5 599 Faryab 54.4 2.1 43.5 0.0 0.0 100.0 56.4 2,398 Helmand 20.6 5.3 73.9 0.0 0.2 100.0 25.9 898 Badghis 5.9 0.0 93.0 0.0 1.1 100.0 5.9 775 Herat 37.1 2.2 60.6 0.0 0.1 100.0 39.3 2,149 Farah 42.1 0.2 57.6 0.0 0.0 100.0 42.4 825 Nimroz 64.2 1.1 34.3 0.1 0.3 100.0 65.3 295 Mother's education No education 38.7 4.2 56.2 0.6 0.4 100.0 42.9 26,567 Primary 60.6 9.5 29.0 0.6 0.4 100.0 70.1 2,504 Secondary 66.0 10.0 22.7 0.4 0.9 100.0 76.0 2,242 More than secondary 81.4 10.6 7.4 0.6 0.0 100.0 92.0 489 Wealth quintile Lowest 21.0 1.2 77.1 0.3 0.4 100.0 22.2 6,127 Second 33.0 1.5 64.5 0.6 0.4 100.0 34.5 6,506 Middle 37.7 3.3 57.9 0.7 0.4 100.0 41.0 6,779 Fourth 56.5 6.1 36.1 0.8 0.4 100.0 62.6 6,605 Highest 68.2 14.3 16.6 0.3 0.5 100.0 82.5 5,786 Total 43.0 5.1 50.9 0.6 0.4 100.0 48.1 31,802 1 Includes only the most recent birth in the 5 years preceding the survey 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Maternal Health Care • 151 Table 9.8 Assistance during delivery Percent distribution of live births in the 5 years preceding the survey by person providing assistance during delivery, percentage of births assisted by a skilled provider, and percentage delivered by cesarean section, according to background characteristics, Afghanistan 2015 Person providing assistance during delivery Per- centage delivered by a skilled provider1 Per- centage delivered by C- section Number of births Background characteristic Doctor Nurse/ midwife Auxiliary nurse/ midwife Other health worker Tra- ditional birth atten- dant Relative/ other No one Don't know/ missing Total Mother's age at birth <20 17.1 27.2 5.8 0.2 35.4 13.2 0.4 0.7 100.0 50.1 1.9 4,521 20-34 17.1 27.6 6.2 0.4 32.6 14.7 1.0 0.4 100.0 50.9 2.7 23,246 35-49 17.2 26.7 4.7 0.5 33.9 15.8 1.0 0.3 100.0 48.6 3.8 4,035 Birth order 1 20.7 33.7 6.9 0.2 25.7 11.6 0.6 0.6 100.0 61.3 3.9 6,119 2-3 17.5 27.8 6.0 0.3 32.4 14.7 1.0 0.4 100.0 51.3 2.6 10,348 4-5 16.4 25.1 5.6 0.5 35.6 15.5 0.9 0.4 100.0 47.1 2.5 7,357 6+ 14.4 24.3 5.3 0.6 37.6 16.2 1.2 0.3 100.0 44.1 2.1 7,978 Antenatal care visits2 None 9.2 17.0 5.6 0.4 45.8 20.5 1.3 0.3 100.0 31.7 1.7 7,492 1-3 18.6 35.2 7.3 0.2 26.9 10.8 1.0 0.0 100.0 61.1 2.8 8,260 4+ 33.6 43.3 4.9 0.1 11.5 6.3 0.2 0.0 100.0 81.8 8.5 3,494 Don't know/missing 31.6 19.1 13.3 0.0 30.2 5.0 0.5 0.3 100.0 64.0 3.8 386 Place of delivery Health facility 34.0 54.6 10.9 0.1 0.3 0.1 0.0 0.1 100.0 99.5 5.6 13,702 Elsewhere 4.2 7.0 2.2 0.7 58.4 25.8 1.6 0.1 100.0 13.4 0.6 17,966 Missing 8.3 2.8 0.0 0.0 8.1 3.2 0.0 77.7 100.0 11.1 0.0 133 Residence Urban 34.4 39.8 4.8 0.0 12.6 7.4 0.6 0.5 100.0 78.9 6.7 7,246 Rural 12.0 23.8 6.3 0.5 39.2 16.8 1.0 0.4 100.0 42.1 1.5 24,555 Province3 Kabul 44.5 36.1 3.9 0.1 6.4 7.8 0.5 0.7 100.0 84.5 9.1 3,769 Kapisa 0.6 48.1 1.1 0.0 1.7 46.8 0.1 1.6 100.0 49.8 1.5 219 Parwan 10.4 33.4 8.7 0.0 13.4 31.7 0.9 1.4 100.0 52.5 3.2 728 Wardak 4.5 35.3 20.9 0.3 18.1 19.4 0.8 0.6 100.0 60.7 3.0 345 Logar 33.0 36.5 0.1 0.9 13.8 15.3 0.0 0.4 100.0 69.6 4.9 439 Nangarhar 55.7 10.3 0.3 0.0 4.3 29.1 0.2 0.1 100.0 66.3 1.9 1,028 Laghman 28.8 23.3 10.0 0.0 15.4 21.6 0.9 0.0 100.0 62.2 2.2 809 Panjsher 43.2 21.3 0.3 0.0 9.4 24.2 1.2 0.4 100.0 64.8 3.1 40 Baghlan 2.5 25.7 3.1 0.2 23.3 44.2 0.0 1.0 100.0 31.3 3.9 751 Bamyan 3.3 42.2 1.4 0.0 16.9 35.7 0.2 0.3 100.0 46.9 3.1 328 Ghazni 10.2 48.8 13.3 0.8 12.3 12.6 0.4 1.5 100.0 72.3 6.5 834 Paktika 3.3 7.0 25.7 8.7 22.0 30.3 2.3 1.0 100.0 35.9 0.8 874 Paktya 3.4 2.0 55.4 0.0 2.8 21.0 13.2 2.1 100.0 60.9 1.1 601 Khost 27.1 22.6 14.8 0.1 15.7 19.6 0.0 0.2 100.0 64.5 1.2 1,024 Kunarha 14.9 3.3 23.7 0.1 19.8 38.2 0.0 0.0 100.0 41.8 1.0 725 Nooristan 0.1 0.6 0.4 0.1 14.3 84.3 0.0 0.2 100.0 1.1 0.0 355 Badakhshan 15.7 8.2 1.4 0.1 30.6 43.6 0.1 0.2 100.0 25.4 1.2 939 Takhar 13.8 35.8 0.0 0.0 10.5 39.8 0.0 0.0 100.0 49.7 2.0 1,254 Kunduz 15.5 43.7 0.4 0.0 20.6 9.5 10.1 0.1 100.0 59.7 1.6 1,222 Samangan 1.1 30.2 1.6 0.0 51.6 14.8 0.7 0.0 100.0 32.8 1.1 359 Balkh 22.5 25.2 2.9 0.0 45.7 2.9 0.4 0.4 100.0 50.6 3.4 1,943 Sar-E-Pul 1.7 53.1 1.2 2.8 39.6 1.3 0.0 0.3 100.0 56.0 0.5 625 Ghor 0.6 9.7 6.1 0.7 82.7 0.2 0.0 0.0 100.0 16.4 0.2 913 Daykundi 0.4 21.3 0.9 0.0 68.4 5.8 3.1 0.0 100.0 22.6 1.3 315 Urozgan 2.0 3.8 7.0 0.0 85.3 0.2 1.1 0.6 100.0 12.8 0.2 407 Kandahar 3.7 25.6 7.1 0.0 55.4 8.0 0.1 0.1 100.0 36.4 1.0 2,989 Jawzjan 15.4 56.8 3.2 0.2 18.4 5.2 0.1 0.7 100.0 75.3 1.2 599 Faryab 21.6 37.9 0.4 0.2 38.6 1.4 0.0 0.0 100.0 59.9 0.6 2,398 Helmand 7.8 13.1 5.7 0.0 73.0 0.2 0.0 0.2 100.0 26.6 0.5 898 Badghis 0.3 5.8 0.1 0.0 92.8 0.0 0.0 0.9 100.0 6.3 0.6 775 Herat 15.5 24.3 0.4 0.3 53.8 5.6 0.0 0.2 100.0 40.2 4.0 2,149 Farah 4.7 37.2 2.0 0.1 48.4 7.6 0.0 0.0 100.0 43.9 0.5 825 Nimroz 0.4 65.9 0.0 0.0 22.4 10.9 0.2 0.3 100.0 66.2 3.1 295 Mother's education No education 13.7 24.9 6.4 0.5 36.9 16.1 1.1 0.4 100.0 45.0 2.1 26,567 Primary 32.4 37.3 3.6 0.3 16.7 9.3 0.1 0.5 100.0 73.2 5.1 2,504 Secondary 32.8 42.8 3.6 0.0 13.7 6.2 0.0 0.9 100.0 79.1 5.6 2,242 More than secondary 51.7 43.5 2.1 0.0 1.8 0.9 0.0 0.0 100.0 97.3 11.0 489 (Continued…) 152 • Maternal Health Care Table 9.8—Continued Person providing assistance during delivery Per- centage delivered by a skilled provider1 Per- centage delivered by C- section Number of births Background characteristic Doctor Nurse/ midwife Auxiliary nurse/ midwife Other health worker Tra- ditional birth atten- dant Relative/ other No one Don't know/ missing Total Wealth quintile Lowest 4.6 16.7 2.8 0.6 55.7 18.7 0.7 0.3 100.0 24.0 0.9 6,127 Second 8.8 22.9 5.2 1.0 41.9 18.4 1.4 0.4 100.0 36.9 1.7 6,506 Middle 12.7 22.6 8.4 0.3 36.8 17.4 1.4 0.4 100.0 43.6 1.3 6,779 Fourth 20.9 36.2 7.8 0.1 19.6 14.2 0.7 0.4 100.0 64.9 3.3 6,605 Highest 40.3 39.8 5.1 0.0 10.7 3.4 0.3 0.4 100.0 85.2 6.8 5,786 Total 17.1 27.5 5.9 0.4 33.2 14.6 0.9 0.4 100.0 50.5 2.7 31,802 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife, and auxiliary nurse/midwife. 2 Includes only the most recent birth in the 5 years preceding the survey 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Maternal Health Care • 153 Table 9.9 Timing of first postnatal checkup for the mother Among women age 15-49 giving birth in the 2 years preceding the survey, the percent distribution of the mother's first postnatal checkup for the last live birth by time after delivery, and the percentage of women with a live birth in the 2 years preceding the survey who received a postnatal checkup in the first 2 days after giving birth, according to background characteristics, Afghanistan 2015 Time after delivery of mother's first postnatal checkup Percentage of women with a postnatal checkup in the first 2 days after birth Background characteristic Less than 4 hours 4-23 hours 1-2 days 3-6 days 7-41 days Don't know/ missing No postnatal checkup1 Total Number of women Mother's age at birth <20 33.0 1.4 3.0 0.8 1.1 3.0 57.7 100.0 37.3 1,469 20-34 35.9 2.4 2.1 0.9 1.4 2.5 54.9 100.0 40.4 8,458 35-49 34.9 1.5 3.1 1.0 1.5 1.1 56.8 100.0 39.5 1,612 Birth order 1 43.8 2.3 1.1 0.8 1.9 3.3 46.8 100.0 47.1 2,144 2-3 35.6 2.7 3.0 0.9 1.3 2.2 54.4 100.0 41.3 3,873 4-5 32.5 1.6 2.6 1.2 1.3 2.3 58.6 100.0 36.6 2,665 6+ 31.5 1.9 2.0 0.8 1.2 1.9 60.7 100.0 35.5 2,856 Place of delivery2 Health facility 56.8 3.6 3.0 0.8 1.2 3.5 31.1 100.0 63.4 5,624 Elsewhere 15.2 0.8 1.7 1.0 1.5 1.2 78.6 100.0 17.6 5,896 Residence Urban 44.2 3.4 4.5 1.0 1.9 1.7 43.4 100.0 52.0 2,794 Rural 32.6 1.8 1.6 0.9 1.2 2.6 59.4 100.0 36.0 8,745 Province3 Kabul 44.7 5.1 6.4 1.2 1.9 2.0 38.6 100.0 56.2 1,463 Kapisa 12.6 3.2 1.3 1.2 2.2 0.6 78.8 100.0 17.1 78 Parwan 40.0 0.4 1.3 0.4 0.6 1.2 56.2 100.0 41.7 295 Wardak 35.7 1.5 0.0 0.1 0.6 20.0 42.0 100.0 37.2 130 Logar 47.6 4.9 0.1 0.0 0.4 0.0 47.1 100.0 52.6 137 Nangarhar 45.8 2.5 2.0 1.2 1.0 2.6 44.9 100.0 50.3 390 Laghman 45.7 1.0 2.9 1.5 6.1 0.7 42.0 100.0 49.6 276 Panjsher 59.8 2.8 1.0 0.2 0.8 1.2 34.1 100.0 63.6 13 Baghlan 19.4 1.6 2.7 1.1 4.3 0.1 70.8 100.0 23.7 256 Bamyan 32.4 5.1 0.4 1.8 3.7 1.3 55.4 100.0 37.9 130 Ghazni 20.1 1.7 1.5 0.3 2.7 1.8 71.9 100.0 23.3 274 Paktika 29.7 0.6 0.4 1.2 0.2 0.5 67.4 100.0 30.7 352 Paktya 24.9 1.6 0.4 0.0 1.1 2.3 69.7 100.0 26.9 192 Khost 22.6 5.8 0.3 0.0 5.2 10.2 55.9 100.0 28.7 338 Kunarha 5.5 0.4 2.3 1.5 0.0 5.8 84.5 100.0 8.2 276 Nooristan 1.0 0.1 0.0 0.2 1.1 0.1 97.5 100.0 1.1 132 Badakhshan 16.4 0.9 2.6 0.3 1.5 0.3 78.1 100.0 19.8 366 Takhar 14.3 1.2 1.7 0.9 0.3 0.0 81.6 100.0 17.2 489 Kunduz 47.4 4.6 2.2 0.2 0.1 2.7 42.8 100.0 54.2 404 Samangan 26.5 0.6 0.1 0.1 0.5 8.9 63.3 100.0 27.2 125 Balkh 53.5 1.2 1.2 1.6 1.7 0.1 40.6 100.0 56.0 754 Sar-E-Pul 46.4 1.9 3.5 1.1 0.9 0.5 45.6 100.0 51.9 239 Ghor 17.6 0.1 0.1 0.1 0.3 0.0 81.9 100.0 17.8 261 Daykundi 12.5 0.5 2.9 0.4 0.8 6.6 76.2 100.0 16.0 131 Urozgan 3.5 1.4 0.0 0.1 0.6 12.3 82.0 100.0 5.0 157 Kandahar 8.5 3.1 1.1 1.1 1.5 0.1 84.5 100.0 12.7 1,044 Jawzjan 43.8 0.6 0.4 0.0 0.0 0.6 54.7 100.0 44.8 155 Faryab 62.3 0.7 2.9 2.2 0.9 0.7 30.2 100.0 65.9 953 Helmand 11.6 1.0 3.4 0.0 0.3 16.5 67.3 100.0 15.9 274 Badghis 17.2 2.1 4.0 1.6 0.8 0.4 73.9 100.0 23.3 296 Herat 76.2 0.5 1.1 0.0 0.6 3.4 18.1 100.0 77.9 752 Farah 41.1 2.5 5.2 1.2 0.4 0.0 49.7 100.0 48.8 275 Nimroz 22.0 0.8 0.1 0.1 0.0 1.2 75.8 100.0 22.8 121 Education No education 31.1 1.9 2.0 1.0 1.3 2.5 60.2 100.0 35.0 9,291 Primary 50.3 2.2 1.5 0.7 0.8 1.3 43.3 100.0 54.0 1,011 Secondary 53.7 3.1 5.2 0.1 2.1 2.3 33.6 100.0 62.0 1,009 More than secondary 65.6 8.0 6.3 0.9 2.6 1.3 15.3 100.0 79.9 229 Wealth quintile Lowest 29.1 0.7 1.6 1.1 1.1 1.6 64.8 100.0 31.4 2,052 Second 29.6 1.9 1.5 1.0 1.2 1.5 63.2 100.0 33.1 2,313 Middle 31.6 2.0 2.4 0.7 1.0 2.5 59.9 100.0 35.9 2,463 Fourth 38.1 2.2 0.8 0.5 1.7 3.9 52.8 100.0 41.1 2,486 Highest 48.4 3.8 5.4 1.3 2.0 2.0 37.0 100.0 57.7 2,226 Total 35.4 2.1 2.3 0.9 1.4 2.3 55.5 100.0 39.9 11,539 1 Includes women who received a checkup after 41 days 2 Total includes 19 women with missing information on place of delivery. 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 154 • Maternal Health Care Table 9.10 Type of provider of first postnatal checkup for the mother Among women age 15-49 giving birth in the 2 years preceding the survey, the percent distribution by type of provider of the mother's first postnatal health check in the 2 days after the last live birth, according to background characteristics, Afghanistan 2015 Type of health provider of mother's first postnatal checkup No postnatal checkup in the first 2 days after birth Background characteristic Doctor/ nurse/ midwife Auxiliary nurse/ midwife Community health worker Traditional birth atten- dant Total Number of women Mother's age at birth <20 30.8 2.2 0.0 4.4 62.7 100.0 1,469 20-34 33.0 3.1 0.0 4.2 59.6 100.0 8,458 35-49 33.9 2.2 0.0 3.4 60.5 100.0 1,612 Birth order 1 39.3 3.9 0.0 3.9 52.9 100.0 2,144 2-3 34.1 2.7 0.0 4.5 58.7 100.0 3,873 4-5 29.5 2.8 0.0 4.3 63.4 100.0 2,665 6+ 29.5 2.3 0.0 3.6 64.5 100.0 2,856 Place of delivery1 Health facility 58.6 4.7 0.0 0.0 36.6 100.0 5,624 Elsewhere 8.4 1.1 0.0 8.1 82.4 100.0 5,896 Residence Urban 49.8 1.8 0.0 0.3 48.0 100.0 2,794 Rural 27.4 3.2 0.0 5.4 64.0 100.0 8,745 Province2 Kabul 54.6 1.6 0.0 0.0 43.8 100.0 1,463 Kapisa 16.5 0.7 0.0 0.0 82.9 100.0 78 Parwan 38.9 2.6 0.0 0.3 58.3 100.0 295 Wardak 23.6 13.0 0.0 0.5 62.8 100.0 130 Logar 50.1 0.6 0.0 1.9 47.4 100.0 137 Nangarhar 47.2 2.5 0.0 0.6 49.7 100.0 390 Laghman 41.8 7.5 0.0 0.3 50.4 100.0 276 Panjsher 63.6 0.0 0.0 0.0 36.4 100.0 13 Baghlan 21.3 0.2 0.0 2.2 76.3 100.0 256 Bamyan 37.8 0.1 0.0 0.0 62.1 100.0 130 Ghazni 19.3 3.1 0.0 0.9 76.7 100.0 274 Paktika 9.4 21.1 0.0 0.2 69.3 100.0 352 Paktya 4.2 22.0 0.0 0.7 73.1 100.0 192 Khost 21.7 7.0 0.0 0.0 71.3 100.0 338 Kunarha 8.1 0.1 0.0 0.0 91.8 100.0 276 Nooristan 0.9 0.1 0.0 0.0 98.9 100.0 132 Badakhshan 17.0 1.6 0.0 1.3 80.2 100.0 366 Takhar 16.9 0.3 0.0 0.0 82.8 100.0 489 Kunduz 52.4 1.0 0.0 0.8 45.8 100.0 404 Samangan 27.1 0.0 0.0 0.1 72.8 100.0 125 Balkh 47.8 4.1 0.0 4.1 44.0 100.0 754 Sar-E-Pul 46.8 0.6 0.4 4.1 48.1 100.0 239 Ghor 9.6 7.9 0.0 0.3 82.2 100.0 261 Daykundi 12.8 2.0 0.0 1.2 84.0 100.0 131 Urozgan 2.1 1.7 0.0 1.2 95.0 100.0 157 Kandahar 12.4 0.4 0.0 0.0 87.3 100.0 1,044 Jawzjan 44.0 0.8 0.0 0.0 55.2 100.0 155 Faryab 56.5 0.5 0.1 8.9 34.1 100.0 953 Helmand 13.8 1.1 0.0 1.1 84.1 100.0 274 Badghis 7.1 0.0 0.0 16.2 76.7 100.0 296 Herat 42.5 0.8 0.0 34.6 22.1 100.0 752 Farah 41.2 3.5 0.0 4.0 51.2 100.0 275 Nimroz 22.5 0.0 0.0 0.3 77.2 100.0 121 Education No education 27.4 3.2 0.0 4.3 65.0 100.0 9,291 Primary 47.0 2.0 0.0 5.0 46.0 100.0 1,011 Secondary 58.4 1.4 0.0 2.2 38.0 100.0 1,009 More than secondary 78.7 0.8 0.0 0.4 20.1 100.0 229 Wealth quintile Lowest 18.8 2.2 0.0 10.4 68.6 100.0 2,052 Second 24.6 2.4 0.0 6.1 66.9 100.0 2,313 Middle 27.7 4.3 0.0 3.9 64.1 100.0 2,463 Fourth 36.7 3.6 0.0 0.7 58.9 100.0 2,486 Highest 55.8 1.5 0.0 0.4 42.3 100.0 2,226 Total 32.9 2.9 0.0 4.1 60.1 100.0 11,539 1 Total includes 19 women with missing information on place of delivery. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Maternal Health Care • 155 Table 9.11 Timing of first postnatal checkup for the newborn Percent distribution of last births in the 2 years preceding the survey by time after birth of first postnatal checkup, and the percentage of births with a postnatal checkup in the first 2 days after birth, according to background characteristics, Afghanistan 2015 Time after birth of newborn's first postnatal checkup Percentage of births with a postnatal checkup in the first 2 days after birth Number of births Background characteristic Less than 1 hour 1-3 hours 4-23 hours 1-2 days 3-6 days Don't know/ missing No postnatal checkup1 Total Mother's age at birth <20 0.6 6.7 0.3 2.9 2.5 0.3 86.7 100.0 10.4 1,469 20-34 0.4 5.9 0.8 2.0 3.1 1.3 86.5 100.0 9.1 8,458 35-49 0.3 5.4 0.7 3.0 3.3 0.8 86.4 100.0 9.5 1,612 Birth order 1 0.6 7.7 0.6 3.0 2.8 1.3 83.9 100.0 11.9 2,144 2-3 0.4 6.3 0.4 2.0 2.6 1.1 87.3 100.0 9.0 3,873 4-5 0.5 4.7 1.2 2.3 4.3 1.1 85.9 100.0 8.7 2,665 6+ 0.3 5.4 0.8 2.0 2.7 1.0 87.9 100.0 8.4 2,856 Place of delivery2 Health facility 0.6 9.1 1.0 2.5 3.2 1.5 82.0 100.0 13.2 5,624 Elsewhere 0.2 3.0 0.4 2.0 2.9 0.7 90.8 100.0 5.6 5,896 Residence Urban 0.4 8.4 0.8 3.1 3.5 1.0 82.9 100.0 12.6 2,794 Rural 0.4 5.2 0.7 2.0 2.9 1.2 87.7 100.0 8.3 8,745 Province3 Kabul 0.4 7.1 1.1 3.7 2.3 0.9 84.5 100.0 12.4 1,463 Kapisa 0.0 0.3 0.0 0.8 0.4 0.0 98.5 100.0 1.1 78 Parwan 0.0 6.9 1.0 2.6 3.3 0.4 85.7 100.0 10.6 295 Wardak 0.0 6.5 0.6 0.2 0.7 16.2 75.8 100.0 7.3 130 Logar 0.0 13.3 0.5 3.5 2.0 0.8 79.8 100.0 17.3 137 Nangarhar 0.0 5.5 0.9 3.4 15.7 4.8 69.7 100.0 9.8 390 Laghman 0.0 10.1 1.9 5.2 2.6 0.0 80.2 100.0 17.2 276 Panjsher 0.0 6.1 1.7 1.0 0.0 1.0 90.2 100.0 8.8 13 Baghlan 0.0 3.7 0.6 2.1 1.7 0.6 91.1 100.0 6.5 256 Bamyan 0.0 9.7 0.7 1.9 2.7 2.4 82.6 100.0 12.3 130 Ghazni 1.0 1.0 0.7 0.0 0.5 1.0 95.9 100.0 2.6 274 Paktika 0.0 6.3 0.1 1.7 2.0 0.7 89.3 100.0 8.1 352 Paktya 4.3 4.5 0.4 4.2 3.0 0.4 83.2 100.0 13.3 192 Khost 0.3 3.9 0.0 0.1 1.2 1.5 92.9 100.0 4.4 338 Kunarha 0.0 0.1 0.0 0.3 0.3 3.1 96.1 100.0 0.4 276 Nooristan 0.0 0.4 0.1 0.1 0.3 0.0 99.2 100.0 0.5 132 Badakhshan 0.0 1.5 0.2 0.3 0.8 0.5 96.7 100.0 2.0 366 Takhar 0.0 1.4 0.0 2.0 1.8 1.3 93.5 100.0 3.4 489 Kunduz 0.3 7.9 1.6 2.7 2.1 0.2 85.1 100.0 12.6 404 Samangan 0.0 0.1 0.0 0.0 0.0 0.4 99.5 100.0 0.1 125 Balkh 3.1 20.1 0.9 3.9 7.7 0.0 64.3 100.0 28.0 754 Sar-E-Pul 0.0 5.5 1.0 1.7 5.1 0.9 85.8 100.0 8.2 239 Ghor 0.0 0.8 0.7 3.1 6.0 1.9 87.5 100.0 4.6 261 Daykundi 0.0 0.0 0.4 0.6 0.6 3.3 95.2 100.0 1.0 131 Urozgan 0.0 1.0 1.6 0.0 1.0 1.3 95.2 100.0 2.6 157 Kandahar 0.0 6.6 0.5 0.5 2.4 1.7 88.2 100.0 7.6 1,044 Jawzjan 0.0 0.7 0.0 1.0 7.5 0.0 90.9 100.0 1.7 155 Faryab 0.6 1.8 0.4 0.6 1.8 0.3 94.6 100.0 3.3 953 Helmand 0.0 10.8 0.5 4.7 0.0 0.5 83.5 100.0 16.0 274 Badghis 0.0 9.5 2.1 4.0 1.1 0.0 83.2 100.0 15.7 296 Herat 0.0 4.0 0.5 2.8 4.4 0.6 87.8 100.0 7.3 752 Farah 0.0 9.5 1.6 6.2 3.7 0.1 78.9 100.0 17.3 275 Nimroz 0.0 0.2 0.0 0.1 0.2 0.0 99.6 100.0 0.3 121 Mother's education No education 0.4 5.6 0.7 2.1 2.8 1.2 87.3 100.0 8.6 9,291 Primary 0.5 6.6 0.2 2.1 4.7 0.4 85.5 100.0 9.4 1,011 Secondary 0.8 5.5 2.0 4.3 2.7 1.3 83.4 100.0 12.6 1,009 More than secondary 0.2 20.9 0.0 1.2 6.5 0.6 70.6 100.0 22.3 229 Wealth quintile Lowest 0.2 4.6 0.7 2.0 3.0 0.8 88.8 100.0 7.5 2,052 Second 0.4 6.3 0.5 2.0 2.1 1.3 87.5 100.0 9.2 2,313 Middle 0.6 4.9 0.6 2.3 3.2 1.0 87.4 100.0 8.5 2,463 Fourth 0.5 5.1 0.7 1.3 3.5 1.6 87.4 100.0 7.5 2,486 Highest 0.5 9.0 1.1 3.6 3.4 0.9 81.5 100.0 14.2 2,226 Total 0.4 6.0 0.7 2.2 3.1 1.1 86.5 100.0 9.3 11,539 1 Includes newborns who received a checkup after the first week 2 Total includes 19 women with missing information on place of delivery. 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 156 • Maternal Health Care Table 9.12 Type of provider of first postnatal checkup for the newborn Percent distribution of last births in the 2 years preceding the survey by type of provider of the newborn's first postnatal health check during the 2 days after the last live birth, according to background characteristics, Afghanistan 2015 Type of health provider of newborn's first postnatal checkup No postnatal checkup in the first 2 days after birth Background characteristic Doctor/ nurse/ midwife Auxiliary nurse/ midwife Com- munity health worker Tra- ditional birth attendant Total Number of births Mother's age at birth <20 7.2 0.4 0.2 2.6 89.6 100.0 1,469 20-34 7.5 0.4 0.0 1.2 90.9 100.0 8,458 35-49 7.9 0.2 0.0 1.4 90.5 100.0 1,612 Birth order 1 10.1 0.6 0.0 1.2 88.1 100.0 2,144 2-3 7.2 0.3 0.1 1.4 91.0 100.0 3,873 4-5 7.1 0.3 0.0 1.3 91.3 100.0 2,665 6+ 6.6 0.4 0.0 1.5 91.6 100.0 2,856 Place of delivery1 Health facility 12.5 0.6 0.0 0.1 86.8 100.0 5,624 Elsewhere 2.8 0.2 0.1 2.6 94.4 100.0 5,896 Residence Urban 12.3 0.3 0.0 0.1 87.4 100.0 2,794 Rural 6.0 0.4 0.0 1.8 91.7 100.0 8,745 Province2 Kabul 12.4 0.0 0.0 0.0 87.6 100.0 1,463 Kapisa 1.1 0.0 0.0 0.0 98.9 100.0 78 Parwan 8.2 2.4 0.0 0.0 89.4 100.0 295 Wardak 5.6 1.6 0.0 0.0 92.7 100.0 130 Logar 12.5 2.1 0.5 2.2 82.7 100.0 137 Nangarhar 9.8 0.0 0.0 0.0 90.2 100.0 390 Laghman 16.7 0.2 0.0 0.3 82.8 100.0 276 Panjsher 8.8 0.0 0.0 0.0 91.2 100.0 13 Baghlan 5.6 0.2 0.0 0.7 93.5 100.0 256 Bamyan 12.3 0.0 0.0 0.0 87.7 100.0 130 Ghazni 2.6 0.0 0.0 0.0 97.4 100.0 274 Paktika 7.6 0.4 0.0 0.1 91.9 100.0 352 Paktya 7.8 4.8 0.0 0.7 86.7 100.0 192 Khost 4.2 0.1 0.0 0.0 95.6 100.0 338 Kunarha 0.4 0.0 0.0 0.0 99.6 100.0 276 Nooristan 0.5 0.0 0.0 0.1 99.5 100.0 132 Badakhshan 1.7 0.0 0.0 0.3 98.0 100.0 366 Takhar 3.4 0.0 0.0 0.0 96.6 100.0 489 Kunduz 12.3 0.4 0.0 0.0 87.4 100.0 404 Samangan 0.0 0.0 0.0 0.1 99.9 100.0 125 Balkh 23.4 0.9 0.0 3.7 72.0 100.0 754 Sar-E-Pul 7.8 0.0 0.0 0.4 91.8 100.0 239 Ghor 4.5 0.0 0.0 0.1 95.4 100.0 261 Daykundi 0.4 0.0 0.5 0.0 99.0 100.0 131 Urozgan 2.2 0.4 0.0 0.0 97.4 100.0 157 Kandahar 7.5 0.2 0.0 0.0 92.4 100.0 1,044 Jawzjan 1.7 0.0 0.0 0.0 98.3 100.0 155 Faryab 1.2 0.0 0.0 2.1 96.7 100.0 953 Helmand 0.8 0.1 0.0 15.1 84.0 100.0 274 Badghis 2.4 0.0 0.0 13.3 84.3 100.0 296 Herat 5.9 0.0 0.3 1.0 92.7 100.0 752 Farah 10.1 2.6 0.0 4.6 82.7 100.0 275 Nimroz 0.1 0.0 0.0 0.2 99.7 100.0 121 Mother's education No education 6.6 0.4 0.0 1.6 91.4 100.0 9,291 Primary 8.5 0.4 0.0 0.6 90.6 100.0 1,011 Secondary 12.4 0.1 0.0 0.1 87.4 100.0 1,009 More than secondary 20.5 1.6 0.0 0.2 77.7 100.0 229 Wealth quintile Lowest 4.5 0.3 0.0 2.6 92.5 100.0 2,052 Second 6.6 0.1 0.0 2.5 90.8 100.0 2,313 Middle 6.4 0.6 0.1 1.3 91.5 100.0 2,463 Fourth 6.5 0.5 0.0 0.5 92.5 100.0 2,486 Highest 13.8 0.4 0.0 0.1 85.8 100.0 2,226 Total 7.5 0.4 0.0 1.4 90.7 100.0 11,539 1 Total includes 19 women with missing information on place of delivery. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Maternal Health Care • 157 Table 9.13 Problems in accessing health care Percentage of ever-married women age 15-49 who reported that they have serious problems in accessing health care for themselves when they are sick, by type of problem, according to background characteristics, Afghanistan 2015 Problems in accessing health care Background characteristic Getting permission to go for treatment Getting money for treatment Distance to health facility Not wanting to go alone At least one problem accessing health care Number of women Age 15-19 56.0 65.0 69.5 76.2 91.3 1,825 20-34 52.5 67.2 67.5 71.8 89.1 16,690 35-49 46.6 66.3 66.3 65.3 87.3 10,945 Number of living children 0 52.4 64.3 67.3 73.7 89.4 2,948 1-2 52.0 65.7 66.3 72.0 87.4 7,353 3-4 49.5 67.1 67.2 69.0 88.8 7,698 5+ 49.8 67.8 67.6 67.4 88.9 11,463 Marital status Married 50.9 66.8 67.3 69.8 88.7 28,671 Divorced/separated/widowed 38.1 63.0 62.5 62.3 82.4 790 Employed last 12 months1 Not employed 52.0 68.3 67.0 70.1 89.0 25,578 Employed for cash 37.8 48.9 64.7 64.6 82.9 2,618 Employed not for cash 46.6 72.8 75.1 71.0 90.6 1,244 Residence Urban 35.2 52.6 46.5 53.2 77.8 6,870 Rural 55.2 71.0 73.4 74.6 91.8 22,591 Province2 Kabul 37.4 51.7 50.8 58.1 80.6 3,658 Kapisa 28.3 67.1 60.2 72.1 86.0 205 Parwan 79.8 82.7 67.9 61.9 90.8 625 Wardak 91.0 85.4 75.0 93.2 97.4 382 Logar 74.1 63.7 60.9 73.5 93.5 472 Nangarhar 63.5 89.5 79.7 88.6 94.8 794 Laghman 27.5 36.6 66.6 60.3 88.3 583 Panjsher 69.2 67.7 86.8 88.3 93.4 54 Baghlan 82.0 86.5 43.0 22.9 90.5 839 Bamyan 59.3 83.8 91.1 90.7 95.0 303 Ghazni 80.1 89.3 81.8 84.7 97.4 1,328 Paktika 40.4 60.2 67.0 59.9 88.8 792 Paktya 88.7 89.4 70.9 88.9 98.3 542 Khost 82.0 92.5 84.8 95.4 99.2 851 Kunarha 41.5 81.0 49.5 40.7 89.0 559 Nooristan 47.6 56.7 67.5 29.7 97.1 222 Badakhshan 55.9 64.4 70.9 87.3 95.1 1,004 Takhar 39.5 38.3 51.6 54.2 61.8 1,105 Kunduz 67.5 68.8 87.4 88.9 92.1 1,232 Samangan 65.2 87.8 61.7 68.7 94.6 330 Balkh 15.2 49.9 55.2 59.3 73.9 1,781 Sar-E-Pul 69.3 75.9 75.6 77.4 94.6 654 Ghor 55.1 82.2 90.0 72.0 96.1 715 Daykundi 86.0 89.3 90.6 90.9 94.7 329 Urozgan 92.0 91.6 96.3 94.6 99.1 230 Kandahar 50.6 85.5 84.4 81.0 94.6 2,227 Jawzjan 19.1 44.7 64.5 59.7 83.7 614 Faryab 10.7 24.9 57.3 58.1 77.2 2,114 Helmand 58.3 44.3 25.0 50.9 93.8 875 Badghis 80.3 63.9 80.9 86.0 93.4 650 Herat 43.6 94.4 76.7 77.9 97.6 2,316 Farah 73.1 66.7 82.1 86.6 93.6 777 Nimroz 17.4 45.7 33.2 38.0 69.2 278 Education No education 53.9 70.6 70.6 72.6 91.2 24,604 Primary 39.8 54.5 55.8 58.4 80.2 2,330 Secondary 31.0 43.9 48.3 54.3 74.9 1,971 More than secondary 14.9 27.9 27.2 36.9 54.1 556 Wealth quintile Lowest 56.6 74.1 80.3 78.7 94.2 5,904 Second 56.9 71.0 73.8 75.8 91.8 6,001 Middle 56.6 72.4 71.6 72.3 90.7 5,888 Fourth 49.9 65.8 64.4 68.1 88.9 6,010 Highest 31.9 49.6 44.6 52.3 76.6 5,657 Total 50.5 66.7 67.2 69.6 88.5 29,461 1 Total includes 22 women with missing information on employment status in the last 12 months. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Child Health • 159 CHILD HEALTH 10 Key Findings  Vaccination: Forty-six percent of children age 12-23 months were fully vaccinated at the time of the survey.  Symptoms of acute respiratory infection (ARI): Thirteen percent of children under age 5 had a cough and other symptoms of ARI in the 2 weeks before the survey. Sixty-two percent of these children were taken to a health facility or provider for advice or treatment.  Fever: Twenty-nine percent of children under age 5 had a fever in the 2 weeks before the survey, and 54% of them were taken to a health facility or provider for advice or treatment.  Diarrhea: Twenty-nine percent of children under age 5 had diarrhea in the 2 weeks before the survey, and 41% continued feeding and were given oral rehydration therapy (ORT)/increased fluids. nformation on child health and survival can help policymakers and program managers assess the efficacy of current strategies, formulate appropriate interventions to prevent deaths from childhood illnesses, and improve the health of children in Afghanistan. This chapter presents information on birth weight and vaccination status for young children. It also looks at the prevalence of, and treatment practices for, three common childhood illnesses: symptoms of acute respiratory infection (ARI), fever, and diarrhea. Because appropriate sanitary practices can help prevent and reduce the severity of diarrheal disease, information is also provided on the disposal of children’s fecal matter. 10.1 BIRTH WEIGHT Low birth weight Percentage of births with a reported birth weight below 2.5 kilograms regardless of gestational age. Sample: Live births in the 5 years before the survey that have a reported birth weight, from either a written record or the mother’s report Written records or mothers’ reports of birth weight were available for only 14% of live births in the 5 years before the survey. Seventeen percent of these infants had a low birth weight (less than 2.5 kilograms), which increases the risk of neonatal and infant mortality and requires special care (Table 10.1). Due to the low percentage of births for which a birth weight was available, it is unlikely that this figure is representative of all births in the country. Birth weights were more often available in urban areas (31%) than in rural areas (9%). Panjsher and Kabul had the highest percentages of infants with a reported birth weight (52% and 43%, respectively), while Urozgan and Kunarha had the lowest (less than 1%). The I 160 • Child Health percentage of infants with reported birth weights increases with increasing wealth, from 5% in the lowest wealth quintile to 35% in the highest quintile. Table 10.1 also includes information on mothers’ estimates of their infant’s size at birth. Although the mother’s estimate of size is subjective, it can be used as a useful proxy for the child’s weight. Seven percent of births are reported as very small, 17% as smaller than average, and 73% as average or larger than average. 10.2 VACCINATION OF CHILDREN All basic vaccinations coverage Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother's report). To have received all basic vaccinations, a child must receive at least:  one dose of BCG vaccine, which protects against tuberculosis.  three doses of pentavalent, which protects against diphtheria, pertussis (whooping cough), tetanus, hepatitis B, and Hib.  three doses of polio vaccine.  one dose of measles vaccine. Sample: Living children age 12-23 months Services under the Expanded Program on Immunization (EPI) were initiated in 1978 in different parts of Afghanistan, mostly in urban areas. Until 2006, the program included vaccines against six diseases (tuberculosis, polio, diphtheria, pertussis, tetanus, and measles). Hepatitis B, Hib (Haemophilus influenzae type b), and PCV (pneumococcal conjugate vaccine) vaccines were introduced into the routine schedule in mid-2006, 2009, and 2013 in sequence (MoPH 2011). In August 2014, a zero dose of HepB vaccine was initiated to be administered to newborns during the first 24 hours of life. In Afghanistan, the target group for routine immunization is children under age 1; however, children up to age 23 months will not be refused vaccinations when brought to a health facility (except for BCG, which is administered only to children less than age 1). The same age groups are targeted during outreach activities. At age 18 months, a second dose of measles vaccine is recommended. Overall, 56% of children age 12-23 months had a vaccination card that was seen by the interviewer (Table 10.3). Based on information from the vaccination card and mothers’ recall, 46% percent of children age 12-23 months had received all basic vaccinations by the time of the survey (Figure 10.1). Almost all children who received all of the recommended vaccinations received them by age 12 months. However, among the 60% who received the measles vaccine, only 51% were vaccinated by age 12 months. This means that there was a 10-percentage-point difference between those receiving the measles vaccination at any time and those receiving the vaccination by age 12 months (Table 10.2). Nationally, vaccination coverage among children age 12-23 months was highest for the first dose of polio vaccine (85%). Fifty-eight percent of children had received three doses of pentavalent vaccine, 65% had Figure 10.1 Childhood vaccinations 74 73 68 58 85 79 65 60 46 13 BCG 1 2 3 1 2 3 All None Percentage of children age 12-23 months vaccinated at any time before the survey Measles BasicPolioDPT/Pentavalent Child Health • 161 received three doses of polio vaccine, 45% had received three doses of PCV, and 60% had received a measles vaccination (Table 10.3). There was a 21% dropout rate at the national level from the first to the third dose of pentavalent vaccine and a 24% dropout rate from the first to the third dose of polio vaccine. Patterns by background characteristics  Urban children are more likely than rural children to have received all basic vaccines (53% versus 43%).  At the provincial level, coverage with all basic vaccinations was highest in Paktika (75%), Badakhshan (72%), and Wardak (71%) and lowest in Nooristan (1%), Urozgan (2%), Paktya (16%), and Kandahar (16%) (Figure 10.2).  Children are more likely to receive all basic vaccinations if their mothers have more than a secondary education (65%) than if their mothers have only a primary education (55%) or no education at all (42%) (Table 10.3).  The economic situation of households is directly related to vaccination coverage. Children belonging to households in the highest wealth quintile are most likely to receive all basic vaccinations. There is a 17-percentage-point difference in coverage between the highest and lowest wealth quintiles (56% versus 38%).  Vaccination coverage among younger children (age 12-23 months) is higher than coverage among children age 48-59 months, indicating that there has been an improvement in coverage over time. For instance, 38% of children age 12-23 months received all basic vaccinations, as compared with only 22% of children age 48-59 months (Table 10.4, Figure 10.3). Figure 10.2 Vaccination coverage by province Percentage of children age 12-23 months who received all basic vaccinations at any time before the survey 162 • Child Health 10.3 SYMPTOMS OF ACUTE RESPIRATORY INFECTION Mothers reported that 13% of children under age 5 had symptoms of acute respiratory infection (ARI) in the 2 weeks before the survey. The prevalence of ARI symptoms peaked at 15% among children age 6- 11 and 24-35 months (Table 10.5). ARI symptoms were reported to be highest in Ghor (28%) and Herat (27%) and lowest (1% or less) in Ghazni, Panjsher, and Logar. Treatment of ARI symptoms Children with ARI symptoms for whom advice or treatment was sought from a health facility or provider. ARI symptoms consist of a cough accompanied by (1) short, rapid breathing that is chest-related and/or (2) difficult breathing that is chest-related. Sample: Children under age 5 with symptoms of ARI in the 2 weeks before the survey Sixty-two percent of children with ARI symptoms were taken to a health facility or provider for advice or treatment, and 54% received antibiotics (Table 10.5). Children with ARI symptoms in urban areas are more likely to be taken to a health facility or provider than those in rural areas (65% versus 60%). 10.4 FEVER Fever is a symptom of malaria, but it may also accompany other illnesses including pneumonia, a common cold, and influenza. Malaria can be a major cause of death in infancy and childhood, but, due to concerns about growing resistance to antimalarial drugs, WHO recommends that any child with fever be tested for malaria before being prescribed such drugs. This also helps to ensure that children with a fever are getting the appropriate treatment when they do not have malaria. Treatment of fever Children with a fever for whom advice or treatment was sought from a health facility or provider. Sample: Children under age 5 with a fever in the 2 weeks before the survey Mothers reported that 29% of children under age 5 were ill with a fever in the 2 weeks before the survey. Fever prevalence peaks at 37% among children age 6-11 months (Table 10.6). Fifty-four percent of children with a fever were taken to a health facility or provider for advice or treatment (Table 10.6). Children with a fever were more likely to receive an antibiotic than an antimalarial drug (46% versus 12%). Chapter 12 presents additional information on prevention and treatment of malaria. Figure 10.3 Vaccinations in first year of life 22 28 31 38 25 23 20 14 48-59 36-47 24-35 12-23 Percentage of children age 12-59 months who received all basic vaccinations by age 12 months at the time of the survey No vaccinations All basic vaccinations Age in months Child Health • 163 10.5 DIARRHEAL DISEASE 10.5.1 Prevalence of Diarrhea Mothers reported that 29% of children under age 5 had diarrhea in the 2 weeks before the survey and that 4% had diarrhea with blood in the stool (Table 10.7). The prevalence of diarrhea rises rapidly after the first 6 months of life, when children are typically introduced to complementary foods. The prevalence peaks at 38% at age 12-23 months, about the time when children start to walk and are at increased risk of contamination from the environment. Introduction of other liquids and foods at the time of weaning can also facilitate the spread of disease-causing microbes (Figure 10.4). Patterns by background characteristics  Children in households that use a shared toilet facility are slightly more likely to suffer from diarrhea than those using an improved toilet facility that is not shared (31% versus 28%).  The prevalence of diarrhea is much lower among children whose mothers have more than a secondary education than among children whose mothers have a primary education (18% versus 32%). 10.5.2 Treatment of Diarrhea Fifty-four percent of children with diarrhea were taken to a health facility or provider for advice or treatment (Table 10.8). Mothers reported seeking help more often for children with bloody diarrhea (68%) than for children with non-bloody diarrhea (52%). Oral rehydration therapy Children with diarrhea are given a fluid made from a special packet of oral rehydration salts (ORS) or government-recommended homemade fluids (RHF). Sample: Children under age 5 with diarrhea in the 2 weeks before the survey Figure 10.4 Diarrhea prevalence by age 21 35 38 32 27 19 29 <6 6-11 12-23 24-35 36-47 48-59 Total Percentage of children under age 5 who had diarrhea in the 2 weeks preceding the survey Age in months 164 • Child Health Oral rehydration therapy (ORT) is a simple and effective way to reduce dehydration caused by diarrhea. Half of children with diarrhea (50%) received some form of ORT, more often ORS packets (46%) than recommended home fluids (11%) (Table 10.8, Figure 10.5). Fifty- nine percent of children received either ORT or increased fluids. Among other treatments, 21% of children received antibiotics, 3% were given anti-motility drugs, and 10% received zinc supplements, which can reduce the duration and severity of diarrhea. Nearly two in five children with diarrhea (39%) were treated with a home remedy. Seventeen percent of children with diarrhea did not receive any treatment. Patterns by background characteristics  Although urban and rural children with diarrhea are equally likely to be taken to a health facility or provider for advice or treatment, rural children are more likely to receive home remedies than urban children (42% versus 32%).  Help-seeking for diarrhea varies greatly by province. Only 20% of children with diarrhea in Ghazni were taken to a health facility or provider, as compared with 94% in Paktika. The proportion of children who received no treatment ranges from less than 1% in Badghis and Paktika to 39% in Kandahar. 10.5.3 Feeding Practices Appropriate feeding practices Children with diarrhea are given more liquids than usual and as much food or more than usual. Sample: Children under age 5 with diarrhea in the 2 weeks before the survey To reduce dehydration and minimize the effects of diarrhea on nutritional status, mothers are encouraged to continue normal feeding of children with diarrhea and to increase the amount of fluids given. Figure 10.5 Treatment of diarrhea 17 39 21 59 21 50 11 46 54 No treatment Home remedy/other Antibiotics ORT or increased fluids Increased fluids ORS or RHF Recommended home fluids Fluid from ORS packet Taken to a health provider Percentage of children under age 5 with diarrhea in the 2 weeks before the survey Child Health • 165 Twenty-one percent of children under age 5 with diarrhea in the 2 weeks before the survey were given more liquids than normal, as recommended. Another 34% received the same amount of liquids as normal. Mothers gave less fluids to 37% of children with diarrhea, while 4% stopped fluids, which is dangerous for children suffering from diarrhea (Figure 10.6). With regard to food intake during a diarrhea episode, not all children with diarrhea were fed according to the recommended practice of giving either more food (9%) or the same amount of food as usual (33%). Forty-six percent of children were given less food than normal, and 1% were given no food. Sixteen percent of children with diarrhea were given increased fluids with continued feeding, while 41% continued feeding and were also given ORT/increased fluids (Table 10.9). 10.5.4 Knowledge of ORS Packets Only two-thirds of women (65%) in Afghanistan know of ORS packets for the treatment of diarrhea (Table 10.10). Women with a secondary education (78%) are more likely to have heard about ORS packets than women with no education (63%). By province, women in Kandahar (21%) and Nooristan (23%) are least likely to have heard about ORS. Treatment of Childhood Illness In summary, during the 2 weeks before the survey, diarrhea and fever were the most common illnesses reported among children under age 5. However, children with ARI symptoms were most often taken for advice or treatment (62%) (Figure 10.7). Professional advice was sought less often when children had a fever (54%) or diarrhea (54%). 10.6 DISPOSAL OF CHILDREN’S STOOLS Safe disposal of children’s stools The child’s last stools were put or rinsed into a toilet or latrine or were buried, or the child used a toilet or latrine. Sample: Youngest child under age 5 living with the mother Proper disposal of children’s feces is important to prevent the spread of disease. Forty-four percent of children under age 5 had their last stool disposed of safely (Table 10.11). Figure 10.6 Feeding practices during diarrhea Figure 10.7 Prevalence and treatment of childhood illnesses 9 21 33 34 46 37 1 4 8Food given Liquids given Percentage of children under age 5 with diarrhea in the 2 weeks before the survey More Same Less None Never gave (compared to usual) (compared to usual) 13 29 29 62 54 54 ARI Fever Diarrhea ARI Fever Diarrhea Percentage of children under age 5 with symptoms in the 2 weeks before the survey Among those with illness, percentage for whom advice or treatment was sought from a health facility or provider 166 • Child Health Patterns by background characteristics  Children’s stools are less likely to be disposed of safely in households that do not use an improved toilet facility than in other households (38% versus 54-55%).  Safe disposal of children’s stools is more common in urban than rural areas (58% versus 39%).  Safe disposal of children’s stools increases with increasing maternal education. Two-thirds (67%) of children whose mothers had more than a secondary education had their stools safely disposed of, as compared with only 41% of children whose mothers had no education.  Safe disposal of children’s stools also increases with increasing household wealth. Only 34% of children in the lowest wealth quintile had their stools safely disposed of, compared with 60% of children in the highest quintile.  There are large provincial differences in safe disposal of children’s stools. The proportion of children whose last stool was disposed of safely ranges from a low of 2% in Urozgan to a high of 89% in Logar. LIST OF TABLES For more information on low birth weight, vaccinations, childhood illness, disposal of children’s stools, and knowledge of childhood illness, see the following tables:  Table 10.1 Child’s size and weight at birth  Table 10.2 Vaccinations by source of information  Table 10.3 Vaccinations by background characteristics  Table 10.4 Vaccinations in first year of life  Table 10.5 Prevalence and treatment of symptoms of ARI  Table 10.6 Prevalence and treatment of fever  Table 10.7 Prevalence of diarrhea  Table 10.8 Diarrhea treatment  Table 10.9 Feeding practices during diarrhea  Table 10.10 Knowledge of ORS packets or ORS pre-packaged liquids  Table 10.11 Disposal of children’s stools  Table 10.12 Knowledge of childhood illness Child Health • 167 Table 10.1 Child’s size and weight at birth Percent distribution of live births in the 5 years preceding the survey by mother’s estimate of baby’s size at birth, percentage of live births in the 5 years preceding the survey that have a reported birth weight, and among live births in the 5 years preceding the survey with a reported birth weight, percentage less than 2.5 kg, according to background characteristics, Afghanistan 2015 Percent distribution of all live births by size of child at birth Percentage of all births that have a reported birth weight1 Number of births Births with a reported birth weight1 Background characteristic Very small Smaller than average Average or larger Don’t know/ missing Total Percentage less than 2.5 kg Number of births Mother’s age at birth <20 6.9 17.5 72.6 3.0 100.0 13.4 4,521 11.7 605 20-34 6.7 16.9 73.3 3.2 100.0 14.1 23,246 19.3 3,274 35-49 8.6 17.5 70.3 3.6 100.0 11.3 4,035 11.2 457 Birth order 1 7.4 18.1 71.6 2.8 100.0 18.4 6,119 21.8 1,123 2-3 6.2 16.0 74.8 3.0 100.0 12.9 10,348 14.3 1,339 4-5 7.0 17.2 72.2 3.5 100.0 13.5 7,357 15.2 995 6+ 7.5 17.3 71.7 3.6 100.0 11.0 7,978 18.8 879 Mother’s smoking status2 Smokes cigarettes/tobacco 11.0 25.4 60.6 3.0 100.0 13.7 815 35.0 112 Does not smoke 6.9 16.8 73.2 3.2 100.0 13.6 30,903 16.8 4,205 Residence Urban 10.5 17.7 69.6 2.2 100.0 30.8 7,246 20.9 2,229 Rural 5.9 16.8 73.7 3.5 100.0 8.6 24,555 13.6 2,107 Province3 Kabul 11.6 16.8 69.6 2.0 100.0 42.8 3,769 22.8 1,615 Kapisa 7.1 9.1 80.3 3.6 100.0 10.0 219 19.2 22 Parwan 3.1 16.0 79.9 1.0 100.0 6.2 728 32.4 45 Wardak 4.9 19.0 72.8 3.3 100.0 20.4 345 11.4 71 Logar 0.5 30.6 58.0 10.9 100.0 35.0 439 2.8 154 Nangarhar 3.3 15.6 80.3 0.8 100.0 13.3 1,028 14.0 136 Laghman 1.1 13.3 84.4 1.2 100.0 21.9 809 5.7 177 Panjsher 7.8 11.4 79.2 1.6 100.0 52.3 40 25.6 21 Baghlan 13.1 32.1 50.1 4.7 100.0 6.1 751 14.7 46 Bamyan 26.7 22.3 50.2 0.9 100.0 21.3 328 56.9 70 Ghazni 5.7 15.3 77.2 1.9 100.0 3.5 834 (6.8) 29 Paktika 0.9 4.6 67.0 27.5 100.0 16.6 874 24.7 145 Paktya 0.8 12.3 72.0 14.8 100.0 1.8 601 (22.2) 11 Khost 1.1 6.5 90.9 1.5 100.0 9.4 1,024 9.0 96 Kunarha 1.2 13.0 85.7 0.1 100.0 0.2 725 * 1 Nooristan 1.8 10.2 83.9 4.1 100.0 0.6 355 * 2 Badakhshan 3.8 15.4 80.4 0.4 100.0 8.0 939 9.6 75 Takhar 5.3 17.2 77.3 0.3 100.0 2.3 1,254 * 29 Kunduz 5.2 16.7 66.3 11.7 100.0 14.8 1,222 10.0 180 Samangan 6.5 22.1 71.0 0.3 100.0 1.8 359 (8.3) 6 Balkh 11.7 26.7 61.2 0.5 100.0 22.7 1,943 5.9 440 Sar-E-Pul 8.7 26.3 64.3 0.6 100.0 17.9 625 16.8 112 Ghor 24.8 20.4 54.7 0.1 100.0 4.2 913 58.5 38 Daykundi 37.3 18.9 41.1 2.7 100.0 4.5 315 (30.9) 14 Urozgan 1.0 10.0 86.9 2.2 100.0 0.1 407 * 0 Kandahar 7.7 16.6 72.4 3.3 100.0 2.3 2,989 (3.8) 70 Jawzjan 4.2 20.6 74.5 0.8 100.0 13.4 599 3.0 81 Faryab 7.5 11.7 80.2 0.7 100.0 4.8 2,398 13.7 114 Helmand 3.4 14.0 71.4 11.3 100.0 1.6 898 * 14 Badghis 2.8 20.6 75.2 1.4 100.0 1.8 775 (7.0) 14 Herat 2.6 20.9 76.3 0.2 100.0 15.6 2,149 25.6 335 Farah 2.5 14.4 81.4 1.6 100.0 9.1 825 2.0 75 Nimroz 6.6 16.0 73.6 3.8 100.0 32.8 295 13.6 97 Mother’s education No education 6.6 17.0 72.9 3.5 100.0 10.2 26,567 19.9 2,700 Primary 10.6 21.2 66.9 1.3 100.0 25.3 2,504 17.3 634 Secondary 8.4 14.4 75.3 2.0 100.0 32.7 2,242 12.8 734 More than secondary 2.5 10.1 85.7 1.7 100.0 55.0 489 4.9 269 Wealth quintile Lowest 8.8 19.6 68.6 3.0 100.0 5.4 6,127 22.4 333 Second 5.4 16.9 72.3 5.4 100.0 7.0 6,506 17.7 458 Middle 4.8 16.1 75.8 3.3 100.0 7.6 6,779 13.5 516 Fourth 5.7 16.3 75.6 2.4 100.0 15.1 6,605 13.8 999 Highest 10.7 16.3 71.0 2.0 100.0 35.1 5,786 19.2 2,031 Total 7.0 17.0 72.8 3.2 100.0 13.6 31,802 17.4 4,336 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Based on either a written record or the mother’s recall 2 Total includes 83 births with missing information on mother’s smoking status. 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 168 • Child Health Table 10.2 Vaccinations by source of information Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother’s report), and percentage vaccinated by age 12 months, Afghanistan 2015 Source of information BCG Pentavalent1 Polio2 Pneumococcal Measles All basic vaccina- tions3 No vaccina- tions Number of children 1 2 3 0 1 2 3 4 1 2 3 1 Vaccinated at any time before survey Vaccination card 54.5 54.7 52.1 47.0 41.1 55.3 52.9 48.2 40.8 48.0 43.8 37.2 43.7 39.7 0.0 3,217 Mother’s report 19.2 18.3 15.8 10.7 15.3 29.7 25.9 16.6 7.4 14.7 11.4 7.7 16.7 6.0 13.0 2,491 Either source 73.7 73.0 67.9 57.7 56.5 85.0 78.8 64.8 48.2 62.6 55.1 44.9 60.4 45.7 13.0 5,708 Vaccinated by age 12 months4 73.0 71.2 65.3 55.0 56.2 83.7 76.4 62.8 42.0 61.4 52.7 41.8 50.6 38.2 14.0 5,708 1 Pentavalent is DPT-HepB-Hib. 2 Polio 0 is the polio vaccination given at birth. 3 BCG, measles, and three doses each of pentavalent and polio vaccine (excluding polio vaccine given at birth) 4 For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccination. Child Health • 169 Ta bl e 10 .3 V ac ci na ti o ns b y ba ck gr o un d ch ar ac te ri st ic s P er ce nt ag e of c hi ld re n ag e 12 -2 3 m on th s w ho r ec ei ve d sp ec ifi c va cc in es a t an y tim e be fo re t he s ur ve y (a cc or di ng t o a va cc in at io n ca rd o r th e m ot he r’s r ep or t) , an d pe rc en ta ge w ith a va cc in at io n ca rd s ee n by th e in te rv ie w er , b y ba ck gr ou nd c ha ra ct er is tic s, A fg ha ni st an 2 01 5 B ac kg ro un d ch ar ac te ris tic B C G P en ta va le nt 1 P ol io 2 P ne um oc oc ca l M ea sl es A ll ba si c va cc in a- tio ns 3 N o va cc in a- tio ns P er ce n- ta ge w ith a va cc in a- tio n ca rd se en N um be r of ch ild re n 1 2 3 0 1 2 3 4 1 2 3 1 S ex M al e 74 .0 73 .5 68 .3 57 .8 56 .8 84 .9 78 .6 64 .0 46 .8 63 .5 56 .1 45 .2 59 .5 45 .0 12 .7 57 .6 2, 89 0 Fe m al e 73 .4 72 .4 67 .6 57 .5 56 .1 85 .1 79 .0 65 .7 49 .7 61 .7 54 .2 44 .7 61 .3 46 .4 13 .2 55 .0 2, 81 8 B ir th o rd er 1 80 .3 80 .5 74 .9 62 .2 66 .1 88 .4 83 .0 66 .0 51 .2 69 .6 62 .7 47 .4 64 .3 48 .7 10 .0 65 .8 1, 13 7 2- 3 71 .2 69 .2 64 .9 53 .6 53 .8 82 .0 76 .1 60 .2 44 .4 61 .3 52 .9 43 .2 56 .9 41 .0 15 .2 52 .4 1, 90 4 4- 5 73 .6 73 .9 67 .9 58 .6 56 .8 86 .9 79 .1 66 .5 49 .8 62 .9 55 .9 46 .1 63 .1 48 .5 10 .9 55 .9 1, 31 3 6+ 71 .9 70 .9 66 .4 58 .8 51 .7 84 .6 78 .5 68 .6 49 .7 58 .2 51 .2 44 .2 59 .4 46 .9 14 .2 54 .5 1, 35 4 R es id en ce U rb an 82 .4 82 .0 77 .4 67 .5 66 .0 88 .0 82 .5 69 .3 53 .7 68 .7 62 .1 53 .5 68 .1 52 .8 9. 8 64 .1 1, 37 7 R ur al 71 .0 70 .1 64 .9 54 .5 53 .4 84 .1 77 .6 63 .4 46 .5 60 .7 52 .9 42 .2 57 .9 43 .4 13 .9 53 .9 4, 33 1 P ro vi nc e4 K ab ul 82 .5 83 .5 79 .9 71 .7 60 .4 86 .6 84 .0 70 .3 61 .0 70 .8 66 .7 57 .7 72 .8 55 .6 11 .6 63 .0 71 8 K ap is a 84 .3 84 .5 79 .1 71 .6 61 .0 94 .6 91 .8 80 .9 48 .2 82 .2 75 .7 65 .1 70 .3 57 .9 4. 3 47 .7 41 P ar w an 88 .8 85 .8 83 .5 75 .4 73 .4 94 .2 90 .1 82 .4 70 .4 77 .4 75 .1 66 .3 73 .1 57 .8 3. 4 68 .7 14 4 W ar da k 90 .5 91 .3 90 .0 77 .6 60 .9 93 .4 92 .1 79 .6 69 .8 88 .6 86 .0 71 .3 82 .4 71 .4 4. 5 91 .0 67 Lo ga r 79 .1 70 .8 56 .8 41 .5 67 .2 88 .1 82 .5 65 .4 49 .7 60 .5 53 .6 42 .4 46 .5 34 .4 10 .0 42 .6 46 N an ga rh ar 88 .3 89 .7 85 .7 77 .9 64 .3 95 .0 92 .1 88 .6 76 .0 70 .4 60 .6 46 .9 69 .8 65 .0 3. 6 72 .6 19 3 La gh m an 93 .6 89 .9 85 .9 64 .9 89 .9 94 .6 91 .6 70 .6 56 .6 50 .2 41 .7 29 .6 72 .6 54 .8 3. 7 61 .1 12 8 P an js he r 79 .9 73 .5 65 .3 59 .0 79 .3 78 .7 66 .1 58 .7 41 .7 72 .9 61 .7 54 .8 64 .0 47 .3 11 .7 47 .6 10 B ag hl an 65 .5 73 .0 67 .9 52 .4 57 .1 79 .8 76 .9 58 .3 46 .5 67 .2 63 .3 51 .1 56 .4 43 .0 18 .7 61 .5 13 7 B am ya n 91 .1 87 .4 84 .8 78 .3 49 .4 91 .4 87 .3 73 .4 52 .9 74 .8 73 .9 67 .9 72 .1 62 .4 6. 9 64 .0 62 G ha zn i 59 .5 56 .9 48 .1 39 .1 50 .1 60 .4 50 .6 42 .1 34 .4 57 .8 49 .3 37 .5 38 .7 32 .3 38 .6 54 .1 15 6 P ak tik a 83 .3 81 .3 80 .3 77 .1 78 .2 87 .9 86 .3 82 .5 77 .0 78 .6 77 .4 73 .2 83 .6 74 .5 11 .3 73 .7 18 1 P ak ty a 88 .7 88 .8 80 .4 45 .0 65 .9 89 .1 70 .0 35 .6 11 .1 48 .1 41 .0 22 .4 49 .8 15 .8 4. 2 28 .5 10 5 K ho st 63 .3 62 .8 55 .8 49 .3 62 .0 76 .8 69 .4 47 .4 23 .9 60 .6 53 .9 45 .8 39 .3 27 .2 19 .2 39 .1 20 4 K un ar ha 51 .6 49 .5 46 .7 42 .7 43 .0 56 .6 51 .5 48 .4 33 .9 41 .4 38 .4 32 .9 42 .1 36 .3 41 .1 38 .4 10 0 N oo ris ta n 1. 5 1. 4 0. 8 0. 7 6. 8 23 .8 12 .3 7. 3 2. 1 0. 8 0. 8 0. 7 1. 4 0. 7 73 .9 0. 7 56 B ad ak hs ha n 96 .7 93 .8 92 .4 80 .9 59 .8 98 .6 97 .1 89 .5 70 .7 82 .1 75 .0 58 .6 84 .9 71 .7 1. 4 54 .0 15 6 T ak ha r 75 .3 74 .9 73 .5 66 .5 63 .7 96 .2 89 .4 74 .7 52 .6 58 .8 48 .0 35 .1 74 .0 56 .5 3. 5 62 .6 25 6 K un du z 87 .3 82 .7 71 .8 56 .9 71 .4 89 .5 84 .4 68 .0 47 .1 65 .4 55 .0 39 .4 46 .8 38 .0 7. 1 64 .4 20 7 S am an ga n 71 .9 66 .3 59 .7 38 .0 62 .7 68 .7 60 .4 35 .5 21 .5 55 .3 43 .3 26 .3 44 .3 24 .3 26 .2 50 .6 60 B al kh 78 .0 75 .6 69 .2 50 .5 59 .8 93 .3 86 .5 65 .7 37 .4 59 .9 53 .8 42 .3 64 .0 38 .9 3. 8 55 .8 37 5 S ar -E -P ul 77 .9 75 .6 67 .1 45 .0 63 .6 80 .2 71 .7 46 .8 33 .5 50 .7 43 .7 28 .9 60 .9 37 .3 19 .8 59 .0 10 4 G ho r 44 .2 48 .2 37 .7 32 .3 35 .0 55 .2 48 .4 37 .5 27 .2 34 .6 25 .0 21 .2 39 .4 25 .9 43 .9 39 .7 12 8 D ay ku nd i 47 .1 55 .7 51 .2 43 .7 14 .2 54 .6 52 .0 46 .5 36 .7 52 .0 49 .4 43 .4 46 .8 33 .7 40 .6 40 .4 63 U ro zg an 26 .0 5. 7 3. 6 2. 1 11 .1 79 .0 56 .3 32 .0 9. 3 3. 7 2. 6 1. 3 3. 5 1. 7 18 .1 0. 5 79 K an da ha r 42 .9 40 .7 32 .7 24 .8 29 .6 72 .2 62 .7 50 .5 29 .5 38 .7 30 .8 23 .9 22 .2 16 .0 22 .9 43 .1 42 6 Ja w zj an 81 .7 75 .2 69 .8 60 .2 70 .1 81 .3 73 .3 56 .0 46 .0 62 .0 57 .2 50 .7 57 .1 44 .8 16 .7 62 .6 94 (C on tin ue d… ) 170 • Child Health Ta bl e 10 .3 — C o nt in ue d B ac kg ro un d ch ar ac te ris tic B C G P en ta va le nt 1 P ol io 2 P ne um oc oc ca l M ea sl es A ll ba si c va cc in a- tio ns 3 N o va cc in a- tio ns P er ce n- ta ge w ith a va cc in a- tio n ca rd se en N um be r of ch ild re n 1 2 3 0 1 2 3 4 1 2 3 1 Fa ry ab 92 .0 92 .3 87 .5 81 .7 53 .4 97 .5 93 .0 88 .7 67 .8 77 .1 66 .6 53 .7 77 .8 69 .0 2. 3 78 .9 48 6 H el m an d 54 .8 54 .4 52 .7 49 .9 44 .9 74 .6 52 .0 36 .8 19 .9 52 .4 49 .4 46 .9 46 .9 21 .7 24 .0 28 .1 17 2 B ad gh is 79 .3 80 .7 74 .5 61 .4 61 .5 96 .8 91 .7 78 .2 54 .1 74 .1 66 .2 53 .9 79 .4 51 .2 0. 8 66 .8 15 1 H er at 77 .9 78 .8 77 .2 62 .0 66 .1 97 .0 94 .4 73 .4 58 .7 83 .9 62 .9 49 .8 79 .8 55 .6 2. 3 57 .8 38 7 Fa ra h 45 .6 49 .7 39 .6 33 .3 43 .2 73 .6 60 .5 41 .4 27 .6 39 .8 35 .1 30 .4 37 .7 27 .7 23 .8 37 .1 13 9 N im ro z 80 .9 81 .3 72 .7 66 .4 49 .3 86 .0 78 .8 69 .4 55 .3 72 .4 69 .3 60 .1 67 .8 56 .0 12 .8 62 .7 73 M ot h er ’s e d uc at io n N o ed uc at io n 70 .5 69 .6 64 .3 53 .5 54 .4 83 .4 76 .6 62 .2 45 .6 59 .4 52 .0 42 .0 57 .0 42 .4 14 .3 53 .8 4, 59 9 P rim ar y 86 .1 85 .5 80 .3 69 .6 60 .4 91 .3 88 .0 73 .9 58 .0 71 .1 65 .2 56 .1 73 .6 54 .8 7. 9 64 .0 47 7 S ec on da ry 88 .7 89 .1 85 .6 78 .8 70 .4 92 .0 87 .7 78 .3 59 .9 79 .6 69 .2 54 .8 74 .0 61 .9 7. 2 72 .0 50 6 M or e th an s ec on da ry 84 .7 83 .9 81 .7 79 .3 61 .9 91 .9 87 .9 72 .4 61 .3 78 .6 76 .0 70 .9 78 .5 65 .1 7. 6 58 .7 12 6 W ea lt h q ui nt ile Lo w es t 64 .7 65 .7 59 .8 47 .9 46 .2 82 .2 76 .4 59 .7 39 .6 57 .9 46 .8 36 .6 56 .7 38 .4 15 .7 49 .2 1, 03 5 S ec on d 67 .5 67 .7 63 .1 51 .9 54 .4 82 .0 76 .3 60 .2 44 .2 57 .3 51 .3 40 .1 56 .8 41 .3 16 .7 49 .5 1, 12 6 M id dl e 72 .0 68 .7 64 .3 53 .6 54 .1 83 .9 75 .4 61 .3 44 .1 58 .4 51 .1 40 .6 53 .7 40 .5 13 .3 52 .9 1, 16 1 Fo ur th 79 .5 77 .4 72 .1 64 .1 61 .7 87 .0 81 .1 68 .7 55 .0 65 .8 58 .9 51 .2 65 .0 51 .7 10 .8 60 .5 1, 32 5 H ig he st 84 .0 84 .7 79 .8 69 .7 64 .6 89 .9 84 .4 73 .6 57 .0 73 .6 67 .1 55 .1 69 .3 55 .5 8. 6 69 .2 1, 06 1 T ot al 73 .7 73 .0 67 .9 57 .7 56 .5 85 .0 78 .8 64 .8 48 .2 62 .6 55 .1 44 .9 60 .4 45 .7 13 .0 56 .4 5, 70 8 1 P en ta va le nt is D P T -H ep B -H ib . 2 P ol io 0 is th e po lio v ac ci na tio n gi ve n at b irt h. 3 B C G , m ea sl es , a nd th re e do se s ea ch o f p en ta va le nt a nd p ol io v ac ci ne ( ex cl ud in g po lio v ac ci ne g iv en a t b irt h) 4 E st im at es fo r Za bu l a re n ot p re se nt ed s ep ar at el y du e to s am pl e co ve ra ge is su es ; h ow ev er , t he y ar e in cl ud ed in th e to ta l n at io na l e st im at es . Child Health • 171 Table 10.4 Vaccinations in first year of life Percentage of children age 12-59 months at the time of the survey who received specific vaccines by age 12 months, and percentage with a vaccination card seen by the interviewer, by current age of child, Afghanistan 2015 Age in months BCG Pentavalent1 Polio2 Measles All basic vaccinations3 No vaccinations Percentage with a vaccination card seen Number of children 1 2 3 0 1 2 3 1 12-23 73.0 71.2 65.3 55.0 56.2 83.7 76.4 62.8 50.6 38.2 14.0 56.4 5,708 24-35 64.0 60.9 54.6 43.8 48.6 77.2 69.7 56.5 45.1 30.7 19.6 38.0 6,598 36-47 60.9 56.1 51.6 42.0 46.6 73.6 68.0 55.3 43.3 27.8 23.2 28.8 6,282 48-59 55.7 50.9 46.6 36.8 38.9 69.5 64.1 52.6 36.5 21.7 25.2 20.1 5,902 Total 63.6 60.0 54.7 44.6 47.7 76.6 70.2 57.3 45.0 30.0 20.0 35.6 24,489 Note: Information was obtained from the vaccination card or, if there was no written record, from the mother. For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccinations. 1 Pentavalent is DPT-HepB-Hib. 2 Polio 0 is the polio vaccination given at birth. 3 BCG, measles, and three doses each of pentavalent and polio vaccine (excluding polio vaccine given at birth) 172 • Child Health Table 10.5 Prevalence and treatment of symptoms of ARI Among children under age 5, the percentage who had symptoms of acute respiratory infection (ARI) in the 2 weeks preceding the survey and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider and the percentage who received antibiotics as treatment, according to background characteristics, Afghanistan 2015 Background characteristic Among children under age 5: Among children under age 5 with symptoms of ARI: Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Age in months <6 10.0 3,095 71.1 49.8 308 6-11 14.7 2,720 64.0 60.7 400 12-23 13.9 5,708 67.3 61.5 792 24-35 14.8 6,598 54.5 52.1 977 36-47 11.3 6,282 61.4 53.5 708 48-59 10.7 5,902 58.5 48.1 631 Sex Male 12.9 15,605 62.4 55.2 2,017 Female 12.2 14,699 60.4 53.4 1,800 Mother’s smoking status Smokes cigarettes/tobacco 13.2 769 61.2 60.3 101 Does not smoke 12.6 29,460 61.5 54.2 3,715 Missing 0.3 75 * * 0 Cooking fuel Electricity or gas 9.9 9,089 70.7 55.8 904 Kerosene * 1 * * 0 Coal/lignite 14.5 99 * * 14 Charcoal 4.5 176 * * 8 Wood/straw3 13.7 15,015 60.2 50.9 2,052 Animal dung 14.1 5,751 55.4 61.7 814 Other fuel 17.9 130 (41.9) (68.9) 23 No food cooked in household (4.0) 20 * * 1 Missing (1.0) 22 * * 0 Residence Urban 11.8 7,040 65.1 50.7 834 Rural 12.8 23,264 60.4 55.4 2,983 Province4 Kabul 6.9 3,677 52.8 47.4 252 Kapisa 15.8 211 50.7 54.2 33 Parwan 2.6 688 * * 18 Wardak 17.3 329 57.1 50.8 57 Logar 1.4 417 * * 6 Nangarhar 18.2 972 68.6 56.8 177 Laghman 16.0 770 76.3 58.5 124 Panjsher 0.9 39 * * 0 Baghlan 26.3 700 37.8 36.2 184 Bamyan 9.3 314 51.3 57.3 29 Ghazni 0.4 778 * * 3 Paktika 2.5 856 (93.0) (86.2) 21 Paktya 7.7 578 75.5 30.0 44 Khost 7.8 991 46.8 93.4 78 Kunarha 4.3 704 (49.4) (70.0) 31 Nooristan 9.1 303 47.1 49.0 28 Badakhshan 17.6 870 22.9 26.0 153 Takhar 9.2 1,187 34.2 65.9 110 Kunduz 9.4 1,177 60.8 75.5 111 Samangan 5.7 345 (74.7) (48.5) 20 Balkh 15.2 1,874 63.8 67.3 285 Sar-E-Pul 3.6 596 * * 21 Ghor 28.3 846 58.2 56.6 239 Daykundi 7.5 308 (12.2) (23.8) 23 Urozgan 6.7 385 93.5 66.5 26 Kandahar 24.0 2,751 60.1 50.4 660 Jawzjan 18.4 569 50.4 56.9 105 Faryab 10.0 2,281 66.7 96.8 229 Helmand 7.7 893 87.2 66.7 69 Badghis 13.5 723 61.6 75.4 97 Herat 27.3 2,046 85.6 33.1 558 Farah 2.4 810 (62.6) (49.6) 19 Nimroz 2.4 290 * * 7 Mother’s education No education 12.9 25,261 61.1 54.0 3,256 Primary 13.1 2,429 62.1 53.0 319 Secondary 9.5 2,130 63.9 64.1 203 More than secondary 7.9 484 (77.7) (47.6) 38 (Continued…) Child Health • 173 Table 10.5—Continued Background characteristic Among children under age five: Among children under age five with symptoms of ARI: Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Wealth quintile Lowest 16.2 5,795 52.9 51.0 939 Second 11.9 6,185 65.6 56.4 737 Middle 12.8 6,398 56.3 51.2 821 Fourth 11.3 6,312 67.1 57.2 714 Highest 10.8 5,614 70.0 58.2 606 Total 12.6 30,304 61.5 54.4 3,817 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Symptoms of ARI consist of cough accompanied by short, rapid breathing that was chest-related and/or by difficult breathing that was chest-related. 2 Excludes pharmacy, shop, market, and traditional practitioner 3 Includes grass, shrubs, and crop residues 4 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 174 • Child Health Table 10.6 Prevalence and treatment of fever Among children under age 5, the percentage who had a fever in the 2 weeks preceding the survey and among children with fever, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage who took antimalarial drugs, and the percentage who received antibiotics as treatment, by background characteristics, Afghanistan 2015 Background characteristic Among children under age 5: Among children under age 5 with fever Percentage with fever Number of children Percentage for whom advice or treatment was sought from a health facility or provider1 Percentage who took antimalarial drugs Percentage who took antibiotic drugs Number of children Age in months <6 23.0 3,095 57.8 21.1 40.1 712 6-11 36.7 2,720 57.9 13.6 45.6 999 12-23 35.3 5,708 55.8 10.0 49.6 2,013 24-35 31.7 6,598 48.7 11.0 45.7 2,094 36-47 27.1 6,282 57.6 11.7 48.2 1,704 48-59 20.1 5,902 50.4 9.3 44.5 1,187 Sex Male 28.6 15,605 56.0 11.1 47.8 4,460 Female 28.9 14,699 52.2 12.5 45.0 4,249 Residence Urban 30.7 7,040 55.2 16.5 43.4 2,162 Rural 28.1 23,264 53.8 10.2 47.5 6,547 Province2 Kabul 29.3 3,677 44.7 21.9 37.1 1,078 Kapisa 20.0 211 29.4 2.5 32.3 42 Parwan 10.9 688 59.9 5.7 50.9 75 Wardak 33.1 329 49.9 1.1 51.3 109 Logar 13.0 417 47.8 7.8 36.8 54 Nangarhar 44.4 972 59.1 4.7 39.7 431 Laghman 34.0 770 85.7 5.1 60.5 262 Panjsher 3.1 39 * * * 1 Baghlan 25.0 700 74.9 10.0 68.8 175 Bamyan 20.6 314 47.6 1.7 45.8 65 Ghazni 12.3 778 18.7 4.9 6.1 96 Paktika 13.1 856 92.6 0.0 32.6 112 Paktya 27.8 578 57.4 4.6 33.6 161 Khost 12.3 991 34.1 0.0 38.0 122 Kunarha 18.9 704 48.8 1.5 28.5 133 Nooristan 25.0 303 34.0 0.0 32.1 76 Badakhshan 26.3 870 36.7 2.3 31.1 229 Takhar 21.7 1,187 32.2 2.9 48.4 258 Kunduz 28.2 1,177 48.4 5.3 67.5 332 Samangan 15.3 345 61.0 35.3 47.1 53 Balkh 33.5 1,874 50.0 2.6 61.2 627 Sar-E-Pul 9.8 596 39.2 0.0 39.2 59 Ghor 51.6 846 57.9 8.6 55.5 437 Daykundi 12.1 308 21.9 1.1 26.0 37 Urozgan 20.5 385 91.7 0.0 54.5 79 Kandahar 49.9 2,751 38.8 0.0 34.2 1,373 Jawzjan 26.5 569 39.9 5.5 46.3 151 Faryab 30.1 2,281 66.5 6.0 87.8 686 Helmand 13.2 893 88.4 3.9 54.4 118 Badghis 22.7 723 55.5 2.5 65.8 164 Herat 49.2 2,046 77.0 54.0 32.8 1,008 Farah 8.4 810 63.5 10.1 50.3 68 Nimroz 12.3 290 34.2 3.6 16.8 36 Mother’s education No education 29.0 25,261 52.6 11.1 46.1 7,316 Primary 32.3 2,429 57.8 14.8 46.6 784 Secondary 23.4 2,130 65.6 12.4 53.5 499 More than secondary 22.6 484 77.8 33.8 38.9 109 Wealth quintile Lowest 28.8 5,795 54.1 11.2 51.5 1,672 Second 27.4 6,185 54.8 13.0 48.4 1,693 Middle 29.9 6,398 47.2 8.4 41.5 1,912 Fourth 27.8 6,312 57.0 9.0 47.2 1,753 Highest 29.9 5,614 58.4 18.0 44.4 1,679 Total 28.7 30,304 54.1 11.8 46.5 8,709 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Excludes pharmacy, shop, market, and traditional practitioner 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Child Health • 175 Table 10.7 Prevalence of diarrhea Percentage of children under age 5 who had diarrhea in the 2 weeks preceding the survey, by background characteristics, Afghanistan 2015 Diarrhea in the 2 weeks preceding the survey Background characteristic All diarrhea Diarrhea with blood Number of children Age in months <6 20.8 1.6 3,095 6-11 34.6 3.0 2,720 12-23 37.9 4.6 5,708 24-35 32.2 4.9 6,598 36-47 26.9 4.2 6,282 48-59 19.1 4.1 5,902 Sex Male 29.5 4.4 15,605 Female 27.8 3.6 14,699 Source of drinking water1 Improved 28.2 3.6 15,272 Not improved 28.1 5.0 8,833 Other/missing 30.5 3.8 6,199 Toilet facility2 Improved, not shared 28.2 3.7 7,141 Shared3 31.0 4.5 2,243 Not improved 28.6 4.1 20,877 Missing 30.9 0.0 44 Residence Urban 32.0 3.8 7,040 Rural 27.7 4.1 23,264 Province4 Kabul 30.8 3.5 3,677 Kapisa 26.5 2.5 211 Parwan 23.4 5.5 688 Wardak 25.3 2.3 329 Logar 23.0 2.2 417 Nangarhar 42.3 4.3 972 Laghman 34.0 6.1 770 Panjsher 3.0 0.0 39 Baghlan 30.0 6.9 700 Bamyan 17.5 3.1 314 Ghazni 12.3 1.9 778 Paktika 16.0 3.7 856 Paktya 24.5 1.6 578 Khost 6.7 0.3 991 Kunarha 22.8 4.0 704 Nooristan 22.9 2.2 303 Badakhshan 23.9 2.7 870 Takhar 38.8 2.0 1,187 Kunduz 32.7 7.4 1,177 Samangan 28.6 0.6 345 Balkh 33.8 3.6 1,874 Sar-E-Pul 22.5 2.1 596 Ghor 52.3 26.2 846 Daykundi 14.9 2.3 308 Urozgan 34.1 1.5 385 Kandahar 41.4 4.2 2,751 Jawzjan 20.3 2.2 569 Faryab 32.5 1.3 2,281 Helmand 3.7 0.8 893 Badghis 8.3 1.1 723 Herat 34.6 5.8 2,046 Farah 19.2 5.5 810 Nimroz 17.4 0.9 290 Mother’s education No education 28.5 4.1 25,261 Primary 32.1 4.2 2,429 Secondary 29.6 3.3 2,130 More than secondary 17.8 0.8 484 (Continued…) 176 • Child Health Table 10.7—Continued Diarrhea in the two weeks preceding the survey Background characteristic All diarrhea Diarrhea with blood Number of children Wealth quintile Lowest 28.1 5.7 5,795 Second 26.5 4.0 6,185 Middle 28.9 3.3 6,398 Fourth 29.7 3.8 6,312 Highest 30.3 3.4 5,614 Total 28.7 4.0 30,304 1 See Table 2.1 for definition of categories. 2 See Table 2.2 for definition of categories. 3 Facilities that would be considered improved if they were not shared by two or more households 4 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Child Health • 177 Table 10.8 Diarrhea treatment Among children under age 5 who had diarrhea in the 2 weeks preceding the survey, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage given oral rehydration therapy (ORT), the percentage given increased fluids, the percentage given ORT or increased fluids, and the percentage who were given other treatments, by background characteristics, Afghanistan 2015 Background characteristic Percentage of children with diarrhea for whom advice or treatment was sought from a health facility or provider1 Oral rehydration therapy (ORT) Other treatments Missing No treatment Number of children with diarrhea Fluid from ORS packets or pre- packaged ORS fluid Recom- mended home fluids (RHF) Either ORS or RHF Increased fluids ORT or increased fluids Anti- biotic drugs Anti- motility drugs Zinc supple- ments Intra- venous solution Home remedy/ other Age in months <6 60.2 33.7 11.0 38.1 12.8 43.6 26.4 3.2 10.9 0.4 32.7 0.6 23.6 645 6-11 58.5 46.0 12.4 52.0 14.5 57.0 18.8 2.0 6.9 0.4 41.8 0.1 15.5 941 12-23 54.3 50.2 10.2 53.7 23.8 63.1 25.2 3.1 9.1 0.8 35.4 0.6 15.5 2,164 24-35 51.2 45.2 11.1 49.3 22.1 59.1 18.2 2.5 9.9 0.5 38.5 0.6 19.1 2,122 36-47 53.5 46.3 12.9 50.4 20.3 57.3 22.1 2.8 10.3 0.9 41.9 0.7 17.0 1,687 48-59 52.8 47.9 11.1 51.4 20.6 60.2 18.3 2.1 10.7 1.0 45.7 0.9 16.7 1,128 Sex Male 55.1 46.1 12.3 50.8 21.0 59.4 22.4 2.2 10.0 0.7 38.5 0.6 16.5 4,601 Female 53.0 46.4 10.4 49.8 19.9 57.5 20.2 3.1 9.2 0.7 40.1 0.6 18.4 4,086 Type of diarrhea Non-bloody 51.9 43.7 10.6 47.9 20.1 56.6 21.8 2.6 9.6 0.6 36.4 0.4 18.8 6,898 Bloody 67.6 58.9 14.7 63.1 23.7 68.7 21.0 3.1 8.6 1.4 54.0 0.9 10.0 1,221 Missing 51.8 49.2 13.2 52.2 18.1 60.1 17.3 1.8 12.7 0.1 41.7 2.6 15.9 568 Residence Urban 55.1 43.7 16.2 49.0 23.4 60.1 22.9 2.7 6.5 0.7 32.2 1.0 17.5 2,254 Rural 53.7 47.1 9.7 50.8 19.4 58.0 20.9 2.6 10.7 0.7 41.7 0.5 17.3 6,433 Province2 Kabul 46.7 42.7 23.0 50.2 25.0 62.9 22.2 1.7 6.2 1.3 24.8 1.7 17.8 1,133 Kapisa 41.1 44.9 2.1 46.2 14.2 53.6 1.8 1.7 17.7 0.0 62.0 1.4 14.8 56 Parwan 57.4 70.5 9.3 74.8 36.2 83.3 18.1 0.0 6.7 2.2 41.5 3.2 3.6 161 Wardak 57.1 64.6 19.0 72.7 57.5 78.8 8.0 0.5 2.8 0.5 46.1 1.1 17.6 83 Logar 41.5 83.9 27.0 85.3 32.3 86.9 32.0 2.3 24.3 0.0 2.5 0.0 8.5 96 Nangarhar 63.2 63.2 10.0 68.7 14.0 73.4 3.8 0.5 5.4 0.2 68.9 0.2 7.6 411 Laghman 81.9 77.1 30.1 78.8 17.4 82.6 34.7 3.2 4.4 0.0 30.7 0.2 8.4 262 Panjsher * * * * * * * * * * * * * 1 Baghlan 71.8 25.6 33.0 37.1 36.8 70.9 22.6 0.0 1.1 0.2 75.8 1.1 2.2 210 Bamyan 51.4 26.8 9.7 29.4 8.9 34.6 44.1 0.4 1.4 0.0 31.6 1.0 14.4 55 Ghazni 19.6 24.3 24.8 47.7 22.8 57.2 7.0 5.3 0.0 0.0 35.3 0.0 21.8 95 Paktika 93.6 98.7 1.7 98.7 2.6 98.7 26.6 1.7 83.9 0.0 9.9 0.4 0.6 137 Paktya 50.9 73.5 11.4 83.7 0.1 83.7 20.4 2.4 22.9 1.1 28.7 0.1 8.8 142 Khost 60.1 87.5 3.4 88.7 29.1 92.8 4.0 0.0 11.0 0.0 53.8 2.1 2.1 66 Kunarha 46.9 32.0 3.5 33.7 10.8 37.9 1.5 0.1 0.2 0.0 43.7 3.0 37.1 161 Nooristan 22.0 20.6 2.5 22.7 12.7 31.3 11.5 0.6 6.9 0.3 45.3 1.8 33.2 69 Badakhshan 56.0 80.8 7.2 83.7 11.7 86.8 13.8 0.4 24.9 0.0 18.8 0.0 6.0 208 Takhar 41.5 46.3 1.1 46.7 22.0 53.7 11.3 0.3 0.0 0.0 30.7 0.0 27.8 461 Kunduz 44.7 67.1 5.2 67.5 10.0 69.5 23.0 1.8 12.9 0.0 28.6 0.6 10.7 385 Samangan 51.0 35.0 9.6 44.4 21.9 53.4 14.9 4.5 11.7 0.0 48.9 0.0 7.8 99 Balkh 45.1 27.8 0.9 27.9 24.9 42.8 16.0 1.6 1.0 0.0 55.4 0.0 21.2 634 Sar-E-Pul 35.1 45.4 0.1 45.4 35.1 63.7 19.7 21.9 7.9 2.0 45.6 0.0 21.0 134 Ghor 55.9 37.7 3.6 38.7 11.3 42.3 8.9 0.2 6.8 4.2 61.9 0.0 22.8 443 Daykundi 28.7 11.8 27.3 38.9 12.5 47.8 13.8 1.1 4.9 0.0 21.9 0.0 32.4 46 Urozgan 73.9 69.7 9.5 77.2 4.6 78.5 12.3 0.2 9.0 0.0 64.8 0.3 8.1 131 Kandahar 48.2 20.3 7.4 24.7 4.6 27.6 10.9 0.0 0.1 0.1 43.4 0.7 38.6 1,139 Jawzjan 35.3 60.5 3.8 61.5 8.0 65.0 1.6 0.7 0.0 0.0 26.8 0.0 25.5 115 Faryab 60.3 37.2 3.8 41.0 15.6 46.9 53.6 2.6 6.6 0.0 20.4 0.3 12.0 742 Helmand (86.8) (68.2) (13.8) (68.2) (3.9) (68.2) (79.4) (7.7) (2.5) (0.0) (32.6) (1.4) (4.6) 33 Badghis 66.9 81.2 5.9 86.1 36.0 93.2 28.3 0.0 48.4 1.9 62.4 0.0 0.5 60 Herat 78.7 67.0 24.8 68.1 56.2 82.2 45.0 13.4 35.6 0.8 35.9 0.0 3.2 707 Farah 40.2 20.6 15.8 36.2 20.4 52.0 7.3 3.6 10.0 6.5 66.4 0.0 8.2 156 Nimroz 30.2 19.4 2.3 21.7 21.0 36.1 9.5 12.7 0.0 0.0 31.1 0.0 28.3 50 Mother’s education No education 53.5 45.4 10.7 49.5 19.6 57.7 20.3 2.5 9.4 0.7 40.8 0.6 18.1 7,191 Primary 56.2 54.2 20.4 59.6 20.2 67.5 22.1 3.6 10.5 1.0 37.8 0.1 12.2 780 Secondary 56.1 44.6 8.2 46.7 26.3 54.9 30.3 1.6 10.8 0.3 25.1 1.8 16.4 630 More than secondary 68.2 59.1 9.5 60.0 52.0 73.4 38.7 8.7 11.7 0.0 28.9 0.2 12.1 86 (Continued…) 178 • Child Health Table 10.8—Continued Background characteristic Percentage of children with diarrhea for whom advice or treatment was sought from a health facility or provider1 Oral rehydration therapy (ORT) Other treatments Fluid from ORS packets or pre- packaged ORS fluid Recom- mended home fluids (RHF) Either ORS or RHF Increased fluids ORT or increased fluids Anti- biotic drugs Anti- motility drugs Zinc supple- ments Intra- venous solution Home remedy/ other Missing No treatment Number of children with diarrhea Wealth quintile Lowest 49.9 45.3 8.4 49.5 18.8 56.7 17.5 2.2 10.3 1.4 46.5 0.3 16.9 1,627 Second 55.0 48.3 14.8 53.4 21.0 61.9 20.5 2.7 11.0 0.7 40.9 0.1 16.5 1,637 Middle 50.5 45.0 8.3 47.8 18.2 54.2 18.7 2.9 10.3 0.3 39.6 0.8 21.5 1,847 Fourth 56.7 50.1 11.2 54.2 20.2 61.2 24.8 2.5 9.6 0.8 36.0 0.7 15.4 1,873 Highest 58.3 42.1 14.4 46.9 24.5 58.7 25.1 2.8 6.9 0.5 33.9 1.0 16.5 1,702 Total 54.1 46.2 11.4 50.3 20.5 58.5 21.4 2.6 9.6 0.7 39.3 0.6 17.4 8,687 Note: ORT includes fluid prepared from oral rehydration salt (ORS) packets, pre-packaged ORS fluid, and recommended home fluids (RHF). Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Excludes pharmacy, shop, market, and traditional practitioner 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Child Health • 179 Ta bl e 10 .9 F ee di ng p ra ct ic es d ur in g d ia rr he a P er ce nt d is tri bu tio n of c hi ld re n un de r ag e 5 w ho h ad d ia rr he a in th e 2 w ee ks p re ce di ng th e su rv ey b y am ou nt o f l iq ui ds a nd fo od o ffe re d co m pa re d w ith n or m al p ra ct ic e, th e pe rc en ta ge o f c hi ld re n gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g du rin g th e di ar rh ea e pi so de , a nd th e pe rc en ta ge o f c hi ld re n w ho c on tin ue d fe ed in g an d w er e gi ve n O R T a nd /o r in cr ea se d flu id s du rin g th e ep is od e of d ia rr he a, b y ba ck gr ou nd c ha ra ct er is tic s, A fg ha ni st an 2 01 5 A m ou nt o f l iq ui ds g iv en A m ou nt o f f oo d gi ve n P er ce nt ag e gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g1 P er ce nt ag e w ho co nt in ue d fe ed in g an d w er e gi ve n O R T a nd /o r in cr ea se d flu id s1 N um be r of ch ild re n w ith di ar rh ea B ac kg ro un d ch ar ac te ris tic M or e S am e as us ua l S om e- w ha t le ss M uc h le ss N on e D on ’t kn ow / m is si ng T ot al M or e S am e as us ua l S om e- w ha t le ss M uc h le ss N on e N ev er ga ve fo od D on ’t kn ow / m is si ng T ot al A ge in m o nt hs <6 12 .8 31 .7 18 .3 19 .2 16 .4 1. 6 10 0. 0 8. 7 22 .6 13 .9 12 .3 2. 7 38 .4 1. 3 10 0. 0 7. 0 20 .4 64 5 6- 11 14 .5 33 .6 27 .5 15 .2 6. 4 2. 8 10 0. 0 8. 0 25 .2 29 .3 15 .8 1. 6 16 .2 3. 9 10 0. 0 9. 6 33 .8 94 1 12 -2 3 23 .8 31 .2 23 .9 14 .5 3. 1 3. 6 10 0. 0 7. 3 29 .8 33 .8 18 .0 1. 0 6. 5 3. 5 10 0. 0 17 .7 44 .5 2, 16 4 24 -3 5 22 .1 36 .8 18 .3 16 .1 3. 0 3. 7 10 0. 0 9. 6 37 .2 28 .1 17 .8 1. 0 3. 0 3. 4 10 0. 0 17 .8 43 .1 2, 12 2 36 -4 7 20 .3 37 .0 19 .9 15 .3 2. 4 5. 2 10 0. 0 11 .0 37 .1 26 .9 17 .4 0. 8 1. 8 5. 0 10 0. 0 17 .4 44 .0 1, 68 7 48 -5 9 20 .6 33 .5 18 .6 19 .7 1. 7 5. 9 10 0. 0 11 .2 33 .7 25 .7 22 .5 0. 6 1. 1 5. 3 10 0. 0 14 .3 41 .2 1, 12 8 S ex M al e 21 .0 34 .1 21 .6 16 .2 3. 4 3. 7 10 0. 0 9. 9 31 .9 28 .8 17 .7 0. 9 6. 8 4. 0 10 0. 0 16 .3 41 .7 4, 60 1 Fe m al e 19 .9 34 .5 20 .4 16 .1 4. 9 4. 3 10 0. 0 8. 6 33 .2 27 .3 17 .8 1. 3 8. 2 3. 8 10 0. 0 14 .7 39 .5 4, 08 6 T yp e of d ia rr he a N on -b lo od y 20 .1 36 .4 21 .0 14 .0 4. 2 4. 3 10 0. 0 9. 0 34 .2 28 .5 15 .2 1. 1 7. 9 4. 0 10 0. 0 15 .6 40 .6 6, 89 8 B lo od y 23 .7 19 .3 22 .3 29 .7 3. 9 1. 0 10 0. 0 9. 7 19 .7 27 .6 34 .2 1. 3 5. 9 1. 5 10 0. 0 15 .5 40 .5 1, 22 1 M is si ng 18 .1 40 .7 18 .8 12 .9 2. 6 7. 0 10 0. 0 11 .4 38 .8 23 .3 13 .1 1. 1 5. 2 7. 2 10 0. 0 15 .7 42 .2 56 8 R es id en ce U rb an 23 .4 29 .9 21 .0 18 .8 5. 1 1. 7 10 0. 0 10 .1 24 .7 32 .6 19 .3 0. 6 11 .6 1. 0 10 0. 0 16 .6 39 .8 2, 25 4 R ur al 19 .4 35 .8 21 .0 15 .2 3. 7 4. 8 10 0. 0 9. 0 35 .2 26 .4 17 .2 1. 3 6. 0 4. 9 10 0. 0 15 .2 41 .0 6, 43 3 P ro vi nc e2 K ab ul 25 .0 31 .4 18 .9 15 .6 6. 4 2. 7 10 0. 0 12 .5 22 .2 32 .7 17 .6 0. 7 13 .8 0. 4 10 0. 0 18 .3 40 .8 1, 13 3 K ap is a 14 .2 22 .3 11 .5 23 .2 27 .1 1. 7 10 0. 0 11 .4 36 .9 11 .3 25 .0 2. 9 10 .4 2. 2 10 0. 0 11 .2 34 .9 56 P ar w an 36 .2 26 .8 13 .6 19 .7 0. 2 3. 6 10 0. 0 29 .0 25 .0 23 .6 5. 9 2. 8 3. 9 9. 7 10 0. 0 27 .4 64 .1 16 1 W ar da k 57 .5 22 .2 7. 8 4. 5 4. 9 3. 2 10 0. 0 0. 5 25 .0 46 .8 14 .2 5. 9 5. 9 1. 7 10 0. 0 46 .7 64 .3 83 Lo ga r 32 .3 40 .4 11 .1 15 .1 1. 1 0. 0 10 0. 0 14 .9 45 .8 9. 3 24 .1 0. 0 5. 3 0. 6 10 0. 0 30 .9 64 .8 96 N an ga rh ar 14 .0 38 .1 20 .6 19 .4 6. 5 1. 5 10 0. 0 2. 1 34 .8 31 .4 20 .0 1. 5 7. 9 2. 3 10 0. 0 12 .7 48 .7 41 1 La gh m an 17 .4 39 .6 10 .7 4. 2 23 .7 4. 4 10 0. 0 22 .9 22 .0 14 .9 10 .9 4. 8 20 .0 4. 6 10 0. 0 15 .1 57 .5 26 2 P an js he r * * * * * * 10 0. 0 * * * * * * * 10 0. 0 * * 1 B ag hl an 36 .8 4. 8 29 .6 21 .6 2. 5 4. 7 10 0. 0 34 .6 8. 2 23 .2 28 .2 1. 9 0. 7 3. 1 10 0. 0 26 .5 45 .9 21 0 B am ya n 8. 9 21 .7 15 .1 19 .3 32 .8 2. 1 10 0. 0 1. 6 35 .9 17 .9 23 .1 2. 2 17 .1 2. 2 10 0. 0 6. 3 21 .1 55 G ha zn i 22 .8 39 .8 22 .6 6. 5 4. 8 3. 5 10 0. 0 23 .8 40 .9 20 .8 8. 3 0. 0 5. 0 1. 2 10 0. 0 19 .0 47 .5 95 P ak tik a 2. 6 17 .8 32 .0 35 .8 11 .8 0. 0 10 0. 0 2. 3 19 .3 32 .8 33 .1 0. 8 11 .7 0. 0 10 0. 0 2. 6 53 .1 13 7 P ak ty a 0. 1 10 .7 37 .1 41 .3 8. 5 2. 4 10 0. 0 1. 5 29 .4 27 .9 13 .2 1. 5 6. 7 19 .9 10 0. 0 0. 1 50 .5 14 2 K ho st 29 .1 37 .0 15 .9 13 .4 1. 4 3. 2 10 0. 0 5. 6 34 .2 40 .3 10 .6 0. 0 4. 7 4. 5 10 0. 0 28 .9 79 .7 66 K un ar ha 10 .8 10 .1 71 .9 1. 9 0. 0 5. 3 10 0. 0 9. 7 13 .2 65 .8 3. 0 0. 6 1. 9 5. 9 10 0. 0 10 .8 33 .6 16 1 N oo ris ta n 12 .7 50 .2 27 .4 6. 5 0. 1 3. 1 10 0. 0 4. 3 38 .7 39 .6 9. 4 0. 6 3. 7 3. 8 10 0. 0 7. 7 23 .9 69 (C on tin ue d… ) 180 • Child Health Ta bl e 10 .9 — C o nt in ue d A m ou nt o f l iq ui ds g iv en A m ou nt o f f oo d gi ve n P er ce nt ag e gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g1 P er ce nt ag e w ho co nt in ue d fe ed in g an d w er e gi ve n O R T a nd /o r in cr ea se d flu id s1 N um be r of ch ild re n w ith di ar rh ea B ac kg ro un d ch ar ac te ris tic M or e S am e as us ua l S om e- w ha t le ss M uc h le ss N on e D on ’t kn ow / m is si ng T ot al M or e S am e as us ua l S om e- w ha t le ss M uc h le ss N on e N ev er ga ve fo od D on ’t kn ow / m is si ng T ot al B ad ak hs ha n 11 .7 58 .7 14 .7 14 .7 0. 2 0. 0 10 0. 0 5. 3 56 .5 16 .5 16 .9 0. 0 4. 7 0. 0 10 0. 0 6. 9 70 .2 20 8 T ak ha r 22 .0 44 .6 27 .4 5. 8 0. 0 0. 3 10 0. 0 21 .1 50 .4 20 .0 6. 0 0. 1 2. 1 0. 3 10 0. 0 21 .0 50 .1 46 1 K un du z 10 .0 27 .4 25 .5 23 .3 4. 4 9. 4 10 0. 0 10 .5 23 .2 28 .4 25 .5 2. 3 2. 6 7. 6 10 0. 0 7. 9 41 .0 38 5 S am an ga n 21 .9 44 .8 24 .2 6. 0 0. 8 2. 3 10 0. 0 6. 5 44 .6 37 .9 9. 2 0. 0 1. 2 0. 6 10 0. 0 17 .8 46 .4 99 B al kh 24 .9 48 .2 16 .1 3. 7 5. 8 1. 3 10 0. 0 8. 4 39 .6 30 .5 7. 8 2. 3 11 .2 0. 3 10 0. 0 19 .2 33 .0 63 4 S ar -E -P ul 35 .1 27 .7 19 .0 7. 8 2. 8 7. 6 10 0. 0 9. 9 43 .4 24 .5 9. 1 0. 0 7. 4 5. 6 10 0. 0 32 .0 54 .5 13 4 G ho r 11 .3 1. 5 21 .0 63 .4 2. 5 0. 3 10 0. 0 1. 6 5. 9 30 .8 58 .0 0. 9 2. 6 0. 2 10 0. 0 9. 9 18 .0 44 3 D ay ku nd i 12 .5 38 .8 9. 7 8. 6 24 .7 5. 6 10 0. 0 13 .6 35 .4 13 .3 3. 9 2. 0 26 .8 5. 1 10 0. 0 9. 3 36 .0 46 U ro zg an 4. 6 20 .4 28 .8 45 .3 0. 5 0. 5 10 0. 0 1. 4 19 .5 43 .6 21 .5 4. 8 7. 7 1. 5 10 0. 0 4. 0 50 .4 13 1 K an da ha r 4. 6 43 .6 16 .2 19 .0 0. 3 16 .3 10 0. 0 2. 2 36 .3 23 .5 16 .2 0. 0 5. 6 16 .2 10 0. 0 3. 8 17 .9 1, 13 9 Ja w zj an 8. 0 25 .6 8. 9 51 .7 5. 7 0. 0 10 0. 0 8. 1 24 .6 7. 2 49 .1 2. 2 7. 0 1. 7 10 0. 0 6. 5 19 .0 11 5 Fa ry ab 15 .6 45 .7 37 .1 1. 6 0. 0 0. 1 10 0. 0 8. 1 51 .1 36 .2 2. 9 0. 3 1. 5 0. 0 10 0. 0 14 .2 44 .7 74 2 H el m an d (3 .9 ) (4 .2 ) (7 .9 ) (7 6. 1) (0 .0 ) (7 .9 ) 10 0. 0 (5 .5 ) (6 .6 ) (2 0. 5) (5 9. 8) (6 .3 ) (0 .0 ) (1 .4 ) 10 0. 0 (0 .0 ) (1 5. 2) 33 B ad gh is 36 .0 29 .7 17 .5 15 .2 1. 6 0. 0 10 0. 0 4. 9 27 .5 33 .3 26 .5 1. 9 3. 9 1. 9 10 0. 0 15 .1 63 .5 60 H er at 56 .2 31 .6 6. 4 2. 8 2. 6 0. 4 10 0. 0 7. 3 32 .6 21 .0 24 .8 0. 4 13 .6 0. 3 10 0. 0 33 .9 49 .5 70 7 Fa ra h 20 .4 54 .4 21 .5 1. 2 1. 2 1. 2 10 0. 0 5. 6 55 .5 27 .6 5. 0 0. 0 3. 1 3. 1 10 0. 0 14 .1 43 .5 15 6 N im ro z 21 .0 17 .9 32 .8 23 .2 3. 4 1. 6 10 0. 0 8. 5 19 .3 37 .2 24 .9 4. 6 4. 7 0. 8 10 0. 0 15 .2 27 .8 50 M ot h er ’s e d uc at io n N o ed uc at io n 19 .6 34 .1 21 .2 16 .9 3. 8 4. 4 10 0. 0 8. 8 32 .0 28 .3 18 .6 1. 1 6. 7 4. 4 10 0. 0 15 .0 39 .8 7, 19 1 P rim ar y 20 .2 39 .7 20 .4 10 .9 6. 4 2. 5 10 0. 0 10 .6 29 .2 29 .2 15 .8 1. 6 11 .9 1. 7 10 0. 0 14 .8 45 .9 78 0 S ec on da ry 26 .3 32 .3 19 .8 14 .8 5. 2 1. 6 10 0. 0 10 .2 41 .8 23 .8 11 .3 0. 6 10 .5 1. 7 10 0. 0 18 .7 41 .8 63 0 M or e th an se co nd ar y 52 .0 13 .5 22 .3 12 .0 0. 2 0. 0 10 0. 0 24 .2 31 .8 25 .7 10 .2 0. 0 8. 1 0. 0 10 0. 0 46 .3 62 .1 86 W ea lt h q ui nt ile Lo w es t 18 .8 32 .8 21 .8 20 .1 4. 0 2. 5 10 0. 0 7. 8 33 .4 27 .6 22 .8 1. 3 5. 8 1. 2 10 0. 0 14 .4 40 .9 1, 62 7 S ec on d 21 .0 35 .5 22 .0 15 .9 2. 8 2. 8 10 0. 0 13 .3 33 .8 26 .4 16 .5 1. 2 5. 5 3. 3 10 0. 0 17 .0 44 .5 1, 63 7 M id dl e 18 .2 37 .9 19 .6 12 .7 3. 6 8. 1 10 0. 0 7. 4 36 .0 25 .5 14 .7 1. 3 6. 6 8. 4 10 0. 0 13 .8 37 .4 1, 84 7 Fo ur th 20 .2 37 .7 20 .3 12 .9 4. 3 4. 7 10 0. 0 9. 3 32 .9 28 .2 17 .1 1. 1 6. 5 4. 8 10 0. 0 15 .1 41 .0 1, 87 3 H ig he st 24 .5 26 .9 21 .7 19 .9 5. 7 1. 3 10 0. 0 8. 7 26 .1 32 .5 18 .1 0. 6 12 .8 1. 1 10 0. 0 17 .8 40 .0 1, 70 2 T ot al 20 .5 34 .3 21 .0 16 .2 4. 1 4. 0 10 0. 0 9. 2 32 .5 28 .0 17 .8 1. 1 7. 5 3. 9 10 0. 0 15 .6 40 .7 8, 68 7 N ot e: I t i s re co m m en de d th at c hi ld re n be g iv en m or e liq ui ds to d rin k du rin g di ar rh ea a nd t ha t f oo d no t b e re du ce d. F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. 1 C on tin ue d fe ed in g in cl ud es c hi ld re n w ho w er e gi ve n m or e, th e sa m e as u su al , o r so m ew ha t l es s fo od d ur in g th e di ar rh ea e pi so de . 2 E st im at es fo r Za bu l a re n ot p re se nt ed s ep ar at el y du e to s am pl e co ve ra ge is su es ; h ow ev er , t he y ar e in cl ud ed in th e to ta l n at io na l e st im at es . Child Health • 181 Table 10.10 Knowledge of ORS packets or ORS pre- packaged liquids Percentage of women age 15-49 with a live birth in the 5 years preceding the survey who know about ORS packets or ORS pre-packaged liquids for treatment of diarrhea by background characteristics, Afghanistan 2015 Background characteristic Percentage of women who know about ORS packets or ORS pre- packaged liquids Number of women Age 15-19 58.4 856 20-24 63.1 4,962 25-34 66.0 9,075 35-49 67.3 4,749 Residence Urban 63.9 4,566 Rural 65.7 15,076 Province1 Kabul 65.6 2,392 Kapisa 89.0 129 Parwan 88.8 437 Wardak 61.1 249 Logar 82.8 276 Nangarhar 97.5 576 Laghman 87.5 428 Panjsher 79.2 26 Baghlan 48.8 504 Bamyan 44.7 206 Ghazni 53.1 639 Paktika 85.7 525 Paktya 59.5 347 Khost 80.1 580 Kunarha 45.2 421 Nooristan 23.4 184 Badakhshan 68.5 650 Takhar 75.5 751 Kunduz 85.3 760 Samangan 81.5 225 Balkh 60.3 1,232 Sar-E-Pul 65.6 430 Ghor 88.7 542 Daykundi 28.8 216 Urozgan 62.8 200 Kandahar 21.3 1,631 Jawzjan 88.7 398 Faryab 56.5 1,451 Helmand 35.2 570 Badghis 65.0 499 Herat 90.9 1,465 Farah 62.9 493 Nimroz 72.8 195 Education No education 62.9 16,288 Primary 76.0 1,596 Secondary 78.3 1,432 More than secondary 72.9 325 Wealth quintile Lowest 65.8 3,914 Second 66.7 3,966 Middle 60.8 4,020 Fourth 67.0 4,057 Highest 66.1 3,685 Total 65.3 19,642 ORS = Oral rehydration salts 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 182 • Child Health Table 10.11 Disposal of children’s stools Percent distribution of youngest children under age 5 living with their mother by the manner of disposal of the child’s last fecal matter, and percentage of children whose stools are disposed of safely, according to background characteristics, Afghanistan 2015 Manner of disposal of children’s stools Total Percentage of children whose stools are disposed of safely1 Number of children Background characteristic Child used toilet or latrine Put/rinsed into toilet or latrine Buried Put/rinsed into drain or ditch Thrown into garbage Left in the open Other Don’t know/ missing Age in months <6 13.6 14.7 10.2 23.2 17.8 15.5 4.5 0.5 100.0 38.5 3,071 6-11 15.8 12.1 7.8 19.3 18.3 23.1 2.6 0.9 100.0 35.7 2,697 12-23 20.1 13.4 8.8 17.7 16.3 21.3 1.9 0.5 100.0 42.3 5,334 24-35 21.6 13.3 10.0 14.8 13.0 25.4 1.2 0.8 100.0 44.9 4,247 36-47 30.3 12.8 8.6 10.3 12.4 23.1 0.9 1.6 100.0 51.7 2,404 48-59 36.3 11.1 7.9 8.1 11.8 22.9 0.4 1.5 100.0 55.3 1,485 Toilet facility2 Improved, not shared 28.6 20.6 6.3 13.4 17.7 10.7 1.7 1.1 100.0 55.4 4,603 Shared3 36.3 12.9 5.2 17.5 15.4 8.8 3.6 0.3 100.0 54.4 1,499 Non-improved or shared 17.0 10.6 10.5 17.5 14.4 27.3 1.9 0.8 100.0 38.1 13,111 Residence Urban 26.5 23.4 7.9 10.6 18.7 8.3 3.6 1.1 100.0 57.7 4,510 Rural 19.7 10.0 9.4 18.3 14.2 26.0 1.5 0.8 100.0 39.2 14,727 Province4 Kabul 32.1 15.0 7.7 5.1 25.1 8.2 6.3 0.6 100.0 54.7 2,364 Kapisa 78.4 2.4 1.4 1.6 1.6 14.5 0.1 0.2 100.0 82.1 128 Parwan 23.7 5.2 5.3 17.7 33.6 13.0 0.0 1.5 100.0 34.2 422 Wardak 7.6 3.8 0.0 72.4 5.0 8.0 1.7 1.4 100.0 11.5 245 Logar 69.5 19.6 0.1 4.5 3.7 0.9 0.0 1.8 100.0 89.1 267 Nangarhar 4.0 9.9 8.7 18.3 39.3 16.0 2.0 1.7 100.0 22.7 555 Laghman 7.8 8.4 20.1 17.4 20.3 24.4 0.0 1.6 100.0 36.4 420 Panjsher 76.9 4.8 1.2 1.5 12.5 0.0 0.0 3.1 100.0 82.9 26 Baghlan 26.1 6.6 3.6 2.0 18.1 40.3 1.8 1.5 100.0 36.4 490 Bamyan 35.2 23.1 3.5 4.3 1.1 19.1 13.2 0.6 100.0 61.8 203 Ghazni 40.5 13.8 5.4 14.2 8.4 16.4 0.2 1.1 100.0 59.7 606 Paktika 0.3 5.4 12.7 16.7 26.8 19.9 16.9 1.4 100.0 18.4 517 Paktya 1.6 13.3 1.1 29.1 40.3 13.3 0.0 1.3 100.0 16.0 343 Khost 0.7 33.4 2.4 25.7 30.4 6.2 0.3 0.9 100.0 36.5 574 Kunarha 0.0 3.3 2.8 34.8 36.8 18.2 4.1 0.0 100.0 6.1 420 Nooristan 16.2 12.5 4.0 27.9 7.5 13.7 18.1 0.1 100.0 32.8 177 Badakhshan 1.9 2.7 59.3 1.3 2.9 31.8 0.1 0.1 100.0 63.8 626 Takhar 17.2 5.9 28.0 3.0 13.2 32.4 0.4 0.0 100.0 51.1 737 Kunduz 21.4 5.2 16.9 17.7 5.2 32.5 0.3 0.7 100.0 43.6 747 Samangan 36.0 26.0 1.5 19.2 4.3 12.9 0.0 0.1 100.0 63.4 219 Balkh 8.4 11.0 10.1 14.9 10.2 43.5 1.1 0.8 100.0 29.5 1,217 Sar-E-Pul 37.8 5.9 8.5 29.2 9.0 9.1 0.0 0.4 100.0 52.3 423 Ghor 0.6 4.1 6.2 28.8 4.2 54.9 0.6 0.5 100.0 10.9 519 Daykundi 8.0 1.8 1.2 1.6 3.0 82.6 0.5 1.3 100.0 11.0 215 Urozgan 0.0 1.3 0.3 1.8 4.3 90.1 0.1 2.2 100.0 1.6 200 Kandahar 1.6 38.7 1.4 27.2 4.2 24.6 0.8 1.5 100.0 41.7 1,574 Jawzjan 21.6 39.1 0.2 6.0 2.7 30.5 0.0 0.0 100.0 60.9 391 Faryab 77.9 5.0 0.7 0.9 4.0 11.4 0.0 0.0 100.0 83.6 1,439 Helmand 7.8 22.2 4.5 20.2 34.9 7.6 0.0 2.8 100.0 34.5 565 Badghis 5.0 0.3 15.7 12.2 8.3 57.6 0.1 0.9 100.0 20.9 490 Herat 21.8 11.2 1.0 45.3 18.6 1.5 0.0 0.6 100.0 34.0 1,425 Farah 6.9 2.0 38.4 4.9 14.5 33.4 0.0 0.0 100.0 47.2 489 Nimroz 38.3 31.1 0.9 1.4 19.1 2.5 6.6 0.0 100.0 70.4 191 Mother’s education No education 18.9 12.8 9.1 17.9 14.8 23.6 2.1 0.8 100.0 40.8 15,928 Primary 28.5 16.1 10.0 11.2 13.7 18.0 1.8 0.7 100.0 54.6 1,568 Secondary 35.3 13.0 7.9 8.7 20.5 11.0 2.1 1.5 100.0 56.3 1,416 More than secondary 45.5 15.0 6.5 5.3 22.4 3.8 0.6 1.0 100.0 66.9 325 Wealth quintile Lowest 16.0 5.1 12.8 17.5 8.6 38.4 1.1 0.5 100.0 33.9 3,815 Second 17.6 8.3 11.3 17.0 13.9 28.5 2.7 0.7 100.0 37.3 3,876 Middle 17.8 11.6 8.3 20.3 15.8 23.6 1.0 1.6 100.0 37.7 3,915 Fourth 26.0 16.1 7.5 16.7 18.0 13.6 1.7 0.3 100.0 49.7 3,988 Highest 29.4 25.1 5.1 10.6 20.3 4.7 3.6 1.1 100.0 59.6 3,643 Total 21.3 13.2 9.0 16.5 15.3 21.9 2.0 0.8 100.0 43.5 19,237 1 Children’s stools are considered to be disposed of safely if the child used a toilet or latrine, if the fecal matter was put/rinsed into a toilet or latrine, or if it was buried. 2 See Table 2.2 for definition of categories. Total includes 25 children with missing information on type of toilet facility. 3 Facilities that would be considered improved if they were not shared by two or more households 4 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Child Health • 183 Table 10.12 Knowledge of childhood illness Among ever-married women age 15-49, the percentage with knowledge of symptoms of childhood illness that would prompt seeking immediate care in a health facility, according to background characteristics, Afghanistan 2015 Background characteristic Child not able to drink or breastfeed Child becomes sicker Child develops a fever Child has fast breathing Child has difficulty breathing Child has blood in stool Child is drinking poorly Other Missing Number of women Mother’s age at birth <20 47.9 50.0 68.3 39.5 31.9 29.8 22.0 3.5 0.4 5,458 20-34 46.6 51.7 69.3 38.1 33.6 30.4 23.5 3.1 0.4 20,211 35-49 44.5 49.3 70.4 38.0 31.7 29.0 23.1 3.3 0.2 3,792 Birth order 1 46.6 50.5 69.2 38.0 32.2 29.9 23.5 3.0 0.3 9,250 2-3 48.7 51.9 68.8 40.4 35.1 31.9 23.4 2.9 0.5 7,593 4-5 45.0 51.7 69.5 38.5 33.0 29.1 23.0 3.5 0.4 6,071 6+ 45.5 50.2 69.4 36.4 32.0 29.1 22.5 3.5 0.2 6,547 Residence Urban 46.4 48.4 76.9 41.8 37.3 33.8 28.0 4.4 0.2 6,870 Rural 46.6 51.8 66.9 37.3 31.8 29.0 21.7 2.8 0.4 22,591 Province1 Kabul 37.8 44.0 77.6 38.0 34.4 32.8 22.9 5.8 0.0 3,658 Kapisa 41.1 16.8 53.2 49.5 15.9 24.7 4.3 39.3 0.1 205 Parwan 22.9 36.5 67.8 44.2 31.5 36.9 12.3 2.4 0.1 625 Wardak 61.9 66.0 73.5 43.9 39.1 46.5 41.6 0.9 0.8 382 Logar 29.2 54.3 57.8 15.3 23.2 15.1 23.8 3.4 0.4 472 Nangarhar 35.6 36.7 68.2 16.7 18.4 10.8 21.0 20.3 0.3 794 Laghman 51.8 50.0 58.1 51.5 39.9 29.2 23.1 0.7 0.7 583 Panjsher 86.4 92.3 65.7 54.4 50.4 42.7 33.2 0.5 0.6 54 Baghlan 49.9 58.0 77.3 49.4 50.0 39.7 17.6 0.0 0.4 839 Bamyan 37.5 70.0 66.1 25.8 16.8 14.3 23.1 0.1 0.6 303 Ghazni 56.1 78.2 68.5 66.2 59.9 56.3 35.7 0.3 0.6 1,328 Paktika 59.0 29.6 39.1 43.1 45.1 42.2 40.9 0.2 0.7 792 Paktya 65.2 50.9 51.3 10.6 5.7 5.4 11.1 1.3 1.8 542 Khost 37.1 48.2 61.0 33.6 32.2 15.3 15.7 0.3 0.1 851 Kunarha 34.4 31.2 61.4 39.0 24.4 44.5 5.3 0.7 0.1 559 Nooristan 53.2 30.4 28.0 36.4 55.6 17.8 37.8 1.4 0.5 222 Badakhshan 56.3 53.3 70.3 40.8 38.0 27.5 32.1 0.0 0.0 1,004 Takhar 28.8 47.3 63.2 29.3 26.1 21.8 5.5 0.3 0.0 1,105 Kunduz 87.4 85.6 83.6 73.9 56.0 47.1 37.5 0.7 1.0 1,232 Samangan 22.3 55.3 45.3 13.8 25.8 48.5 59.7 0.2 0.4 330 Balkh 32.8 47.9 82.0 34.9 35.7 55.1 22.6 3.5 0.3 1,781 Sar-E-Pul 80.7 65.2 69.9 34.9 45.6 29.4 38.2 3.8 0.0 654 Ghor 60.3 67.2 87.8 32.5 17.5 13.3 25.8 1.1 0.1 715 Daykundi 19.5 25.5 77.2 8.1 1.0 2.4 8.8 9.1 0.9 329 Urozgan 20.9 43.0 70.0 40.6 20.2 32.0 5.7 0.3 1.1 230 Kandahar 63.5 42.1 47.2 35.8 36.2 29.5 31.8 0.9 1.2 2,227 Jawzjan 76.1 88.8 92.3 64.8 19.5 5.3 4.0 0.2 0.0 614 Faryab 23.0 50.7 69.7 12.7 11.6 7.8 11.9 2.9 0.0 2,114 Helmand 80.5 92.8 91.3 83.5 64.8 46.4 38.1 0.0 0.7 875 Badghis 83.8 81.0 85.5 69.7 54.6 69.4 42.0 1.3 0.2 650 Herat 29.5 27.6 69.0 29.4 23.0 13.2 13.9 2.9 0.1 2,316 Farah 44.5 39.9 61.1 29.8 24.3 30.8 16.9 7.0 0.0 777 Nimroz 9.9 10.6 72.2 5.1 5.4 28.3 3.9 25.3 0.1 278 Education No education 47.0 51.1 68.2 38.1 32.8 30.0 23.2 2.9 0.4 24,604 Primary 47.9 51.7 72.7 37.7 31.3 30.1 24.3 3.9 0.2 2,330 Secondary 40.4 48.5 76.6 40.7 36.7 29.8 21.4 5.1 0.2 1,971 More than secondary 44.2 55.3 73.7 46.4 41.0 33.0 22.5 3.9 0.5 556 Wealth quintile Lowest 46.7 54.6 72.5 32.9 29.2 28.4 21.1 2.7 0.2 5,904 Second 47.6 51.5 64.5 40.3 31.8 31.0 20.2 2.4 0.4 6,001 Middle 49.3 52.0 63.8 38.0 33.9 29.4 22.1 2.3 0.6 5,888 Fourth 45.2 49.9 69.2 39.3 32.5 29.7 25.3 3.6 0.3 6,010 Highest 43.9 47.2 76.4 41.5 38.0 32.1 27.3 4.9 0.3 5,657 Total 46.6 51.0 69.2 38.4 33.1 30.1 23.1 3.2 0.4 29,461 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Nutrition of Children and Women • 185 NUTRITION OF CHILDREN AND WOMEN 11 Key Findings  Breastfeeding: Almost all Afghan children (98%) are breastfed at some point in their life. Only 43% of infants under age 6 months are exclusively breastfed.  Minimum acceptable diet: Minimum acceptable diet standards with respect to infant and young child feeding (IYCF) practices are met for 16% of children age 6-23 months.  Iodized salt: Fifty-seven percent of the households in Afghanistan use iodized salt. his chapter focuses on the nutritional status of children and women. It describes infant and young child feeding practices, including breastfeeding and feeding with solid/semisolid foods. Also covered are the diversity of foods fed and the frequency of feeding as well as micronutrient status, supplementation, and fortification. Relevant aspects of the nutritional status of women age 15-49 are addressed. 11.1 INFANT AND YOUNG CHILD FEEDING PRACTICES Appropriate infant and young child feeding (IYCF) practices include exclusive breastfeeding in the first 6 months of life, continued breastfeeding through age 2, introduction of solid and semisolid foods at age 6 months, and gradual increases in the amount of food given and frequency of feeding as the child gets older. It is also important for young children to receive a diverse diet, that is, eating foods from different food groups to take care of growing micronutrient needs (WHO 2008). 11.1.1 Breastfeeding Initiation of Breastfeeding Early initiation of breastfeeding is important for both the mother and the child. The first breast milk contains colostrum, which is highly nutritious and has antibodies that protect the newborn from diseases. Early initiation of breastfeeding also encourages bonding between the mother and her newborn and facilitates the production of regular breast milk. Thus, it is recommended that children be put to the breast immediately or within 1 hour after birth and that prelacteal feeding (i.e., feeding newborns anything other than breast milk before breast milk is regularly given) be discouraged. Early breastfeeding Initiation of breastfeeding within 1 hour of birth. Sample: Last-born children who were born in the 2 years before the survey Table 11.1 shows that 98% of last-born children born in the 2 years before the survey were breastfed at some point in their life. About two-fifths (41%) of infants were breastfed within 1 hour of birth, and 9 of 10 began breastfeeding within 1 day of birth (91%). T 186 • Nutrition of Children and Adults Patterns by background characteristics  The proportion of children breastfed within 1 hour of birth was higher among those delivered in a health facility (43%) than among those born at home (40%).  The proportion of children breastfed within 1 hour of birth was higher in rural areas (42%) than in urban areas (38%).  Children in Farah were most likely to start breastfeeding within 1 hour of birth (87%), while children in Baghlan (13%) and Paktika (14%) were least likely to do so.  Mothers in the lowest wealth quintile were more likely than those in the highest wealth quintile to initiate breastfeeding within 1 hour of birth (45% versus 35%). The practice of giving prelacteal feeds limits the frequency of suckling by the infant and exposes the baby to the risk of infection. Overall, 43% of infants received a prelacteal feed. Infants whose delivery was assisted by a health professional were less likely than those whose delivery was assisted by a traditional birth attendant to be given a prelacteal feed (39% versus 55%). 11.1.2 Exclusive Breastfeeding Breast milk contains all of the nutrients needed by children in the first 6 months of life and is an uncontaminated nutritional source. It is recommended that children be exclusively breastfed in the first 6 months of their life; that is, they are given nothing but breast milk. Complementing breast milk before age 6 months is unnecessary and is discouraged because the likelihood of contamination and resulting risk of diarrheal disease are high. Early initiation of complementary feeding also reduces breast milk output because the production and release of breast milk is modulated by the frequency and intensity of suckling. Table 11.2 and Figure 11.1 show breastfeeding practices by child’s age. Contrary to recommendations, only 43% of infants under age 6 months are exclusively breastfed (i.e., fed breast milk only). In addition to breast milk, 10% of infants consume plain water, 2% consume non-milk liquids, 28% consume other milk, and 14% consume complementary foods. Nineteen percent of infants under age 6 months are fed using a bottle with a nipple, a practice that is discouraged because of the risk of illness to the child. Figure 11.1 Breastfeeding practices by age Percent distribution of children under age 2 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% <2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age group in months AfDHS 2015 Exclusive breastfeeding Breastfeeding and complementary foods Not breastfeeding Breastfeeding and water only Breastfeeding and other liquids Breastfeeding and other milk Nutrition of Children and Women • 187 Exclusive breastfeeding declines with age: only 33% of infants age 4- 5 months are exclusively breastfed (Figure 11.2). Seventy-eight percent of children age 12-15 months continued breastfeeding at 1 year, while 59% of children age 20- 23 months continued breastfeeding at 2 years; 24% of children age 0-23 months were bottle fed. Overall, 60% of children are receiving age- appropriate breastfeeding (i.e., children age 0-5 months are exclusively breastfed and children age 6-23 months receive breast milk and complementary foods) (Figure 11.2). 11.1.3 Median Duration of Breastfeeding The median duration of breastfeeding in Afghanistan is 21 months; that is, half of children are breastfed until age 21 months (Table 11.3). The median duration of exclusive breastfeeding is 1.5 months, and the median duration of predominant breastfeeding (i.e., the period in which an infant receives only water or other non-milk liquids in addition to breast milk) is 3 months. Patterns by background characteristics  There is not much variation in the median duration of breastfeeding by the sex of the child, residence, mother’s education, or household wealth.  The median duration of breastfeeding varies by province, with the shortest durations in Panjsher (17.1 months), Paktika (17.7 months), and Nooristan (18.1 months). Ghor has the highest median duration of breastfeeding (24.6 months). 11.1.4 Complementary Feeding After the first 6 months, breast milk is no longer enough to meet the nutritional needs of infants; therefore, complementary foods should be added to their diet. The transition from exclusive breastfeeding to family foods is referred to as complementary feeding. This is the most critical period for children, as during this transition children are most vulnerable to becoming undernourished. Complementary feeding should be timely; that is, all infants should start receiving foods in addition to breast milk from 6 months onwards. Appropriate complementary feeding should include feeding children a variety of foods to ensure that requirements for nutrients are met. Fruits and vegetables rich in vitamin A should be consumed daily. Eating a range of fruits and vegetables, in addition to those rich in vitamin A, is also important. Studies have shown that plant-based complementary foods by themselves are insufficient to meet the needs for certain micronutrients. Therefore, it has been recommended that meat, poultry, fish, or eggs be part of the daily diet as well or eaten as often as possible (WHO 1998). Table 11.4 indicates that the types of foods received by children during the day and night before the survey depend on the child’s age and breastfeeding status. Among both breastfeeding and nonbreastfeeding children age 6-23 months, food made from grains is the most commonly consumed item. Figure 11.2 IYCF breastfeeding indicators Percentage of children * Predominant breastfeeding includes exclusive breastfeeding, breastfeeding plus water, and breastfeeding plus non-milk liquids/juice ** Age-appropriate breastfeeding = Children age 0-5 months who are exclusively breastfed + children age 6-23 months who receive breast milk and complementary foods 24 60 61 59 78 55 33 43 Bottle feeding (0-23 months) Age-appropriate breastfeeding** (0-23 months) Introduction of solid, semisolid, or soft foods (6-8 months) Continued breastfeeding at 2 years Continued breastfeeding at 1 year Predominant breastfeeding* (0-5 months) Exclusive breastfeeding at age 4-5 months Exclusive breastfeeding under age 6 months 188 • Nutrition of Children and Adults Patterns by background characteristics  Forty-three percent of nonbreastfeeding children age 6-23 months consumed fruits and vegetables rich in vitamin A, as compared with 34% of breastfeeding children in the same age group.  Foods made from roots and tubers are more often given to nonbreastfeeding children age 6-23 months (42%) than to breastfeeding children (29%) in the same age group.  Nonbreastfeeding children age 6-23 months are more likely to consume eggs (28%) and meat, fish, and poultry (24%) than breastfeeding children (20% and 14%, respectively). 11.1.5 Minimum Acceptable Diet Infants and young children should be fed a minimum acceptable diet to ensure appropriate growth and development. Without adequate diversity and meal frequency, infants and young children are vulnerable to undernutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality. The WHO minimum acceptable diet recommendation, which is a combination of dietary diversity and minimum meal frequency, is different for breastfed and nonbreastfed children. The definition of the composite indicator of a minimum acceptable diet for all children age 6-23 months is presented in the box below. Dietary diversity is a proxy for adequate micronutrient density of foods. Minimum dietary diversity means feeding the child food from at least four food groups. The cut-off of four food groups is associated with better-quality diets for both breastfed and nonbreastfed children. Consumption of food from at least four groups means that the child has a high likelihood of consuming at least one animal source of food and at least one fruit or vegetable in addition to a staple food (grains, roots, or tubers) (WHO 2008). The four groups should come from a list of seven food groups: grains, roots, and tubers; legumes and nuts; dairy products (milk, yogurt, cheese); flesh foods (meat, fish, poultry, liver/organ meat); eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. Minimum meal frequency is a proxy for a child’s energy requirements. For infants and young children, the indicator is based on how much energy the child needs and, if the child is breastfed, the amount of energy needs not met by breast milk. Breastfed children are considered to be fed with a minimum meal frequency if they receive solid, semisolid, or soft foods at least twice a day (for infants age 6-8 months) or at least three times a day (for children age 9-23 months). Nonbreastfed children age 6-23 months are considered to be fed with a minimum meal frequency if they receive solid, semisolid, or soft foods at least four times a day. Minimum acceptable diet Proportion of children age 6-23 months who receive a minimum acceptable diet (apart from breast milk). This composite indicator is calculated from the following two fractions: Breastfed children age 6-23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day Breastfed children age 6-23 months and Nonbreastfed children age 6-23 months who received at least two milk feedings and had at least the minimum dietary diversity (not including milk feeds) and the minimum meal frequency during the previous day Nonbreastfed children age 6-23 months The 2015 AfDHS indicates that 91% of Afghan children age 6-23 months received breast milk or other milk or milk products (two or more times) during the day or night before the interview (Table 11.5). Nutrition of Children and Women • 189 Twenty-four percent of children had an adequately diverse diet—that is, they had been given foods from the appropriate number of food groups—and 51% had been fed the minimum number of times appropriate for their age. The minimum standards with respect to all three IYCF feeding practices were met for 16% of Afghan children age 6-23 months (Table 11.5). IYCF indicators for a minimum acceptable diet by breastfeeding status are summarized in Figure 11.3. Minimum standards (four or more food groups and minimum meal frequency) are met among 16% of breastfed children age 6-23 months who are fed according to IYCF practices. Similarly, minimum standards (milk or milk products, four or more food groups, and minimum meal frequency) are met among 14% of nonbreastfeeding children fed according to IYCF practices. Patterns by background characteristics  The percentage of children age 6-23 months fed according to IYCF guidelines is higher in urban areas (22%) than in rural areas (13%).  There are wide variations in feeding practices by province. Two percent or less of children in Wardak, Paktya, Nooristan, Daykundi, Kandahar, Jawzjan, Helmand, and Nimroz are fed according to the IYCF guidelines. On the contrary, more than 35% of children in Nangarhar, Baghlan, Paktika, and Sar-E-Pul are fed according to the guidelines.  Mother’s education has a positive impact on children’s feeding practices. Twenty-nine percent of children whose mothers have more than a secondary education are fed according to the IYCF guidelines, as compared with only 14% of children whose mothers have no education. 11.2 MICRONUTRIENT INTAKE AND SUPPLEMENTATION AMONG CHILDREN Micronutrient deficiency is a major contributor to childhood morbidity and mortality. Micronutrients are available in foods and can also be provided through direct supplementation. Breastfeeding children benefit from supplements given to the mother. The information collected on food consumption among the youngest children under age 2 is useful in assessing the extent to which children are consuming food groups rich in two key micronutrients—vitamin A and iron—in their daily diet. Iron deficiency is one of the primary causes of anemia, which has serious health consequences for both women and children. Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye damage and is the leading cause of childhood blindness. VAD also increases the severity of infections such as measles and diarrheal disease in children and slows recovery from illness. VAD is common in dry environments where fresh fruits and vegetables are not readily available. Vitamin A supplementation is an important strategy undertaken in Afghanistan to prevent VAD among young children. Children receive vitamin A supplements as part of National Immunization Day (NID) Figure 11.3 IYCF indicators on minimum acceptable diet 23 49 16 31 61 14 24 51 16 Minimum dietary diversity Minimum meal frequency Minimum acceptable diet Percentage of children age 6-23 months Breastfed Nonbreastfed All children 6-23 months 190 • Nutrition of Children and Adults campaigns (MoPH 2010b). The 2015 AfDHS included questions designed to ascertain whether young children had received vitamin A supplements or deworming medication in the 6 months before the survey. Nearly half of children (48%) under age 2 in Afghanistan consumed vitamin A-rich foods in the 24 hours before the interview, and 30% consumed iron-rich foods (Table 11.6). Nonbreastfeeding children were more likely than breastfeeding children to consume foods rich in vitamin A (61% versus 45%) and iron (43% versus 27%). Forty-eight percent of children age 6-59 months received a vitamin A supplement in the 6 months before the survey. Only 6% of children age 6-59 months received iron supplements in the 7 days prior to the survey, and 19% received deworming medication in the 6 months before the survey (Table 11.6). 11.3 PRESENCE OF IODIZED SALT IN HOUSEHOLDS Iodine is an essential micronutrient, and iodized salt prevents goiter and other thyroid-related health problems among children and adults. In line with food and drug regulations, household salt should be fortified with iodine to at least 15 parts per million. Afghanistan adopted a universal salt iodization policy in 2003 and has established salt iodization factories throughout the country (MoPH 2010b). The 2015 AfDHS tested for the presence of iodine in household salt; overall, salt was tested in 97% of households (Table 11.7). Among households in which salt was tested, 57% had iodized salt. It should be noted that household salt was tested for the presence or absence of iodine only; the iodine content of the salt was not measured. Patterns by background characteristics  Among households with salt tested for iodine, the percentage with iodized salt was higher in urban areas (82%) than in rural areas (48%).  Households in the higher wealth quintiles are more likely to consume iodized salt than those in the lower quintiles. For instance, only 26% of households in the lowest quintile used iodized salt, as opposed to 88% in the highest quintile. 11.4 MICRONUTRIENT INTAKE AMONG MOTHERS The 2015 AfDHS included questions to ascertain whether mothers had received iron supplements during pregnancy. Pregnant women should take iron supplements, eat iron-rich foods, and avoid parasites and malaria to prevent anemia. Only 7% of women who gave birth in the 5 years before the survey took iron supplements for 90 days or more, as recommended. More than half of women (55%) did not take iron supplements at all. Only 3% of women took deworming medication during their most recent pregnancy (Table 11.8). LIST OF TABLES For more information on nutrition of children and women, see the following tables:  Table 11.1 Initial breastfeeding  Table 11.2 Breastfeeding status by age  Table 11.3 Median duration of breastfeeding  Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview  Table 11.5 Infant and young child feeding (IYCF) practices  Table 11.6 Micronutrient intake among children  Table 11.7 Presence of iodized salt in household  Table 11.8 Micronutrient intake among mothers Nutrition of Children and Women • 191 Table 11.1 Initial breastfeeding Among last-born children who were born in the 2 years preceding the survey, the percentage who were ever breastfed and the percentages who started breastfeeding within 1 hour and within 1 day of birth, and among last-born children born in the 2 years preceding the survey who were ever breastfed, the percentage who received a prelacteal feed, by background characteristics, Afghanistan 2015 Background characteristic Among last-born children born in the past 2 years: Among last-born children born in the past 2 years who were ever breastfed: Percentage ever breastfed Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Number of last-born children Percentage who received a prelacteal feed2 Number of last-born children ever breastfed Sex Male 97.4 40.8 90.4 6,002 44.1 5,845 Female 98.2 41.0 91.8 5,537 42.3 5,439 Assistance at delivery3 Health professional4 97.7 41.7 90.4 6,513 38.9 6,363 Traditional birth attendant 98.2 38.2 92.9 3,401 55.3 3,342 Other 98.4 43.4 90.5 1,526 34.5 1,502 No one 92.8 46.8 86.6 80 44.3 74 Place of delivery5 Health facility 97.7 42.6 90.4 5,624 38.5 5,493 At home 98.2 40.1 91.9 5,194 48.4 5,099 Other 98.1 33.6 91.2 701 42.6 688 Residence Urban 97.2 37.7 89.3 2,794 38.6 2,715 Rural 98.0 41.9 91.6 8,745 44.7 8,569 Province6 Kabul 96.5 32.9 88.5 1,463 24.9 1,412 Kapisa 98.9 45.1 96.7 78 18.8 77 Parwan 96.4 55.2 91.5 295 32.5 284 Wardak 97.6 34.9 90.1 130 38.5 126 Logar 99.2 52.3 96.7 137 31.1 136 Nangarhar 98.1 52.7 90.9 390 58.0 383 Laghman 99.1 31.4 94.6 276 27.8 274 Panjsher 97.7 66.9 91.8 13 26.1 12 Baghlan 93.3 13.1 58.3 256 54.8 239 Bamyan 99.1 50.1 95.4 130 9.9 129 Ghazni 95.9 26.8 81.9 274 14.5 263 Paktika 98.6 14.4 97.6 352 42.8 347 Paktya 92.3 25.8 91.7 192 14.9 178 Khost 97.7 49.9 91.1 338 25.2 331 Kunarha 97.3 25.8 85.0 276 49.3 269 Nooristan 97.5 80.9 93.3 132 19.8 129 Badakhshan 98.7 43.8 96.6 366 31.5 361 Takhar 99.0 55.9 96.2 489 30.7 485 Kunduz 96.0 52.9 91.2 404 47.9 388 Samangan 99.7 77.6 98.4 125 22.5 125 Balkh 99.3 28.7 88.2 754 71.4 749 Sar-E-Pul 97.5 56.6 88.2 239 55.7 233 Ghor 98.9 40.8 98.5 261 78.9 258 Daykundi 100.0 57.1 85.2 131 17.6 131 Urozgan 98.6 64.4 96.7 157 13.2 155 Kandahar 95.3 18.4 87.6 1,044 76.7 995 Jawzjan 99.2 57.6 95.6 155 28.1 154 Faryab 99.6 44.3 93.1 953 47.3 949 Helmand 100.0 34.8 94.0 274 29.2 274 Badghis 98.4 55.6 94.1 296 49.2 292 Herat 99.7 50.2 94.7 752 62.9 749 Farah 99.1 86.8 98.6 275 28.0 273 Nimroz 96.8 35.0 94.8 121 8.2 117 Mother's education No education 97.7 40.2 91.3 9,291 43.6 9,075 Primary 98.3 45.2 89.1 1,011 39.7 993 Secondary 98.4 42.7 89.9 1,009 42.9 993 More than secondary 97.8 42.9 93.2 229 43.4 224 (Continued…) 192 • Nutrition of Children and Adults Table 11.1–Continued Background characteristic Among last-born children born in the past 2 years: Among last-born children born in the past 2 years who were ever breastfed: Percentage ever breastfed Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Number of last-born children Percentage who received a prelacteal feed2 Number of last-born children ever breastfed Wealth quintile Lowest 98.6 45.0 92.0 2,052 49.0 2,023 Second 98.1 40.7 91.0 2,313 44.9 2,268 Middle 97.6 41.0 92.1 2,463 45.5 2,404 Fourth 97.3 42.5 91.6 2,486 35.8 2,419 Highest 97.5 35.4 88.5 2,226 41.9 2,170 Total 97.8 40.9 91.0 11,539 43.2 11,285 Note: Table is based on last-born children born in the 2 years preceding the survey regardless of whether the children were living or dead at the time of the interview. 1 Includes children who started breastfeeding within 1 hour of birth 2 Children given something other than breast milk during the first 3 days of life 3 Total includes 19 last-born children for whom information on assistance at delivery was missing. 4 Doctor, nurse/midwife, or auxiliary midwife 5 Total includes 19 last-born children for whom information on place of delivery was missing. 6 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Table 11.2 Breastfeeding status by age Percent distribution of youngest children under age 2 who are living with their mother by breastfeeding status and the percentage currently breastfeeding, and the percentage of all children under age 2 using a bottle with a nipple, according to age in months, Afghanistan 2015 Age in months Not breast- feeding Breastfeeding status Total Per- centage currently breast- feeding Number of youngest children under age 2 living with their mother Per- centage using a bottle with a nipple Number of all children under age 2 Exclu- sively breastfed Breast- feeding and consu- ming plain water only Breast- feeding and consum- ing non- milk liquids1 Breast- feeding and consum- ing other milk Breast- feeding and consum- ing comple- mentary foods 0-1 1.7 56.8 5.3 1.6 30.1 4.4 100.0 98.3 778 15.8 784 2-3 4.3 43.6 9.9 1.6 29.7 10.9 100.0 95.7 1,225 19.1 1,238 4-5 4.2 33.2 12.2 1.6 25.8 22.9 100.0 95.8 1,068 22.6 1,072 6-8 6.4 10.3 10.3 1.9 15.1 56.0 100.0 93.6 1,558 25.7 1,572 9-11 14.0 4.0 3.6 1.9 7.3 69.2 100.0 86.0 1,139 30.9 1,148 12-17 22.7 1.2 1.9 1.0 1.6 71.6 100.0 77.3 3,596 27.5 3,723 18-23 33.4 1.4 1.3 1.5 1.7 60.7 100.0 66.6 1,738 20.8 1,985 0-3 3.3 48.7 8.1 1.6 29.8 8.4 100.0 96.7 2,003 17.8 2,022 0-5 3.6 43.3 9.6 1.6 28.4 13.5 100.0 96.4 3,071 19.4 3,095 6-9 6.9 9.8 9.0 2.0 14.3 57.9 100.0 93.1 2,002 26.1 2,020 12-15 21.6 1.2 1.6 0.8 1.7 73.1 100.0 78.4 2,438 29.4 2,511 12-23 26.2 1.3 1.7 1.1 1.6 68.1 100.0 73.8 5,334 25.2 5,708 20-23 41.4 0.7 1.1 1.0 1.7 54.1 100.0 58.6 883 21.0 1,067 Note: Breastfeeding status refers to a "24-hour" period (yesterday and last night). Children who are classified as breastfeeding and consuming plain water only consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfed, and breastfeeding and consuming plain water, non-milk liquids, other milk, and complementary foods (solids and semisolids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus, children who receive breast milk and non-milk liquids and who do not receive other milk and who do not receive complementary foods are classified in the non-milk liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Non-milk liquids include juice, juice drinks, clear broth, or other liquids. Nutrition of Children and Women • 193 Table 11.3 Median duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the 3 years preceding the survey, by background characteristics, Afghanistan 2015 Median duration (months) of breastfeeding among children born in the past 3 years1 Background characteristic Any breastfeeding Exclusive breastfeeding Predominant breastfeeding2 Sex Male 20.9 1.3 2.5 Female 21.1 1.6 3.7 Residence Urban 21.1 1.6 3.2 Rural 20.9 1.4 3.0 Province3 Kabul 20.8 * 3.5 Kapisa 22.1 3.4 6.3 Parwan 19.4 3.1 4.9 Wardak (21.6) 6.3 6.9 Logar (21.2) a a Nangarhar 18.5 (2.4) 5.0 Laghman 19.9 (0.9) (0.9) Panjsher 17.1 * * Baghlan (21.9) * * Bamyan 22.2 3.9 6.0 Ghazni (20.9) a * Paktika 17.7 5.5 5.9 Paktya 21.0 (1.9) 3.7 Khost 21.7 5.7 7.6 Kunarha 20.8 4.0 5.4 Nooristan 18.1 5.9 6.5 Badakhshan 22.0 3.6 6.1 Takhar 22.0 a a Kunduz 21.9 3.6 4.9 Samangan 21.5 4.2 6.7 Balkh 21.3 a a Sar-E-Pul 22.0 * 4.5 Ghor 24.6 a a Daykundi 23.1 5.5 6.8 Urozgan 21.2 3.6 4.6 Kandahar 20.9 2.7 4.1 Jawzjan 22.2 * 8.0 Faryab 20.7 a a Helmand (21.8) a a Badghis 21.1 3.7 4.6 Herat 18.9 * * Farah 19.7 1.1 7.6 Nimroz 21.7 3.0 7.0 Mother's education No education 21.0 1.2 3.3 Primary 21.0 2.1 2.6 Secondary 20.9 1.7 2.5 More than secondary (19.8) a a Wealth quintile Lowest 21.7 1.5 2.5 Second 21.2 1.3 2.6 Middle 20.7 a 3.7 Fourth 20.9 1.7 3.5 Highest 20.2 1.8 3.1 Total 21.0 1.5 3.0 Mean for all children 20.3 3.7 5.0 Note: Median and mean durations are based on the distributions at the time of the survey of the proportion of births by months since birth. Includes children living and deceased at the time of the survey. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 It is assumed that non-last-born children and last-born children not currently living with their mother are not currently breastfeeding. 2 Either exclusively breastfed or received breast milk and plain water and/or non-milk liquids only 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. a = Omitted because less than 50% of the children in this group were exclusively or predominantly breastfeeding 194 • Nutrition of Children and Adults Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview Percentage of youngest children under age 2 who are living with their mother by type of foods consumed in the day or night preceding the interview, according to breastfeeding status and age, Afghanistan 2015 Liquids Solid or semisolid foods Any solid or semisolid food Number of children Age in months Infant formula Other milk1 Other liquids2 Fortified baby foods Food made from grains3 Fruits and vegeta- bles rich in vitamin A4 Other fruits and vegeta- bles Food made from roots and tubers Food made from legumes and nuts Meat, fish, poultry Eggs Cheese, yogurt, other milk products BREASTFEEDING CHILDREN 0-1 5.9 29.3 6.7 1.9 1.9 1.2 1.0 1.1 0.8 0.8 1.4 1.4 4.5 765 2-3 7.8 33.8 12.3 2.9 6.3 3.6 0.9 4.3 2.6 2.6 3.4 4.3 11.4 1,172 4-5 10.3 32.9 17.8 7.4 10.4 5.8 2.3 7.5 3.1 3.0 3.6 6.4 24.0 1,023 6-8 14.3 38.1 34.0 11.2 39.0 19.6 8.9 16.5 12.9 7.2 9.5 17.7 59.8 1,458 9-11 13.7 36.8 45.6 14.1 62.8 38.6 12.9 29.5 16.7 9.1 16.9 23.7 80.5 980 12-17 9.3 35.7 54.7 14.9 74.8 38.6 17.2 32.9 19.7 17.0 24.7 37.2 92.7 2,778 18-23 7.0 35.5 51.6 12.4 75.4 38.6 19.3 36.7 20.2 16.8 23.3 36.2 91.2 1,158 6-23 10.7 36.4 48.0 13.5 64.9 34.2 15.0 29.3 17.8 13.5 19.8 30.5 83.0 6,374 Total 9.9 35.1 36.8 10.5 46.4 24.6 10.7 21.5 12.9 9.9 14.4 22.2 61.1 9,334 NONBREASTFEEDING CHILDREN <6 18.1 37.7 17.1 13.4 4.0 6.1 2.9 5.5 3.5 5.1 4.8 7.2 24.6 111 6-8 21.7 45.2 35.1 27.9 47.1 24.0 13.9 24.8 19.2 7.8 13.7 29.2 78.1 100 9-11 26.1 57.0 50.4 15.9 66.0 47.3 16.3 41.9 22.8 11.8 30.9 38.6 82.3 159 12-17 22.4 45.2 59.8 16.2 74.8 44.7 23.9 41.8 27.2 24.5 30.2 46.5 95.2 817 18-23 11.3 28.3 61.4 15.7 75.8 41.4 21.3 46.2 24.0 28.5 27.2 47.6 95.8 580 6-23 18.8 40.4 58.0 16.7 72.6 42.5 21.7 42.3 25.2 23.6 28.2 45.1 93.2 1,657 Total 18.8 40.3 55.4 16.5 68.3 40.3 20.5 40.0 23.8 22.5 26.7 42.7 88.8 1,768 Note: Breastfeeding status and food consumed refer to a “24-hour" period (yesterday and last night). 1 Other milk includes fresh, tinned, and powdered cow or other animal milk. 2 Does not include plain water 3 Includes fortified baby food 4 Includes fruits and vegetables such as pumpkin, squash, carrots, dark green leafy vegetables, mangoes, and other locally grown fruits and vegetables that are rich in vitamin A Nutrition of Children and Women • 195 Ta bl e 11 .5 I n fa nt a nd y o u ng c hi ld f ee di n g (IY C F ) p ra ct ic es P er ce nt ag e of y ou ng es t c hi ld re n ag e 6- 23 m on th s liv in g w ith th ei r m ot he r w ho a re fe d ac co rd in g to th re e IY C F p ra ct ic es b as ed o n br ea st fe ed in g st at us , n um be r of fo od g ro up s, a nd ti m es th ey a re fe d du rin g th e da y or n ig ht p re ce di ng th e su rv ey , b y ba ck gr ou nd c ha ra ct er is tic s, A fg ha ni st an 2 01 5 A m on g br ea st fe d ch ild re n 6- 23 m on th s, pe rc en ta ge fe d: A m on g no nb re as tfe d ch ild re n 6- 23 m on th s, p er ce nt ag e fe d: A m on g al l c hi ld re n 6- 23 m on th s, p er ce nt ag e fe d: B ac kg ro un d ch ar ac te ris tic 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 2 B ot h 4+ fo od gr ou ps a nd m in im um m ea l fre qu en cy N um be r of br ea st fe d ch ild re n 6- 23 m on th s M ilk o r m ilk pr od uc ts 3 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 4 W ith 3 IY C F pr ac tic es 5 N um be r of no nb re as tf ed c hi ld re n 6- 23 m on th s B re as t m ilk , m ilk , or m ilk pr od uc ts 6 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 7 W ith 3 IY C F pr ac tic es N um be r of al l c hi ld re n 6- 23 m on th s A ge in m o nt hs 6- 8 12 .1 44 .7 10 .8 1, 45 8 59 .7 25 .0 59 .6 4. 5 10 0 97 .4 12 .9 45 .7 10 .4 1, 55 8 9- 11 17 .7 42 .1 11 .2 98 0 60 .2 34 .3 68 .1 16 .3 15 9 94 .4 20 .0 45 .7 11 .9 1, 13 9 12 -1 7 27 .4 50 .8 18 .9 2, 77 8 59 .4 33 .6 61 .7 14 .2 81 7 90 .8 28 .8 53 .3 17 .8 3, 59 6 18 -2 3 28 .2 54 .6 19 .4 1, 15 8 43 .8 28 .0 57 .5 14 .1 58 0 81 .3 28 .1 55 .6 17 .6 1, 73 8 S ex M al e 21 .5 48 .9 15 .7 3, 29 8 55 .9 29 .7 61 .9 14 .4 81 4 91 .3 23 .2 51 .5 15 .4 4, 11 2 Fe m al e 23 .6 48 .6 16 .2 3, 07 6 52 .2 32 .6 59 .5 13 .2 84 3 89 .7 25 .5 50 .9 15 .6 3, 91 9 R es id en ce U rb an 32 .2 48 .8 21 .9 1, 53 4 56 .5 46 .9 62 .1 21 .8 45 5 90 .1 35 .6 51 .8 21 .8 1, 98 9 R ur al 19 .5 48 .8 14 .1 4, 84 0 53 .1 25 .2 60 .2 10 .7 1, 20 2 90 .7 20 .6 51 .0 13 .4 6, 04 2 P ro vi nc e8 K ab ul 43 .6 48 .8 30 .0 76 0 60 .8 60 .0 61 .0 25 .0 28 0 89 .4 48 .0 52 .1 28 .7 1, 04 0 K ap is a 16 .7 73 .2 16 .7 45 54 .8 45 .0 76 .3 25 .4 12 90 .3 22 .8 73 .9 18 .6 57 P ar w an 23 .9 55 .3 23 .0 14 8 36 .9 21 .0 53 .6 7. 8 61 81 .4 23 .1 54 .8 18 .5 20 9 W ar da k 15 .6 9. 2 0. 7 79 * * * * 9 94 .5 15 .4 9. 8 0. 8 88 Lo ga r 18 .1 61 .6 18 .1 50 (7 4. 9) (2 6. 8) (8 8. 3) (1 0. 7) 14 94 .7 20 .0 67 .2 16 .6 64 N an ga rh ar 40 .2 65 .3 37 .2 22 7 55 .1 61 .9 71 .1 28 .7 54 91 .3 44 .4 66 .4 35 .6 28 1 La gh m an 11 .1 83 .1 10 .4 15 0 (3 9. 7) (9 .4 ) (7 0. 8) (3 .2 ) 31 89 .6 10 .8 81 .0 9. 1 18 1 P an js he r 23 .8 24 .0 8. 0 7 (6 5. 7) (2 4. 4) (7 0. 6) (9 .3 ) 4 87 .5 24 .0 41 .0 8. 5 11 B ag hl an 40 .6 70 .2 40 .2 14 3 (2 6. 3) (4 3. 6) (4 9. 2) (1 4. 3) 29 87 .6 41 .1 66 .6 35 .8 17 2 B am ya n 4. 4 52 .5 3. 9 78 * * * * 12 91 .8 5. 6 52 .9 3. 4 90 G ha zn i 12 .2 46 .5 9. 9 14 5 (4 7. 1) (2 8. 5) (4 9. 7) (6 .9 ) 50 86 .4 16 .4 47 .3 9. 2 19 5 P ak tik a 48 .8 45 .0 35 .1 11 8 91 .1 89 .2 91 .1 65 .4 86 96 .3 65 .8 64 .5 47 .9 20 4 P ak ty a 1. 5 31 .4 1. 3 97 60 .1 6. 5 58 .7 0. 6 45 87 .3 3. 1 40 .1 1. 1 14 2 K ho st 15 .0 60 .0 14 .5 18 2 64 .9 11 .0 62 .7 0. 0 49 92 .6 14 .1 60 .6 11 .4 23 1 K un ar ha 13 .8 9. 0 2. 1 14 8 (7 4. 1) (1 8. 8) (4 4. 0) (5 .7 ) 24 96 .4 14 .5 13 .8 2. 6 17 1 N oo ris ta n 4. 1 32 .3 2. 3 62 39 .4 7. 5 50 .3 0. 4 17 86 .8 4. 8 36 .2 1. 9 79 B ad ak hs ha n 5. 0 30 .3 4. 1 22 4 (5 8. 8) (1 2. 6) (7 1. 2) (1 0. 1) 34 94 .6 6. 0 35 .6 4. 9 25 8 T ak ha r 13 .1 62 .7 6. 3 28 0 (3 3. 5) (2 3. 3) (6 8. 6) (4 .7 ) 62 87 .9 15 .0 63 .8 6. 0 34 3 K un du z 30 .6 57 .2 16 .3 22 7 (6 8. 0) (4 1. 7) (6 4. 0) (2 3. 1) 61 93 .2 32 .9 58 .6 17 .8 28 8 S am an ga n 10 .0 30 .5 4. 4 75 * * * * 9 97 .9 12 .1 35 .5 5. 3 84 B al kh 35 .6 83 .3 35 .3 46 2 (7 4. 2) (3 7. 7) (9 8. 0) (1 8. 3) 79 96 .2 35 .9 85 .4 32 .8 54 0 S ar -E -P ul 46 .6 72 .0 43 .9 13 7 (4 8. 9) (6 1. 5) (8 4. 0) (2 3. 3) 22 93 .0 48 .7 73 .7 41 .1 15 9 G ho r 25 .8 77 .2 17 .8 15 5 * * * * 12 95 .7 26 .6 77 .6 17 .1 16 8 D ay ku nd i 8. 4 22 .8 0. 6 86 * * * * 8 92 .3 9. 9 23 .2 0. 6 95 (C on tin ue d… ) 196 • Nutrition of Children and Adults Ta bl e 11 .5 — C o nt in ue d A m on g br ea st fe d ch ild re n 6- 23 m on th s, pe rc en ta ge fe d: A m on g no n- br ea st fe d ch ild re n 6- 23 m on th s, p er ce nt ag e fe d: A m on g al l c hi ld re n 6- 23 m on th s, p er ce nt ag e fe d: B ac kg ro un d ch ar ac te ris tic 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 2 B ot h 4+ fo od gr ou ps a nd m in im um m ea l fre qu en cy N um be r of br ea st fe d ch ild re n 6- 23 m on th s M ilk o r m ilk pr od uc ts 3 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 4 W ith 3 IY C F pr ac tic es 5 N um be r of no n- br ea st fe d ch ild re n 6- 23 m on th s B re as t m ilk , m ilk , or m ilk pr od uc ts 6 4+ fo od gr ou ps 1 M in im um m ea l fre qu en cy 7 W ith 3 IY C F pr ac tic es N um be r of al l c hi ld re n 6- 23 m on th s U ro zg an 16 .2 94 .4 15 .2 10 6 17 .6 14 .4 90 .7 1. 1 16 89 .3 16 .0 94 .0 13 .3 12 2 K an da ha r 2. 3 38 .5 1. 2 59 5 79 .9 6. 1 75 .4 2. 3 12 9 96 .4 3. 0 45 .1 1. 4 72 4 Ja w zj an 8. 2 4. 6 0. 3 11 1 (3 8. 6) (6 .3 ) (1 9. 3) (0 .0 ) 15 92 .8 8. 0 6. 3 0. 3 12 6 Fa ry ab 11 .4 29 .6 7. 8 57 2 (5 2. 5) (1 1. 2) (5 5. 3) (6 .0 ) 12 8 91 .3 11 .3 34 .3 7. 5 70 0 H el m an d 50 .1 3. 7 0. 8 19 5 (4 2. 1) (4 1. 7) (2 5. 6) (9 .0 ) 30 92 .3 49 .0 6. 6 1. 9 22 4 B ad gh is 7. 5 85 .6 6. 7 16 8 33 .7 2. 6 73 .2 1. 3 47 85 .6 6. 5 82 .9 5. 5 21 5 H er at 29 .2 40 .1 20 .7 35 9 22 .9 16 .8 25 .8 6. 4 15 3 76 .9 25 .5 35 .9 16 .4 51 2 Fa ra h 19 .2 26 .4 10 .8 10 7 50 .5 9. 1 44 .6 0. 2 51 83 .9 15 .9 32 .3 7. 3 15 8 N im ro z 2. 1 37 .5 2. 1 73 (2 9. 6) (8 .4 ) (2 1. 8) (1 .5 ) 22 83 .6 3. 6 33 .8 2. 0 95 M ot h er 's ed uc at io n N o ed uc at io n 20 .9 49 .3 14 .9 5, 07 3 53 .7 29 .8 59 .1 12 .1 1, 36 5 90 .2 22 .8 51 .4 14 .3 6, 43 9 P rim ar y 22 .0 48 .1 15 .6 60 2 56 .6 40 .4 64 .1 14 .7 10 6 93 .5 24 .7 50 .5 15 .5 70 8 S ec on da ry 31 .8 46 .8 23 .2 56 1 53 .9 32 .3 66 .9 22 .0 15 1 90 .2 31 .9 51 .1 22 .9 71 2 M or e th an se co nd ar y 47 .0 39 .7 25 .3 13 7 (6 2. 5) (5 0. 5) (8 5. 7) (4 2. 5) 34 92 .5 47 .7 48 .9 28 .7 17 1 W ea lt h q ui nt ile Lo w es t 19 .7 53 .2 13 .7 1, 19 8 45 .2 19 .3 58 .5 6. 1 24 0 90 .9 19 .6 54 .1 12 .4 1, 43 7 S ec on d 26 .3 51 .7 17 .5 1, 21 4 54 .7 31 .8 58 .8 19 .6 33 9 90 .1 27 .5 53 .3 17 .9 1, 55 3 M id dl e 15 .5 46 .3 11 .4 1, 36 2 56 .9 24 .3 64 .6 9. 0 30 0 92 .2 17 .1 49 .6 10 .9 1, 66 2 Fo ur th 18 .8 49 .8 14 .5 1, 36 9 48 .3 27 .0 56 .7 8. 3 41 6 88 .0 20 .7 51 .4 13 .1 1, 78 5 H ig he st 33 .6 43 .1 23 .3 1, 23 1 63 .5 48 .9 65 .3 23 .7 36 2 91 .7 37 .1 48 .2 23 .3 1, 59 3 T ot al 22 .5 48 .8 15 .9 6, 37 4 54 .0 31 .2 60 .7 13 .8 1, 65 7 90 .5 24 .3 51 .2 15 .5 8, 03 1 N ot e: F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. 1 Fo od g ro up s: a . i nf an t f or m ul a, m ilk o th er th an b re as t m ilk , c he es e or y og ur t or o th er m ilk p ro du ct s; b . f oo ds m ad e fro m g ra in s, r oo ts , an d tu be rs , i nc lu di ng p or rid ge a nd f or tif ie d ba by fo od f ro m gr ai ns ; c . v ita m in A -r ic h fr ui ts a nd v eg et ab le s (a nd r ed p al m o il) ; d . o th er fr ui ts a nd v eg et ab le s; e . e gg s; f. m ea t, po ul tr y, fi sh , a nd s he llf is h (a nd o rg an m ea ts ); g . l eg um es a nd n ut s. 2 Fo r b re as tfe d ch ild re n, m in im um m ea l f re qu en cy is r ec ei vi ng s ol id o r s em is ol id fo od a t l ea st tw ic e a da y fo r i nf an ts a ge 6 -8 m on th s an d at le as t t hr ee ti m es a d ay fo r c hi ld re n ag e 9- 23 m on th s. 3 In cl ud es tw o or m or e fe ed in gs o f c om m er ci al in fa nt fo rm ul a; fr es h, ti nn ed , a nd p ow de re d an im al m ilk ; a nd y og ur t 4 Fo r n on br ea st fe d ch ild re n ag e 6- 23 m on th s, m in im um m ea l f re qu en cy is r ec ei vi ng s ol id o r se m is ol id fo od o r m ilk fe ed s at le as t f ou r t im es a d ay . 5 N on br ea st fe d ch ild re n ag e 6- 23 m on th s ar e co ns id er ed t o be f ed w ith a m in im um s ta nd ar d of t hr ee I Y C F pr ac tic es if t he y re ce iv e ot he r m ilk o r m ilk p ro du ct s at le as t tw ic e a da y, r ec ei ve t he m in im um m ea l f re qu en cy , a nd re ce iv e so lid o r s em is ol id fo od s fr om a t l ea st fo ur fo od g ro up s no t i nc lu di ng th e m ilk o r m ilk p ro du ct s fo od g ro up . 6 B re as tfe ed in g, o r no t b re as tfe ed in g an d re ce iv in g tw o or m or e fe ed in gs o f c om m er ci al in fa nt fo rm ul a; fr es h, ti nn ed , a nd p ow de re d an im al m ilk ; a nd y og ur t 7 C hi ld re n ar e fe d th e m in im um re co m m en de d nu m be r o f t im es p er d ay a cc or di ng to th ei r ag e an d br ea st fe ed in g st at us a s de sc rib ed in n ot es 2 a nd 4 . 8 E st im at es fo r Za bu l a re n ot p re se nt ed s ep ar at el y du e to s am pl e co ve ra ge is su es ; h ow ev er , t he y ar e in cl ud ed in th e to ta l n at io na l e st im at es . Nutrition of Children and Women • 197 Table 11.6 Micronutrient intake among children Among youngest children age 6-23 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night preceding the survey, and among all children age 6-59 months, the percentages who were given vitamin A supplements in the 6 months preceding the survey, who were given iron supplements in the past 7 days, and who were given deworming medication in the 6 +months preceding the survey, and among all children age 6-59 months who live in households that were tested for iodized salt, the percentage who live in households with iodized salt, by background characteristics, Afghanistan 2015 Among youngest children age 6-23 months living with their mother: Among all children age 6-59 months: Among children age 6- 59 months living in households tested for iodized salt Background characteristic Percentage who consumed foods rich in vitamin A in last 24 hours1 Percentage who consumed foods rich in iron in last 24 hours2 Number of children Percentage given vitamin A supplements in last 6 months Percentage given iron supple- ments in last 7 days Percentage given deworming medication in last 6 months3 Number of children Percentage living in households with iodized salt4 Number of children Age in months 6-8 26.8 13.9 1,558 42.6 4.8 5.7 1,572 62.0 1,522 9-11 47.0 25.0 1,139 40.5 5.3 9.8 1,148 61.3 1,128 12-17 53.0 35.7 3,596 50.7 6.1 15.4 3,723 62.3 3,631 18-23 56.5 37.2 1,738 48.7 6.7 17.9 1,985 56.1 1,939 24-35 na na na 47.2 6.4 18.8 6,598 58.5 6,417 36-47 na na na 49.2 7.2 24.1 6,282 58.0 6,128 48-59 na na na 46.2 5.7 22.7 5,902 57.6 5,732 Sex Male 46.4 29.9 4,112 47.3 6.4 19.2 13,961 58.8 13,613 Female 49.3 30.7 3,919 47.7 6.1 19.2 13,248 58.9 12,885 Breastfeeding status Breastfeeding 44.5 27.0 6,374 46.8 6.9 13.7 7,810 59.5 7,626 Not breastfeeding 60.7 43.0 1,651 47.9 6.0 21.5 19,208 58.5 18,685 Don’t know * * 6 32.5 4.1 15.6 192 66.2 187 Mother's age at birth 15-19 44.8 32.0 450 43.9 6.5 13.3 739 56.2 728 20-29 49.9 32.0 4,920 47.3 6.3 19.1 15,407 60.0 15,057 30-39 44.1 27.4 2,189 48.0 6.1 19.5 8,945 58.5 8,643 40-49 45.8 23.9 471 48.1 6.1 20.6 2,118 52.7 2,070 Residence Urban 53.9 36.2 1,989 47.6 7.0 17.7 6,271 82.4 6,087 Rural 45.8 28.3 6,042 47.5 6.0 19.7 20,938 51.8 20,411 Province5 Kabul 62.0 48.7 1,040 43.2 7.6 14.6 3,277 90.3 3,156 Kapisa 49.8 33.6 57 79.4 3.2 26.7 192 76.1 185 Parwan 54.6 25.5 209 18.1 1.6 10.5 613 69.6 603 Wardak 25.3 10.1 88 51.7 15.7 19.9 293 60.6 285 Logar 42.9 33.2 64 31.8 6.6 12.1 356 65.4 348 Nangarhar 73.9 59.7 281 60.6 7.4 30.6 873 59.8 855 Laghman 53.7 39.0 181 58.2 24.1 32.6 687 86.8 679 Panjsher 43.3 30.6 11 50.1 17.1 34.3 37 79.6 36 Baghlan 59.3 45.8 172 77.1 15.4 7.6 641 46.1 626 Bamyan 22.8 7.2 90 52.0 2.6 25.8 279 72.4 275 Ghazni 30.3 22.6 195 64.4 11.8 35.1 717 53.9 703 Paktika 82.5 62.6 204 91.5 13.9 23.8 714 96.4 694 Paktya 18.3 8.3 142 77.1 10.3 59.0 537 73.5 519 Khost 35.8 24.4 231 44.8 8.8 18.5 895 41.0 894 Kunarha 40.5 23.0 171 33.2 6.6 19.4 605 31.0 351 Nooristan 17.6 13.1 79 15.2 0.2 4.2 262 47.1 261 Badakhshan 22.8 11.3 258 30.6 3.5 28.6 782 20.5 774 Takhar 58.3 15.5 343 24.1 0.8 6.1 1,050 34.1 1,041 Kunduz 64.2 39.8 288 35.8 1.1 42.8 1,071 48.9 1,053 Samangan 34.0 33.3 84 9.1 1.2 1.2 306 66.4 304 Balkh 64.1 38.6 540 73.5 9.1 12.8 1,680 52.8 1,675 Sar-E-Pul 71.1 42.7 159 12.3 1.6 5.8 524 55.4 520 Ghor 46.5 35.5 168 91.7 14.0 3.8 761 30.6 721 Daykundi 28.4 18.4 95 26.8 6.4 8.2 272 44.2 264 Urozgan 27.3 9.9 122 8.6 1.4 6.5 354 52.9 346 Kandahar 36.2 6.2 724 16.9 1.2 6.7 2,484 96.3 2,474 Jawzjan 18.7 5.0 126 22.4 3.1 7.2 543 53.7 542 Faryab 24.0 12.2 700 84.1 8.9 35.5 2,067 54.4 2,017 Helmand 71.7 53.3 224 22.0 0.8 2.9 844 66.4 827 Badghis 31.3 28.7 215 49.5 3.9 7.0 656 29.8 645 Herat 56.7 46.3 512 58.8 1.8 36.4 1,849 11.3 1,847 Farah 48.7 27.5 158 29.2 3.6 13.1 698 37.1 694 Nimroz 33.5 17.8 95 49.7 0.1 10.4 266 85.2 260 (Continued…) 198 • Nutrition of Children and Women Table 11.6—Continued Among youngest children age 6-23 months living with the mother: Among all children age 6-59 months: Among children age 6-59 months living in households tested for iodized salt Background characteristic Percentage who consumed foods rich in vitamin A in last 24 hours1 Percentage who consumed foods rich in iron in last 24 hours2 Number of children Percentage given vitamin A supplements in last 6 months Percentage given iron supple- ments in last 7 days Percentage given deworming medication in last 6 months3 Number of children Percentage living in households with iodized salt4 Number of children Mother's education No education 47.6 29.6 6,439 45.6 5.8 18.7 22,774 56.7 22,170 Primary 41.5 27.6 708 55.3 6.5 18.7 2,154 62.9 2,117 Secondary 52.3 36.3 712 60.1 10.2 24.9 1,854 73.5 1,799 More than secondary 62.9 42.2 171 56.6 11.9 22.7 428 89.1 411 Wealth quintile Lowest 42.8 25.8 1,437 49.4 4.0 16.8 5,265 26.6 5,174 Second 52.8 33.9 1,553 44.1 6.2 17.5 5,518 46.6 5,406 Middle 46.3 27.0 1,662 41.7 6.0 19.7 5,695 62.5 5,497 Fourth 44.4 26.7 1,785 51.6 5.9 21.8 5,717 71.5 5,563 Highest 53.0 38.3 1,593 51.0 9.4 20.1 5,014 88.1 4,857 Total 47.8 30.3 8,031 47.5 6.3 19.2 27,209 58.9 26,498 Note: Information on vitamin A is based on both mother's recall and the immunization card (where available). Information on iron supplements and deworming medication is based on the mother's recall. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, squash, carrots, dark green leafy vegetables, mango, and other locally grown fruits and vegetables that are rich in vitamin A 2 Includes meat (and organ meat), fish, poultry, and eggs 3 Deworming for intestinal parasites is commonly done for helminthes and for schistosomiasis. 4 Excludes children in households in which salt was not tested 5 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Nutrition of Children and Women • 199 Table 11.7 Presence of iodized salt in household Among all households, the percentage with salt tested for iodine content and the percentage with no salt in the household, and among households with salt tested, the percentage with iodized salt, according to background characteristics, Afghanistan 2015 Among all households, the percentage Among households with tested salt: Background characteristic With salt tested With no salt in the household Number of house- holds Percentage with iodized salt Number of households Residence Urban 96.8 0.8 6,269 82.4 6,068 Rural 97.2 0.3 18,126 48.1 17,623 Province1 Kabul 96.3 1.0 3,369 90.9 3,243 Kapisa 96.6 0.5 179 76.5 173 Parwan 98.9 0.1 601 68.8 594 Wardak 96.9 0.5 351 53.3 341 Logar 97.0 1.8 398 66.1 386 Nangarhar 98.0 0.1 625 59.9 612 Laghman 98.6 0.3 446 86.7 440 Panjsher 95.9 0.5 54 79.2 52 Baghlan 97.9 0.0 776 40.4 759 Bamyan 98.0 0.5 300 70.2 294 Ghazni 97.5 1.2 864 52.3 842 Paktika 95.5 0.3 514 97.3 491 Paktya 97.3 0.2 353 70.1 344 Khost 99.8 0.0 457 37.2 456 Kunarha 50.0 0.3 507 30.6 254 Nooristan 99.5 0.2 127 43.8 127 Badakhshan 98.4 0.1 849 19.7 836 Takhar 99.4 0.0 1,027 31.9 1,021 Kunduz 98.7 0.4 1,070 44.3 1,056 Samangan 99.4 0.5 316 66.8 314 Balkh 99.4 0.3 1,510 58.1 1,500 Sar-E-Pul 98.7 0.4 644 52.6 636 Ghor 94.5 1.3 626 29.8 591 Daykundi 98.1 0.1 346 41.8 340 Urozgan 97.7 0.4 167 50.9 163 Kandahar 99.1 0.1 1,659 93.6 1,644 Jawzjan 99.6 0.2 563 52.3 561 Faryab 98.0 0.4 1,680 53.1 1,647 Helmand 96.5 1.3 718 63.3 692 Badghis 98.6 0.0 531 27.2 523 Herat 99.9 0.1 2,011 15.2 2,009 Farah 99.7 0.2 501 43.6 500 Nimroz 98.3 0.1 238 78.2 234 Wealth quintile Lowest 98.1 0.4 4,852 26.0 4,762 Second 97.7 0.2 4,838 42.1 4,728 Middle 96.0 0.5 4,871 56.2 4,677 Fourth 97.1 0.2 4,859 72.2 4,720 Highest 96.5 0.8 4,976 87.6 4,804 Total 97.1 0.4 24,395 56.9 23,691 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 200 • Nutrition of Children and Women Table 11.8 Micronutrient intake among mothers Among ever-married women age 15-49 with a child born in the past 5 years, the percentage who received a vitamin A dose in the first 2 months after the birth of the last child, the percent distribution by number of days they took iron tablets or syrup during the pregnancy of the last child, and the percentage who took deworming medication during the pregnancy of the last child, and among women age 15-49 with a child born in the past 5 years and who live in households that were tested for iodized salt, the percentage who live in households with iodized salt, by background characteristics, Afghanistan 2015 Background characteristic Percentage who received vitamin A dose postpartum1 Number of days women took iron tablets or syrup during pregnancy of last birth Percentage of women who took deworming medication during pregnancy of last birth Number of women Among women with a child born in the last 5 years who live in households that were tested for iodized salt None <60 60-89 90+ Don't know/ missing Total Percentage living in households with iodized salt2 Number of women Age 15-19 20.6 61.9 25.6 2.4 5.7 4.4 100.0 2.6 856 55.5 831 20-29 22.9 55.6 26.3 4.8 6.5 6.8 100.0 3.3 10,569 58.5 10,317 30-39 24.6 52.7 25.9 5.7 7.7 8.1 100.0 2.6 6,434 58.1 6,228 40-49 21.0 57.5 25.4 5.1 5.5 6.5 100.0 2.5 1,773 51.5 1,737 Residence Urban 29.6 48.4 30.1 5.8 8.2 7.4 100.0 2.9 4,559 82.9 4,421 Rural 21.3 57.1 24.8 4.8 6.3 7.0 100.0 3.1 15,073 50.0 14,693 Province3 Kabul 29.3 42.7 33.7 6.5 9.9 7.2 100.0 4.0 2,385 90.7 2,293 Kapisa 40.8 51.2 39.1 5.5 3.9 0.2 100.0 1.2 129 76.1 125 Parwan 24.0 28.2 26.5 14.1 30.1 1.1 100.0 3.8 437 68.4 428 Wardak 14.9 33.2 31.4 8.0 2.6 24.8 100.0 0.8 249 62.7 243 Logar 36.1 42.2 30.4 24.3 3.1 0.0 100.0 2.5 276 63.9 267 Nangarhar 41.1 33.9 31.3 11.0 9.8 13.9 100.0 0.9 576 60.1 568 Laghman 50.1 39.3 54.1 1.8 4.0 0.8 100.0 5.4 428 86.3 421 Panjsher 37.2 40.4 55.4 0.6 0.2 3.4 100.0 15.1 26 78.8 25 Baghlan 67.1 49.5 28.2 6.7 7.8 7.8 100.0 0.9 504 41.7 496 Bamyan 11.5 37.0 49.6 4.8 5.6 3.0 100.0 4.8 206 71.0 203 Ghazni 30.8 73.0 9.7 1.3 0.2 15.8 100.0 11.9 638 51.7 624 Paktika 32.7 52.5 29.6 3.1 12.0 2.8 100.0 4.0 525 97.1 505 Paktya 26.9 55.5 23.6 1.2 0.2 19.5 100.0 1.8 347 74.6 335 Khost 8.5 58.4 26.4 1.3 1.0 12.9 100.0 4.8 580 41.0 579 Kunarha 23.1 68.0 11.5 2.8 1.4 16.3 100.0 1.9 421 31.0 237 Nooristan 0.6 96.3 1.1 0.1 0.1 2.5 100.0 0.0 184 46.0 183 Badakhshan 8.7 70.4 15.2 6.3 8.0 0.1 100.0 2.4 650 20.6 643 Takhar 15.9 75.8 17.3 2.6 3.7 0.6 100.0 0.2 751 33.3 745 Kunduz 10.5 52.8 13.4 7.3 19.7 6.8 100.0 2.9 760 47.5 749 Samangan 6.8 75.3 19.4 0.2 0.0 5.0 100.0 0.6 225 66.2 223 Balkh 36.4 49.1 37.4 6.1 4.6 2.7 100.0 0.3 1,232 53.6 1,229 Sar-E-Pul 11.0 66.0 14.5 5.7 13.7 0.1 100.0 0.5 430 52.1 424 Ghor 54.8 54.3 44.0 1.2 0.5 0.0 100.0 3.4 542 32.3 513 Daykundi 7.1 80.9 9.6 0.7 0.3 8.5 100.0 2.0 216 44.5 212 Urozgan 12.0 73.8 21.2 0.0 0.0 5.0 100.0 0.3 200 51.3 196 Kandahar 3.5 86.6 10.3 1.2 0.0 1.9 100.0 1.2 1,631 95.1 1,618 Jawzjan 21.1 83.5 14.2 0.3 0.9 1.1 100.0 1.1 398 54.3 397 Faryab 19.7 28.8 41.9 6.9 16.9 5.5 100.0 4.6 1,451 53.0 1,426 Helmand 6.1 69.3 1.5 0.0 0.9 28.4 100.0 3.8 568 65.6 555 Badghis 3.1 86.2 7.8 2.9 2.8 0.3 100.0 0.6 499 29.0 491 Herat 27.1 23.6 46.1 7.9 4.5 18.0 100.0 4.0 1,465 12.4 1,464 Farah 14.5 81.3 8.0 4.2 3.7 2.7 100.0 7.6 493 39.7 491 Nimroz 40.0 58.7 8.5 9.2 20.7 2.9 100.0 0.5 195 83.1 191 Education No education 21.5 58.5 24.6 4.5 5.5 6.9 100.0 2.9 16,279 55.1 15,855 Primary 28.9 43.0 31.1 7.9 9.8 8.2 100.0 1.4 1,596 61.3 1,565 Secondary 30.9 35.5 37.1 8.5 11.7 7.3 100.0 5.4 1,432 75.4 1,387 More than secondary 44.7 26.7 28.2 3.6 32.8 8.7 100.0 7.1 325 87.1 306 Wealth quintile Lowest 18.3 61.3 25.8 3.7 4.9 4.3 100.0 1.6 3,914 26.3 3,849 Second 18.5 60.7 22.0 4.1 5.5 7.7 100.0 3.2 3,964 45.1 3,883 Middle 20.9 56.9 24.8 4.5 6.0 7.8 100.0 3.3 4,020 59.0 3,881 Fourth 27.0 52.6 26.4 6.0 7.5 7.5 100.0 3.7 4,056 70.8 3,944 Highest 31.9 43.1 31.8 6.9 10.2 8.1 100.0 3.2 3,679 88.8 3,557 Total 23.2 55.1 26.1 5.0 6.8 7.1 100.0 3.0 19,632 57.6 19,113 1 In the first 2 months after delivery of last birth 2 Excludes women in households where salt was not tested 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Malaria • 201 MALARIA 12 Key Findings Ownership of nets: A total of 26% of households in Afghanistan have at least one insecticide-treated mosquito net (ITN). Access to ITN: Only 13% of the household population have access to an ITN (if each ITN in the household is used by up to 2 people). Slept under ITN: Four percent of the household population, 5% of children under age 5, and 4% of pregnant women slept under an ITN the night before the survey. ACT for treatment of fever: While advice or treatment was sought for 63% of children with a fever, only about 1% were treated with artemisinin-based combination therapy (ACT). alaria is endemic in many areas of Afghanistan at altitudes below 2,000 meters, with an estimated 22.4 million people living in areas with a high risk of transmission. Malaria is most prevalent in snow-fed river valleys and areas used for rice cultivation. Transmission is seasonal, occurring from June to November1. However, many Plasmodium vivax infections relapse during the spring season, which may give rise to a vivax peak around July. The Plasmodium falciparum peak is from August to October, a few months after the summer peak of Plasmodium vivax. The seasonality and relative low prevalence of malaria (about 10% in the most endemic areas) has resulted in a population only partly immune to malaria, with children and teenagers bearing most of the burden (MoPH 2013). Although the incidence of malaria has declined markedly in the last decade, continued efforts are required to decrease the incidence of the two predominant species (Plasmodium falciparum and plasmodium vivax). Much progress has been made in controlling malaria in the last decade. Health services are immeasurably stronger from the support of the international community in scaling up the Basic Package of Health Services (BPHS) to national coverage. The BPHS improved case management and systematized the national reporting system through the Health Management Information System (HMIS) during 2003 and 2004. Increased emphasis on reporting and collaboration between the National Malaria and Leishmaniasis Control Program (NMLCP) and the Health Management Information System (HMIS) have strengthened malaria reporting and expanded the number of sites that provide standardized information (MoPH 2012). Based on the Afghanistan 2005 malaria transmission risk stratification, the 34 provinces in the country have been classified into three risk strata (high, medium, and low, or malaria free) based on risk of 1 The fieldwork of 2015 AfDHS was conducted from June 2015 to February 2016 in all provinces regardless of seasonality and high risk areas in the country. M 202 • Malaria transmission, geography, climate, altitude, and latitude (MoPH 2009)2. An assessment of the 2015 AfDHS with these strata provides useful information for the program in Afghanistan. This chapter presents data for assessing the effectiveness of malaria control strategies, as well as the availability and use of mosquito nets and the prophylactic and therapeutic use of antimalarial drugs. 12.1 OWNERSHIP OF INSECTICIDE-TREATED NETS Ownership of insecticide-treated nets Households that have at least one insecticide-treated net (ITN). An ITN is defined as: (1) a factory-treated net that does not require any further treatment (long-lasting insecticidal net, or LLIN) or (2) a pretreated net obtained within the past 12 months, or (3) a net that has been soaked with insecticide within the past 12 months. Sample: Households Full household ITN coverage Percentage of households with at least 1 ITN for every two people Sample: Households More than one-third of households (37%) in Afghanistan have at least one mosquito net (treated or untreated), with 26% possessing at least one ITN (Table 12.1). Less than 1% of the households had at least one ITN for every two people who stayed in the household the night before the survey; in these households all members had access to an ITN because two people could share a single net. (Table 12.1 and Figure 12.1). Overall, 74% of the households in Afghanistan do not have an ITN. Although the remaining 26% of the households have at least one ITN, these households do not meet the requirement for full household ITN coverage. Patterns by background characteristics  Rural households are more likely to possess at least one ITN than urban households (29% versus 18%) (Table 12.1). 2 High-risk provinces include Nangarhar, Laghman, Kunarha, Khost, Kunduz, Takhar, Badakhshan, Baghlan, Balkh, Faryab, Badghis, Herat, Kandahar, and Helmand. Medium-risk provinces include Samangan, Sar-E-Pul, Jawzjan, Urozgan, Zabul, Nimroz, Farah, Logar, Paktya, Paktika, Wardak, Daykundi, Kabul, Parwan, and Kapisa. Low-risk provinces include Ghor, Bamyan, Panjsher, Nooristan, and Ghazni. Figure 12.1 Household Ownership of ITNs No ITN 74% At least 1 ITN, but not enough for all HH members 26% At least 1 ITN for every 2 people in the HH 0% Percent distribution of households Malaria • 203  Households in the lowest and highest wealth quintiles are least likely to have at least one ITN compared with those in other quintiles (Figure 12.2).  Households in the high-risk strata are more likely to possess at least one ITN. Thirty-two percent of households in the high-risk strata, 20% in the medium-risk strata, and 8% in the low-risk strata possess at least one ITN. 12.2 HOUSEHOLD ACCESS AND USE OF ITNS Access to an ITN Percentage of the population that could sleep under an ITN if each ITN in the household was used by up to two people. Sample: De facto household population Use of ITNs Percentage of population that slept under an ITN the night before the survey. Sample: De facto household population Table 12.2 shows that overall, 13% of the de facto population who stayed in the household the night before the survey could sleep under an ITN if each net was used by a maximum of 2 people. Access to an ITN varies according to the number of people who stayed in the household the night before the survey. Eighteen percent of households with 2 members had access to an ITN. In contrast, only 12% of households with eight or more members had access to an ITN. Since the average household size in Afghanistan is eight members, this indicates overall poor coverage by ITN (see Chapter 2 Table 2.8). Table 12.3 shows that 4% of de facto household population slept under an ITN the night before the survey. Only 15% of the population in households with at least one ITN slept under an ITN the night before the survey. However, this result should be assessed with caution because use of mosquito nets is seasonal. Net usage of an ITN on the night before the survey may not be representative of the pattern of use during periods of high malaria transmission. Patterns by background characteristics  Households in the rural areas are more likely to have access to an ITN than those in the urban areas (15% versus 9%) (Figure 12.3).  In high- and medium- risk strata, 15% and 14% of the household population with at least 1 ITN in the household slept under an ITN the night before the survey, while only 4% in the low-risk strata did so (Table 12.3). Figure 12.2 ITN Ownership by household wealth Figure 12.3 Access to ITNs 21 28 30 32 20 Lowest Second Middle Fourth Highest Percentage of households with at least one ITN Poorest Richest 10.3 16.2 15.1 14.1 10.4 14.6 9.2 13 Highest Fourth Middle Second Lowest Wealth quintile Rural Urban Residence Total Percent Percentage with access to an ITN 204 • Malaria Use of existing ITN Table 12.4 shows that 21% of the ITNs reported as owned by households were used in the household the night before the survey. The percentage of use of existing ITNs is lower in rural areas than in urban areas (17% and 43%, respectively). The proportion of net utilization is higher in the highest wealth quintile (40%) and lower in the lowest quintile (6%). 12.4 USE OF ITNS BY CHILDREN AND PREGNANT WOMEN The use of mosquito nets by vulnerable groups in highly endemic communities is one of the major indicators in the 2013-2017 National Malaria Strategic Plans (MoPH 2012). Table 12.5 presents data on the extent to which children under age 5 slept under various types of nets during the night before the survey. Overall, 7% of children slept under any net and 5% slept under an ITN. Similarly, 4% of pregnant women slept under an ITN the night before the survey (Table 12.6 and Figure 12.4) Patterns by background characteristics  There is difference in usage of ITNs in urban and rural areas; the percentages of children in urban and rural areas who sleep under an ITN are 6% and 4%, respectively. However, when the households with at least one ITN are considered, 31% of children in urban areas and 14% in the rural areas slept under an ITN. The pattern is similar for pregnant women (Table 12.5 and Table 12.6).  Children in the high-risk and medium-risk strata are more likely to sleep under an ITN than those in the low-risk strata (Table 12.5).  In the eastern regional provinces with high risk of malaria transmission, in households with at least one ITN, use by pregnant women age 15-49 was 28% in Nangarhar, 27% in Laghman, and 15% in Kunarha (Table 12.6). 12.5 CASE MANAGEMENT OF MALARIA IN CHILDREN Care seeking for children under age 5 with fever Percentage of children under age 5 with a fever in the 2 weeks before the survey for whom advice or treatment was sought from a health provider, a health facility, or a pharmacy. Sample: Children under age 5 with a fever in the 2 weeks before the survey. Diagnosis of malaria in children under age 5 with fever Percentage of children under age 5 with a fever in the 2 weeks before the survey who had blood taken from a finger or heel for testing. This is a proxy measure of diagnostic testing for malaria. Sample: Children under age 5 with a fever in the 2 weeks before the survey Artemisinin-based combination therapy (ACT) for children under age 5 with fever Among children under age 5 with a fever in the 2 weeks before the survey who took any antimalarial drugs, the percentage who took artemisinin-based combination therapy (ACT). Sample: Children under age 5 with a fever in the 2 weeks before the survey Figure 12.4 Use of ITNs 4 4 5 Household population Pregnant women Children under age 5 Percentage who slept under an ITN the night before the survey Malaria • 205 Community-Based Management of Malaria (CBMM) in Afghanistan, includes training of community health workers, diagnosis and confirmation of malaria cases at the community level, and proper treatment based on National Treatment Guidelines (NTG). Because fever is the main symptom of malaria, the proportion of febrile children in the population is a proxy for malaria prevalence. In the 2015 AfDHS, mothers were asked whether their children under age 5 had had a fever in the 2 weeks before the survey. If fever was reported, the mother was asked if treatment was sought at a health facility and if the child was given any medication. The 2015 AfDHS found that 29% of children under age 5 had a fever during the 2 weeks before the interview (Table 12.7). Overall, advice or treatment was sought for 63% of the children, while 8% had their blood taken for testing. However, only about 1% of these children were prescribed artemisinin combination therapy (ACT), although this therapy is the first line of treatment for uncomplicated Plasmodium falciparum malaria in Afghanistan. Fever was treated more often with other antimalarial drugs (12%). Use of sulfadoxine/pyrimethamine (SP)/Fansidar is relatively common (80%) (Table 12.9). Advice or treatment was sought primarily from the public sector for children (58%), of which government hospitals accounted for 29% (Table 12.8). Advice or treatment was sought from the private sector for 49% of children, primarily from private doctors (22%) and pharmacies (17%). For 3% of children, advice or treatment was sought from other sources such as shops, traditional practitioners, and markets. Patterns by background characteristics  Children age 12-23 months were most likely to have had a fever in the 2 weeks before the survey (35%), although they were less likely to receive treatment than children under 12 months (Table 12.7).  Children in the high-risk areas are more likely than those in other regions to be treated for fever. Six percent of children who received antimalarial drugs in the high-risk areas received an ACT, although 16% received quinine and 80% received SP/Fansidar (Table 12.9). LIST OF TABLES For more information on malaria, see the following tables:  Table 12.1 Household possession of mosquito nets  Table 12.2 Access to an insecticide-treated net (ITN)  Table 12.3 Use of mosquito nets by persons in the household  Table 12.4 Use of existing ITNs  Table 12.5 Use of mosquito nets by children  Table 12.6 Use of mosquito nets by pregnant women  Table 12.7 Prevalence, diagnosis, and prompt treatment of children with fever  Table 12.8 Source of advice or treatment for children with fever  Table 12.9 Type of antimalarial drugs used 206 • Malaria Table 12.1 Household possession of mosquito nets Percentage of households with at least one mosquito net (treated or untreated), insecticide-treated net (ITN), and long-lasting insecticidal net (LLIN); average number of nets, ITNs, and LLINs per household; and percentage of households with at least one net, ITN, and LLIN per two persons who stayed in the household last night, by background characteristics, Afghanistan 2015 Percentage of households with at least one mosquito net Average number of nets per household Number of house- holds Percentage of households with at least one net for every two persons who stayed in the household last night1 Number of house- holds with at least one person who stayed in the household last night Background Characteristic Any mosquito net Insecti- cide- treated mosquito net (ITN)2 Long- lasting insecti- cidal net (LLIN) Any mosquito net Insecti- cide- treated mosquito net (ITN)2 Long- lasting insecti- cidal net (LLIN) Any mosquito net Insecti- cide- treated mosquito net (ITN)2 Long- lasting insecti- cidal net (LLIN) Residence Urban 30.4 18.2 16.5 0.6 0.4 0.3 6,269 2.5 1.8 1.7 6,250 Rural 38.7 28.7 27.8 0.8 0.6 0.6 18,126 4.1 3.3 3.2 18,115 Province3 Kabul 11.0 7.4 6.7 0.2 0.1 0.1 3,369 0.7 0.2 0.2 3,365 Kapisa 84.2 82.7 82.6 2.2 2.1 2.1 179 19.8 19.4 19.4 178 Parwan 46.6 42.6 42.4 1.0 0.9 0.9 601 10.4 9.9 9.9 600 Wardak 0.0 0.0 0.0 0.0 0.0 0.0 351 0.0 0.0 0.0 350 Logar 37.2 34.4 33.9 0.6 0.5 0.5 398 1.2 1.2 1.2 398 Nangarhar 41.7 37.1 36.3 0.9 0.8 0.8 625 3.9 3.6 3.6 624 Laghman 53.5 48.5 48.4 1.2 1.1 1.1 446 7.2 6.3 6.3 446 Panjsher 4.2 4.0 4.0 0.1 0.1 0.1 54 1.0 1.0 1.0 54 Baghlan 25.8 15.0 10.5 0.4 0.2 0.2 776 1.8 0.9 0.9 773 Bamyan 3.2 2.4 2.1 0.1 0.1 0.1 300 0.5 0.5 0.3 300 Ghazni 16.0 15.6 15.0 0.4 0.4 0.3 864 0.3 0.3 0.3 864 Paktika 35.6 35.3 35.3 0.7 0.7 0.7 514 0.2 0.2 0.2 514 Paktya 45.7 44.7 44.3 1.2 1.2 1.2 353 7.5 7.4 7.4 353 Khost 82.6 64.7 62.9 2.9 2.4 2.3 457 7.5 5.4 5.3 457 Kunarha 48.5 46.6 46.4 1.2 1.1 1.1 507 11.1 9.5 9.5 506 Nooristan 15.1 15.0 15.0 0.3 0.3 0.3 127 0.3 0.3 0.3 127 Badakhshan 25.2 12.5 8.6 0.5 0.3 0.2 849 3.0 1.5 1.0 849 Takhar 61.8 54.3 53.7 1.2 1.0 1.0 1,027 7.8 7.2 7.1 1,025 Kunduz 36.1 34.8 34.8 0.5 0.5 0.5 1,070 1.2 1.2 1.2 1,066 Samangan 8.0 4.1 3.8 0.1 0.1 0.0 316 0.0 0.0 0.0 315 Balkh 66.1 33.1 31.8 1.3 0.6 0.6 1,510 6.8 4.3 4.2 1,504 Sar-E-Pul 21.4 20.7 20.6 0.4 0.4 0.4 644 3.1 3.1 3.1 644 Ghor 0.2 0.1 0.1 0.0 0.0 0.0 626 0.0 0.0 0.0 626 Daykundi 16.6 15.0 14.2 0.3 0.3 0.3 346 3.5 3.1 3.1 346 Urozgan 10.4 9.8 9.8 0.2 0.2 0.2 167 0.0 0.0 0.0 167 Kandahar 59.2 14.6 12.1 1.2 0.3 0.3 1,659 2.1 1.4 1.2 1,659 Jawzjan 78.9 52.3 51.7 1.4 0.9 0.9 563 1.2 0.9 0.9 563 Faryab 59.2 49.3 48.8 1.2 1.0 1.0 1,680 9.0 7.4 7.4 1,677 Helmand 29.4 27.4 26.8 0.6 0.5 0.5 718 0.9 0.7 0.7 716 Badghis 24.1 22.3 22.1 0.4 0.4 0.4 531 2.6 2.6 2.6 531 Herat 25.7 21.4 21.1 0.5 0.4 0.4 2,011 3.8 3.4 3.4 2,010 Farah 72.5 15.2 5.8 1.3 0.3 0.1 501 6.2 1.2 0.4 501 Nimroz 1.4 0.4 0.3 0.0 0.0 0.0 238 0.2 0.0 0.0 238 Level of risk High risk stratum 46.1 32.1 30.9 0.9 0.7 0.6 13,865 4.8 3.8 3.7 13,843 Medium risk stratum 27.5 20.2 19.2 0.5 0.4 0.4 8,560 2.6 2.0 2.0 8,552 Low risk stratum 8.7 8.3 8.0 0.2 0.2 0.2 1,970 0.3 0.2 0.2 1,970 Wealth quintile Lowest 28.3 21.2 20.3 0.6 0.4 0.4 4,852 2.3 1.9 1.9 4,850 Second 37.5 28.2 27.4 0.7 0.6 0.6 4,838 3.6 3.0 2.9 4,837 Middle 42.4 29.5 28.8 0.9 0.6 0.6 4,871 4.8 4.0 3.9 4,868 Fourth 43.1 31.5 30.5 0.9 0.7 0.6 4,859 4.9 3.8 3.8 4,852 Highest 31.4 19.6 17.7 0.6 0.4 0.4 4,976 2.7 1.8 1.7 4,958 Total 36.5 26.0 24.9 0.7 0.5 0.5 24,395 3.7 2.9 2.8 24,364 1 De facto household members. 2 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN) or (2) a pretreated net obtained within the past 12 months or (3) a net that has been soaked with insecticide within the past 12 months. 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Malaria • 207 Table 12.2 Access to an insecticide-treated net (ITN) Percent distribution of the de facto household population by number of ITNs owned by each household, according to number of persons who stayed in the household the night before the survey, Afghanistan 2015 Number of persons who stayed in the household the night before the survey Number of ITNs 1 2 3 4 5 6 7 8+ Total 0 72.2 82.1 74.4 72.5 77.1 76.2 76.6 71.5 73.1 1 21.2 14.5 18.3 15.0 12.4 9.3 7.1 5.5 7.1 2 4.2 2.5 6.5 8.7 8.0 10.0 9.8 9.5 9.4 3 2.4 0.9 0.8 3.7 2.4 4.2 5.4 11.5 8.9 4 0.0 0.0 0.0 0.1 0.0 0.1 1.0 0.4 0.4 5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.2 6 0.0 0.0 0.0 0.0 0.0 0.0 0.1 1.1 0.7 7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 115 1,198 3,316 7,020 12,221 18,846 22,973 126,699 192,389 Percent with access to an ITN1 27.8 17.9 19.5 20.0 13.8 14.2 13.3 12.4 13.2 1 Percentage of the de facto household population who could sleep under an ITN if each ITN in the household was used by up to two people. 208 • Malaria Table 12.3 Use of mosquito nets by persons in the household Percentage of the de facto household population who slept the night before the survey under a mosquito net (treated or untreated), under an insecticide-treated net (ITN), under a long-lasting insecticidal net (LLIN); and among the de facto household population in households with at least one ITN, the percentage who slept under an ITN the night before the survey, by background characteristics, Afghanistan 2015 Household population Household population in households with at least one ITN1 Background Characteristic Percentage who slept under any net the night before the survey Percentage who slept under an ITN1 the night before the survey Percentage who slept under an LLIN the night before the survey Number Percentage who slept under an ITN1 the night before the survey Number Age (in years)2 <5 6.6 4.6 4.4 31,144 16.8 8,614 5-14 5.4 3.5 3.3 59,525 12.8 16,118 15-34 5.8 3.8 3.6 63,234 14.4 16,823 35-39 6.7 4.4 4.1 21,830 16.2 5,964 50+ 6.2 3.9 3.6 16,652 15.4 4,261 Sex Male 5.8 3.9 3.6 98,426 14.2 26,638 Female 6.1 4.0 3.8 93,963 15.0 25,146 Residence Urban 9.8 5.5 4.9 47,194 28.3 9,180 Rural 4.7 3.4 3.3 145,195 11.6 42,605 Province3 Kabul 2.3 1.6 1.4 24,901 19.5 1,982 Kapisa 8.6 8.5 8.5 1,380 10.4 1,131 Parwan 11.7 10.5 10.5 4,488 26.1 1,808 Wardak 0.0 0.0 0.0 2,528 * 3 Logar 5.8 5.3 5.3 3,400 15.8 1,150 Nangarhar 11.6 10.4 10.2 5,768 28.9 2,073 Laghman 18.1 16.0 16.0 4,030 34.5 1,872 Panjsher 0.8 0.8 0.8 422 20.9 15 Baghlan 1.2 0.7 0.6 5,546 4.8 863 Bamyan 0.0 0.0 0.0 2,231 0.4 53 Ghazni 0.5 0.5 0.4 7,263 2.9 1,180 Paktika 2.0 2.0 2.0 4,828 5.5 1,744 Paktya 3.2 3.2 3.2 3,524 7.1 1,583 Khost 14.1 11.5 11.3 5,463 16.9 3,718 Kunarha 10.0 9.9 9.7 4,248 20.3 2,064 Nooristan 1.3 1.3 1.2 1,251 8.1 195 Badakhshan 6.8 3.3 3.2 6,181 26.1 772 Takhar 4.3 3.0 2.9 7,220 5.5 3,974 Kunduz 2.3 2.1 2.1 8,546 5.7 3,190 Samangan 4.0 1.7 1.6 2,188 36.5 101 Balkh 9.4 4.0 3.8 11,595 12.6 3,661 Sar-E-Pul 2.0 1.9 1.8 4,188 8.8 886 Ghor 0.0 0.0 0.0 4,747 * 4 Daykundi 1.9 1.5 1.3 2,270 9.4 360 Urozgan 0.1 0.1 0.1 1,501 1.4 159 Kandahar 11.1 5.6 4.4 15,548 41.6 2,111 Jawzjan 5.8 2.5 2.4 4,637 4.7 2,491 Faryab 5.8 4.3 4.2 13,115 8.5 6,578 Helmand 6.5 6.1 6.0 6,059 23.4 1,590 Badghis 0.6 0.6 0.5 4,042 2.6 943 Herat 4.4 2.7 2.6 13,323 12.4 2,882 Farah 24.5 5.8 1.8 4,093 42.9 552 Nimroz 0.1 0.1 0.1 1,707 (14.7) 6 Level of risk High risk stratum 7.4 5.0 4.8 110,684 15.4 36,290 Medium risk stratum 4.8 2.9 2.6 65,790 13.7 14,046 Low risk stratum 0.3 0.3 0.3 15,915 3.7 1,448 Wealth quintile Lowest 1.3 0.9 0.9 38,505 4.0 8,322 Second 3.8 2.5 2.4 38,709 8.9 11,033 Middle 6.1 4.6 4.5 38,325 15.4 11,557 Fourth 8.4 6.0 5.6 38,440 17.9 12,817 Highest 10.0 5.7 4.9 38,410 27.0 8,056 Total 5.9 3.9 3.7 192,389 14.6 51,784 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN), or (2) a pretreated net obtained within the past 12 months, or (3) a net that has been soaked with insecticide within the past 12 months. 2 Total includes 4 cases with missing information on age. 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Malaria • 209 Table 12.4 Use of existing ITNs Percentage of insecticide-treated nets (ITNs) that were used by anyone the night before the survey, by background characteristics, Afghanistan 2015 Background Characteristic Percentage of existing ITNs1 used the night before the survey Number of ITNs1 Residence Urban 43.1 2,210 Rural 16.9 10,787 Province2 Kabul 34.0 419 Kapisa 11.6 384 Parwan 35.5 533 Logar 36.9 210 Nangarhar 40.3 526 Laghman 45.2 494 Panjsher (42.4) 4 Baghlan 9.5 169 Bamyan 0.5 19 Ghazni 4.8 307 Paktika 11.1 367 Paktya 12.8 426 Khost 21.1 1,086 Kunarha 29.4 563 Nooristan 13.0 44 Badakhshan 32.4 229 Takhar 6.8 1,060 Kunduz 12.7 522 Samangan 63.2 16 Balkh 17.9 963 Sar-E-Pul 12.2 239 Daykundi 23.4 109 Urozgan 4.0 31 Kandahar 54.1 537 Jawzjan 7.7 507 Faryab 13.4 1,660 Helmand 34.2 375 Badghis 4.2 207 Herat 16.1 840 Farah 58.4 127 Wealth quintile Lowest 6.3 2,036 Second 12.9 2,780 Middle 22.5 2,956 Fourth 25.5 3,205 Highest 40.2 2,020 Total 21.4 12,996 NOTE: Figures in parentheses are based on 25-49 unweighted cases. 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN), or (2) a pretreated net obtained within the past 12 months, or (3) a net that has been soaked with insecticide within the past 12 months 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 210 • Malaria Table 12.5 Use of mosquito nets by children Percentage of children under age five who, the night before the survey, slept under a mosquito net (treated or untreated), under an insecticide-treated net (ITN), under a long-lasting insecticidal net (LLIN); and among children under age five in households with at least one ITN, the percentage who slept under an ITN the night before the survey, by background characteristics, Afghanistan 2015 Children under age 5 in all households Children under age 5 in households with at least one ITN1 Background Characteristic Percentage who slept under any net the night before the survey Percentage who slept under an ITN1 the night before the survey Percentage who slept under an LLIN the night before the survey Number of children Percentage who slept under an ITN1 the night before the survey Number of children Age (in years) <1 7.0 4.8 4.5 5,916 18.1 1,576 1 6.4 4.4 4.1 5,838 15.5 1,663 2 6.8 4.6 4.4 6,774 16.6 1,883 3 6.4 4.9 4.7 6,484 17.5 1,807 4 6.5 4.5 4.1 6,132 16.3 1,686 Sex Male 6.7 4.7 4.5 16,017 16.9 4,467 Female 6.5 4.6 4.3 15,127 16.7 4,147 Residence Urban 10.7 6.1 5.4 7,168 30.8 1,425 Rural 5.4 4.2 4.1 23,976 14.0 7,189 Province2 Kabul 3.0 2.3 2.1 3,797 26.2 328 Kapisa 10.8 10.8 10.8 216 13.5 173 Parwan 17.6 15.7 15.7 702 37.3 295 Wardak 0.0 0.0 0.0 348 * 1 Logar 6.8 6.6 6.5 425 17.8 157 Nangarhar 13.3 11.7 11.2 1,003 32.7 358 Laghman 20.2 18.3 18.1 784 38.8 369 Panjsher 1.2 1.2 1.2 40 (23.2) 2 Baghlan 1.1 0.5 0.5 737 3.2 125 Bamyan 0.1 0.1 0.1 330 (2.2) 9 Ghazni 0.6 0.6 0.5 792 2.3 194 Paktika 2.3 2.3 2.3 860 6.7 291 Paktya 3.1 3.1 3.1 609 6.9 270 Khost 15.2 12.8 12.6 1,008 18.3 706 Kunarha 11.0 11.0 10.7 745 23.4 352 Nooristan 1.8 1.8 1.7 308 11.5 47 Badakhshan 7.9 4.2 4.2 888 31.7 117 Takhar 6.5 5.0 4.8 1,216 8.7 696 Kunduz 3.2 3.2 3.2 1,203 8.3 472 Samangan 4.3 1.5 1.5 347 34.3 16 Balkh 10.1 4.2 4.0 1,920 13.4 601 Sar-E-Pul 2.6 2.4 2.4 618 11.0 134 Ghor 0.0 0.0 0.0 868 * 1 Daykundi 1.9 1.3 1.1 333 8.7 51 Urozgan 0.1 0.1 0.1 390 1.2 44 Kandahar 9.5 4.4 3.2 2,803 40.0 305 Jawzjan 7.2 3.2 3.1 589 5.5 339 Faryab 6.6 5.3 5.2 2,365 11.3 1,108 Helmand 6.4 6.1 5.9 922 22.3 251 Badghis 0.7 0.7 0.6 745 2.8 183 Herat 4.4 2.9 2.9 2,093 11.9 509 Farah 17.2 4.0 1.8 819 35.1 94 Nimroz 0.2 0.2 0.2 297 * 1 Level of risk High risk stratum 8.1 5.8 5.5 18,431 17.3 6,151 Medium risk stratum 5.4 3.6 3.3 10,375 16.9 2,210 Low risk stratum 0.5 0.5 0.4 2,338 4.2 253 Wealth quintile Lowest 1.6 1.1 1.1 5,995 4.9 1,322 Second 4.4 3.3 3.2 6,387 11.3 1,850 Middle 6.9 5.5 5.3 6,604 18.4 1,976 Fourth 9.5 6.8 6.5 6,389 19.8 2,199 Highest 10.8 6.5 5.7 5,769 29.6 1,267 Total 6.6 4.6 4.4 31,144 16.8 8,614 Note: Table is based on children who stayed in the household the night before the interview. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN), or (2) a pretreated net obtained within the past 12 months, or (3) a net that has been soaked with insecticide within the past 12 months. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Malaria • 211 Table 12.6 Use of mosquito nets by pregnant women Percentages of pregnant women age 15-49 who, the night before the survey, slept under a mosquito net (treated or untreated), under an insecticide-treated net (ITN), under a long-lasting insecticidal net (LLIN); and among pregnant women age 15-49 in households with at least one ITN, the percentage who slept under an ITN the night before the survey, by background characteristics, Afghanistan 2015 Among pregnant women age 15-49 in all households Among pregnant women age 15-49 in households with at least one ITN1 Background Characteristic Percentage who slept under any net the night before the survey Percentage who slept under an ITN1 the night before the survey Percentage who slept under an LLIN the night before the survey Number of women Percentage who slept under an ITN1 the night before the survey Number of women Residence Urban 14.5 8.0 7.4 928 32.6 229 Rural 4.7 3.4 3.2 5,360 12.2 1,489 Province2 Kabul 3.3 2.3 2.3 407 * 61 Kapisa 7.6 7.6 7.6 30 9.2 25 Parwan 11.7 10.7 10.7 107 (34.5) 33 Wardak 0.0 0.0 0.0 55 * 0 Logar 7.7 7.7 7.7 122 23.1 40 Nangarhar 11.8 11.8 11.7 137 27.8 59 Laghman 12.1 11.3 11.3 155 26.6 66 Panjsher 0.0 0.0 0.0 11 * 0 Baghlan 0.7 0.5 0.2 204 (3.4) 32 Bamyan 0.0 0.0 0.0 43 * 1 Ghazni 0.9 0.9 0.9 368 (11.4) 29 Paktika 1.9 1.9 1.9 259 6.0 82 Paktya 4.6 4.6 4.6 92 11.5 37 Khost 17.5 14.9 14.8 209 22.7 138 Kunarha 7.9 7.1 7.1 124 15.0 59 Nooristan 1.7 1.7 1.7 67 11.2 10 Badakhshan 8.4 6.1 6.1 159 (35.4) 27 Takhar 6.4 5.5 5.5 226 9.4 133 Kunduz 2.0 2.0 2.0 343 5.3 129 Samangan 4.0 2.6 2.4 69 * 3 Balkh 7.9 3.1 3.1 370 10.4 111 Sar-E-Pul 1.7 0.7 0.7 144 (4.4) 22 Ghor 0.0 0.0 0.0 208 * 0 Daykundi 1.1 0.2 0.2 48 * 7 Urozgan 0.1 0.1 0.1 42 * 4 Kandahar 8.2 3.6 3.2 596 (34.2) 63 Jawzjan 5.7 1.8 1.8 165 3.6 83 Faryab 7.9 5.7 5.6 426 10.2 241 Helmand 8.8 8.4 8.3 162 (30.9) 44 Badghis 1.1 1.1 1.1 143 (4.0) 38 Herat 3.2 2.5 2.3 457 (11.0) 103 Farah 21.2 5.4 1.2 275 40.7 37 Nimroz 0.0 0.0 0.0 60 * 0 Education No education 5.2 3.5 3.3 5,392 13.1 1,441 Primary 11.7 7.4 6.2 435 25.4 127 Secondary 10.0 7.3 7.0 384 21.8 129 More than secondary 19.0 8.8 7.9 78 (32.0) 21 Wealth quintile Lowest 1.1 0.8 0.8 1,400 4.0 283 Second 4.2 3.0 2.9 1,545 11.7 400 Middle 5.8 4.6 4.6 1,363 16.6 382 Fourth 8.7 5.2 4.6 1,186 15.1 406 Highest 15.4 9.3 8.5 794 29.9 248 Total 6.1 4.1 3.8 6,288 14.9 1,719 Note: Table is based on women who stayed in the household the night before the interview. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN), or (2) a pretreated net obtained within the past 12 months, or (3) a net that has been soaked with insecticide within the past 12 months. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 212 • Malaria Table 12.7 Prevalence, diagnosis, and prompt treatment of children with fever Percentage of children under age five with fever in the two weeks preceding the survey; and among children under age five with fever, the percentage for whom advice or treatment was sought, the percentage who had blood taken from a finger or heel, the percentage who took any artemisinin-based combination therapy (ACT), by background characteristics, Afghanistan 2015 Among children under age five: Among children under age five with fever: Background Characteristic Percentage with fever in the two weeks preceding the survey Number of children Percentage for whom advice or treatment was sought1 Percentage who had blood taken from a finger or heel for testing Percentage who took any ACT Percentage who took antimalarial drugs Number of children Age (in months) <12 29.4 5,815 67.1 7.2 0.4 16.7 1,711 12-23 35.3 5,708 63.9 7.7 0.2 10.0 2,013 24-35 31.7 6,598 59.2 7.8 0.7 11.0 2,094 36-47 27.1 6,282 65.8 8.6 0.8 11.7 1,704 48-59 20.1 5,902 59.7 8.2 0.6 9.3 1,187 Sex Male 28.6 15,605 63.9 8.3 0.6 11.1 4,460 Female 28.9 14,699 62.5 7.4 0.4 12.5 4,249 Residence Urban 30.7 7,040 65.8 6.0 0.0 16.5 2,162 Rural 28.1 23,264 62.3 8.5 0.7 10.2 6,547 Province2 Kabul 29.3 3,677 56.9 5.1 0.0 21.9 1,078 Kapisa 20.0 211 44.4 2.4 0.0 2.5 42 Parwan 10.9 688 66.4 5.1 0.0 5.7 75 Wardak 33.1 329 54.1 2.9 0.0 1.1 109 Logar 13.0 417 49.0 9.7 0.0 7.8 54 Nangarhar 44.4 972 62.7 34.6 0.0 4.7 431 Laghman 34.0 770 88.7 66.7 0.0 5.1 262 Panjsher 3.1 39 * * * * 1 Baghlan 25.0 700 81.9 10.6 0.0 10.0 175 Bamyan 20.6 314 66.6 3.7 0.0 1.7 65 Ghazni 12.3 778 29.7 3.5 0.0 4.9 96 Paktika 13.1 856 96.3 34.2 0.0 0.0 112 Paktya 27.8 578 63.6 11.5 0.4 4.6 161 Khost 12.3 991 35.2 12.0 0.0 0.0 122 Kunarha 18.9 704 48.8 12.6 0.0 1.5 133 Nooristan 25.0 303 40.3 1.3 0.0 0.0 76 Badakhshan 26.3 870 44.6 19.4 0.0 2.3 229 Takhar 21.7 1,187 32.2 2.4 0.0 2.9 258 Kunduz 28.2 1,177 81.2 11.4 0.0 5.3 332 Samangan 15.3 345 65.4 0.0 0.0 35.3 53 Balkh 33.5 1,874 66.7 1.8 0.3 2.6 627 Sar-E-Pul 9.8 596 42.7 0.0 0.0 0.0 59 Ghor 51.6 846 59.5 2.3 0.0 8.6 437 Daykundi 12.1 308 27.0 7.0 0.0 1.1 37 Urozgan 20.5 385 94.1 0.8 0.0 0.0 79 Kandahar 49.9 2,751 49.0 0.7 0.0 0.0 1,373 Jawzjan 26.5 569 41.6 2.1 0.0 5.5 151 Faryab 30.1 2,281 80.8 4.9 0.0 6.0 686 Helmand 13.2 893 88.4 3.1 0.8 3.9 118 Badghis 22.7 723 63.9 2.0 0.0 2.5 164 Herat 49.2 2,046 82.2 0.6 4.0 54.0 1,008 Farah 8.4 810 68.8 9.6 1.8 10.1 68 Nimroz 12.3 290 44.4 3.4 0.0 3.6 36 Mother's education No education 29.0 25,261 61.6 7.9 0.5 11.1 7,316 Primary 32.3 2,429 70.7 8.0 0.9 14.8 784 Secondary 23.4 2,130 71.1 6.6 0.6 12.4 499 More than secondary 22.6 484 78.7 8.5 0.0 33.8 109 Wealth quintile Lowest 28.8 5,795 62.2 3.6 0.7 11.2 1,672 Second 27.4 6,185 63.3 8.7 1.4 13.0 1,693 Middle 29.9 6,398 59.0 9.0 0.2 8.4 1,912 Fourth 27.8 6,312 62.9 11.3 0.4 9.0 1,753 Highest 29.9 5,614 69.1 6.4 0.0 18.0 1,679 Total 28.7 30,304 63.2 7.9 0.5 11.8 8,709 NOTE: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Excludes advice or treatment from a traditional practitioner. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Malaria • 213 Table 12.8 Source of advice or treatment for children with fever Percentage of children under age five with fever in the two weeks preceding the survey for whom advice or treatment was sought from specific sources; and among children under age five with fever in the two weeks preceding the survey for whom advice or treatment was sought, the percentage for whom advice or treatment was sought from specific sources, Afghanistan 2015 Percentage for whom advice or treatment was sought from each source: Sources Among children with fever Among children with fever for whom advice or treatment was sought Any public sector source 36.8 57.8 Government hospital 18.5 29.0 CHC/Polyclinic 12.3 19.4 Basic health center 4.1 6.5 Health sub-center 1.8 2.8 Health post/sub-health post 0.0 0.1 Community health worker 0.6 0.9 Mobile clinic 0.8 1.3 Other 0.2 0.4 Non-government sector 0.1 0.2 Marie Stopes 0.0 0.1 Red Cross Society 0.1 0.1 Other 0.0 0.1 Private medical sector 31.5 49.4 Private hospital/clinic 7.7 12.2 Pharmacy 10.6 16.7 Private doctor 13.8 21.7 Other 0.3 0.4 Other sector 2.0 3.1 Shop 0.7 1.2 Traditional practitioner 0.3 0.5 Market 0.6 0.9 Other 0.4 0.6 Number of children 8,709 5,547 214 • Malaria Table 12.9 Type of antimalarial drugs used Among children under age five with fever in the two weeks preceding the survey who took any antimalarial medication, the percentage who took specific antimalarial drugs, by background characteristics, Afghanistan 2015 Percentage of children who took drug: Number of children with fever who took any anti- malarial drug Background Characteristic Any ACT Qunine SP/ Fansidar Chloroquine Amodi- aquine Artesunate mono- therapy Other anti- malarial Age (in months) <12 2.4 9.7 81.1 23.9 24.5 0.0 0.4 286 12-23 1.6 10.8 76.8 23.8 13.4 1.0 1.5 201 24-35 6.5 15.5 85.1 10.1 21.6 1.4 0.0 230 36-47 6.6 12.7 74.6 15.6 14.2 0.1 1.9 200 48-59 6.3 11.1 82.0 16.2 13.3 0.3 1.4 110 Sex Male 5.3 11.0 74.1 17.4 24.2 0.8 1.9 497 Female 3.6 12.9 85.6 19.3 13.1 0.3 0.0 530 Residence Urban 0.2 6.4 85.2 18.0 21.0 0.8 0.8 356 Rural 6.6 14.9 77.2 18.5 17.2 0.4 1.0 670 Level of risk High risk stratum 6.3 15.7 80.2 15.6 18.8 0.4 1.3 693 Medium risk stratum 0.6 4.7 79.5 25.4 20.2 0.8 0.0 290 Low risk stratum 0.0 0.0 80.8 15.8 1.9 1.5 1.5 44 Mother's education No education 4.3 12.5 79.2 18.9 16.9 0.4 1.2 812 Primary (5.9) (6.1) (85.0) (17.5) (11.3) (1.0) (0.0) 116 Secondary (4.9) (10.2) (73.5) (9.0) (35.0) (0.0) (0.0) 62 More than secondary * * * * * * * 37 Wealth quintile Lowest 5.9 11.4 75.6 13.2 19.8 0.3 0.6 187 Second 11.1 21.1 76.8 19.3 19.9 0.0 0.4 219 Middle 2.2 14.5 79.1 23.4 11.7 1.4 1.0 160 Fourth 3.9 11.2 84.9 22.5 12.1 0.1 0.8 158 Highest 0.0 4.6 82.9 16.0 23.6 0.9 1.6 303 Total 4.4 11.9 80.0 18.3 18.5 0.6 0.9 1,027 NOTE: Provincial level estimates not shown separately since there are only new cases. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. ACT = Artemisinin-based combination therapy. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 215 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13 Key Findings  Knowledge of HIV: Twenty-four percent of ever-married women and 58% of ever-married men age 15-49 have heard about HIV/AIDS.  Knowledge of prevention: Only 9% of ever-married women and 33% of ever-married men know that using condoms and limiting sexual intercourse to one uninfected partner can prevent the transmission of HIV.  Knowledge of prevention of mother-to-child transmission of HIV: Fifteen percent of ever-married women and 38% of ever-married men age 15-49 know that HIV can be transmitted by breastfeeding. Similarly, 8% of these women and 20% of the men know that the risk of mother-to-child transmission can be reduced by a mother taking special medicine during pregnancy.  HIV tests: About 9% of ever-married women and 30% of ever-married men age 15-49 know where to obtain an HIV test. Less than 1% of these women and 4% of the men have ever been tested for HIV and received the results of their last test. fghanistan is a low epidemic country for HIV infection. As of 2015, an estimated 6,700 adults and children in the country were living with HIV (UNAIDS 2015). The principal mode of HIV transmission in Afghanistan is intravenous drug use, which accounts for 44% of all HIV infections in the country. The second most important mode of HIV transmission is vertical transmission, in which the mother passes HIV to her child during pregnancy, childbirth, and breastfeeding. The prevention of mother-to-child transmission (PMTCT) program in Afghanistan is a priority in the fight against HIV/AIDS in children. The program seeks to prevent pediatric HIV infection through primary prevention of HIV infection in the childbearing population, prevention of unintended pregnancies, and provision of care and follow-up psychosocial support. This chapter describes the prevalence of relevant knowledge, perceptions, and behaviors at the national level and within sub-national, urban, and rural geographic subpopulations. In this way, the AIDS control program in Afghanistan can target those groups of individuals who are most at risk of HIV infection and in need of information. A 216 • HIV/AIDS-related Knowledge, Attitudes, and Behavior 13.1 HIV/AIDS KNOWLEDGE, TRANSMISSION, AND PREVENTION METHODS Knowledge of HIV is low in Afghanistan with 24% of women and 58% of men age 15-49 having ever heard of AIDS (Table 13.1). Women and men in the lowest wealth quintile are the least likely to have heard about AIDS (Figure 13.1). The source of HIV knowledge varies in Afghanistan, with the highest percentage of women hearing about HIV from television (15%) and the lowest percentage informed through posters and billboards (1%). Nine percent of women have heard about HIV from their friends and relatives, while only 3% have heard about HIV from health professionals (Table 13.2.1). The types of information sources for men are similar to those for women (Table 13.2.2). Twelve percent of ever- married women and 38% of ever-married men know that using condoms is a way to prevent HIV transmission (Table 13.3). Fourteen percent of ever-married women and 47% of ever-married men recognize that they can reduce the risk of getting HIV by limiting sexual intercourse to one uninfected partner (Table 13.3). Only 9% of women and 33% of men know both prevention methods (Table 13.3). Patterns by background characteristics  Knowledge of prevention of HIV by using condoms and limiting sexual intercourse to one uninfected partner varies considerably between women and men by residence. Urban women (15%) and men (41%) are more aware than rural women (7%) and rural men (31%) (Figure 13.2).  The level of knowledge about the prevention of HIV among women and men varies, with the highest percentage of women with knowledge in Logar (38%) and the lowest in Nooristan (<1%) (Table 13.3 and Figure 13.3). Among men, the highest percentage with knowledge is in Kapisa (67%) and lowest in Baghlan (2%).  Knowledge of HIV increases with education. Only 6% of women and 23% of men with no education know the two major prevention methods compared with 40% of women and 65% of men with more than secondary education (Table 13.3). Figure 13.1 Knowledge of AIDS by wealth status Figure 13.2 Comprehensive knowledge of HIV 12 17 18 28 4443 50 54 67 77 Lowest Second Middle Fourth Highest Percentage of ever-married women and ever-married men age 15-49 who have heard of AIDS Women Men WealthiestPoorest 15 41 2 87 31 1 4 9 33 1 5 Women Men Women Men Urban Rural Total Percentage of ever-married women and ever-married men age 15-49 Know that HIV can be prevented by using condoms and limiting sex to one uninfected partner Has comprehensive knowledge of HIV HIV/AIDS-related Knowledge, Attitudes, and Behavior • 217 Figure 13.3 Knowledge of HIV prevention methods Percent of ever-married women who know that HIV can be prevented by using condoms and limiting sex to one uninfected partner To assess HIV/AIDS knowledge, the 2015 AfDHS obtained information on several common misconceptions about HIV transmission. Overall, the knowledge of HIV seems rather poor in Afghanistan. Only 10% of women and 30% of men age 15-49 believe that a healthy looking person can have HIV. Similarly, only 8% of women and 23% of men age 15-49 know that HIV cannot be transmitted by mosquito bites, while only 9% of women and 23% of men know that a person cannot be infected by sharing food with a person who has AIDS (Tables 13.4.1 and 13.4.2). Comprehensive knowledge of HIV Knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chances of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about transmission or prevention of HIV. Sample: Women and men age 15-49 Comprehensive knowledge of HIV is a composite measure that indicates that a person knows that condom use and limiting sexual intercourse to one uninfected partner can prevent HIV and that a healthy-looking person can have HIV, and rejects the two most common local misconceptions about the transmission of HIV. In Afghanistan, these misconceptions include HIV being transmitted through mosquitoes and a person becoming infected with HIV by sharing food with a person who has AIDS. In Afghanistan, 1% of women and 5% of men have comprehensive knowledge of HIV/AIDS prevention and transmission (Tables 13.4.1 and 13.4.2). 218 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Patterns by background characteristics  The level of comprehensive knowledge is higher among men than women in both the urban (8% versus 2%) and rural areas (4% versus 1%).  Among both women and men, comprehensive knowledge of HIV/AIDS rises with education and wealth quintile (Figure 13.4, Table 13.4.1, and Table 13.4.2). The difference by education among men is particularly striking; only 2% of men with no education have comprehensive knowledge about HIV/AIDS, compared with 19% of men with more than a secondary education. 13.2 KNOWLEDGE ABOUT MOTHER-TO-CHILD TRANSMISSION Increasing the level of general knowledge about transmission of HIV from mother to child and reducing the risk of transmission with antiretroviral drugs are critical in reducing mother-to-child transmission (MTCT) of HIV. To assess MTCT knowledge, respondents were asked whether HIV can be transmitted from mother to child through breastfeeding and whether a mother with HIV can reduce the risk of transmission to her baby by taking certain drugs during pregnancy. More men than women in Afghanistan (38% versus 15%) know that HIV can be transmitted through breastfeeding and that the risk of MTCT can be reduced by taking special medicine (20% versus 8.0%) (Table 13.5, Figure 13.5). Patterns by background characteristics  Knowledge of MTCT is relatively low across the country. Urban women (12%) and men (24%) are more likely to be aware of MTCT than rural women (5%) and rural men (14%).  Knowledge of MTCT increases with education for both women and men. Only 5% of women and 9% of men with no education know about MTCT as compared with 30% of women and 35% of men with more than secondary education. 13.3 HIV/AIDS ATTITUDES 13.3.1 Attitudes toward People Living with HIV/AIDS Widespread stigma and discrimination in a population can adversely affect people’s willingness to be tested and their adherence to antiretroviral therapy (ART). Thus, reduction of stigma and discrimination in Figure 13.4 HIV knowledge by education Figure 13.5 Knowledge of Mother-to- Child Transmission of HIV 1 2 3 10 2 3 8 19 No education Primary Secondary More than secondary Percentage of ever-married women and ever-married men age 15-49 Women Men 26 48 15 28 12 35 6 1815 38 8 20 Women Men Women Men Urban Rural Total Know that HIV can be transmitted by breastfeeding Know that risk of MTCT can be reduced by mother taking special drugs during pregnancy Percentage of ever-married women and ever-married men age 15-49 HIV/AIDS-related Knowledge, Attitudes, and Behavior • 219 a population is an important indicator of the success of programs that target HIV/AIDS prevention and control. Accepting attitudes about HIV Women and men answered four questions that assess the level of stigma associated with HIV/AIDS. Respondents indicate (1) they are willing to care for a family member with AIDS in their home; (2) they would buy fresh vegetables from a shopkeeper who has HIV; (3) that a female teacher who has HIV but is not sick should be allowed to continue teaching, and; (4) they would not want to keep secret that a family member was infected with HIV are considered to have accepting attitudes. Sample: Women and men age 15-49 About one-third of women and men reported accepting attitudes towards HIV-infected relatives, teachers, and shopkeepers (Tables 13.6.1 and 13.6.2). Thirty-four percent of women and 38% of men would be willing to care for a relative with AIDS in their home, and about 31% of women and 27% of men would buy fresh vegetables from a shopkeeper with HIV. Twenty-seven percent of women and 28% of men agree that a female teacher with HIV should be allowed to continue teaching, although more women and men indicated that they would not want to keep secret that a family member was infected with HIV (71% and 68%, respectively). Overall, only 6% of women and men age 15-49 expressed all the specified accepting attitudes toward people living with HIV (Tables 13.6.1 and 13.6.2). Patterns by background characteristics  Rural women are slightly more likely to have accepting attitudes about people living with HIV than urban women. For instance, 7% of rural women expressed acceptance of all specified attitudes as opposed to only 4% among urban women (Table 13.6.1).  There were marked differences by province in the proportions of women and men expressing accepting attitudes, with women in Parwan (44%) and men in Herat (18%) being the most likely to express accepting attitudes on all four indicators (Tables 13.6.1 and 13.6.2).  Women and men with more than secondary education are more likely to express accepting attitudes towards people living with HIV and AIDS. 13.3.2 Attitudes toward Negotiating Safer Sexual Relations with Husbands Knowledge about HIV transmission and prevention is of little use if people feel powerless to negotiate safer sex practices with their partners. To assess attitudes about negotiating safer sexual relations with husbands, women and men were asked whether they thought that a wife was justified in refusing to have sexual intercourse with her husband if she knows that he has sex with other women or asking that he use a condom if she knows he has an sexually transmitted infection (STI). Table 13.7 shows that 54% of women and 69% of men believe that a woman is justified in refusing to have sexual intercourse with her husband if she knows that he has sex with other women. Educated women and men, those living in the urban areas, and those in the highest wealth quintile agreed to this. 13.3.3 Attitudes toward Condom Education for Young People Adults age 18-49 were asked about their support for condom education for children age 12-14. That is, do they agree that children age 12-14 should be taught about using a condom to avoid AIDS. Only 6% of women and 18% of men agreed (Table 13.8). 220 • HIV/AIDS-related Knowledge, Attitudes, and Behavior 13.4 COVERAGE OF HIV TESTING SERVICES Knowledge of HIV status helps HIV-negative individuals make specific decisions to reduce risk and increase safer sex practices to remain disease free. Among those who are living with HIV, knowledge of their status allows them to take action to protect their sexual partners, access care, and receive treatment. To assess awareness and coverage of HIV testing services, AfDHS respondents were asked if they had ever been tested for HIV. If they had, they were asked whether they had received the results of their last test and where they had been tested. If they had never been tested, they were asked if they knew a place where they could be tested. A small proportion of respondents (9% of women and 30% of men) knew of a place where they could obtain an HIV test (Tables 13.9.1 and 13.9.2). One percent of women and 4% of men had been tested for HIV and received the result, while 99% of women and 95% of men were never tested for HIV (Tables 13.9.1 and Tables 13.9.2) 13.5 MALE CIRCUMCISION Afghanistan is an Islamic country in which the prevalence of male circumcision is universal. Most circumcisions are performed by traditional practitioners (43%), followed by health workers (20%). The percentage of circumcisions performed by traditional practitioners is higher in rural areas (48%), while it is more commonly performed by a health worker in the urban areas (39%) (Table 13.10). About 14% of the circumcisions are performed at health facilities, with 13% at the home of the health worker and 57% in the other houses. Utilization of health facilities for circumcision is higher in urban areas (24%) than rural areas (11%), while most circumcisions take place at home in the rural areas (59%) (Table 13.11) More than half of the men (53%) were circumcised during childhood (<5 years). One in three men (34%) was circumcised between age 5-13 and less than 1% was circumcised between age 14-19 (Table 13.12). 13.6 SELF-REPORTING OF SEXUALLY TRANSMITTED INFECTIONS Sexually transmitted infections (STIs) and symptoms Respondents who have ever had sex were asked whether they had an STI or symptoms of an STI (a bad-smelling, abnormal discharge from the vagina/penis or a genital sore or ulcer) in the 12 months before the survey. Sample: Women and men age 15-49 Women were more likely than men to report having had an STI or having experienced STI symptoms (Table 13.13). In the 12 months before the survey, 2% of women reported that they had an STI; 13% had a bad-smelling/abnormal genital discharge, and 8% had a genital sore or ulcer. Among men, 2% reported that they had an STI, 6% had a bad-smelling/abnormal discharge, and 4% had a genital sore or ulcer. Overall, 15% of women and 8% of men had either an STI or symptoms of an STI during the 12 months before the survey. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 221 More than two in five women and one in four men who had an STI or STI symptoms sought advice or treatment from a clinic, hospital, private doctor, or other health professionals. Fifty-three percent of women and 45% of men did not seek any treatment when they had an STI or STI symptoms (Figure 13.6). 13.7 INJECTIONS The overuse of injections in a health care setting can contribute to the transmission of blood-borne pathogens because it amplifies the effect of unsafe practices such as the reuse of injection equipment. The 2015 AfDHS respondents were asked if they had received any injections from a health worker in the 12 months before the survey and, if so, if their last injection was administered with a syringe from a new, unopened package. Self-administered medical injections (insulin injections for diabetes) were not included in the calculations. Thirty-five percent of women and 31% of men reported receiving an injection from a health worker during the 12 months before the survey (Table 3.14). More than 90% of women and men indicated that the syringe for their most recent injection came from a newly opened package. 13.8 HIV/AIDS-RELATED KNOWLEDGE AND BEHAVIOR AMONG YOUNG PEOPLE This section addresses HIV/AIDS-related knowledge among young people age 15-24 and assesses the extent to which young people are engaged in behaviors that put them at risk of contracting HIV. However, because the 2015 AfDHS surveyed ever-married women and men, there is no information for the never married youths age 15-24. 13.8.1 Knowledge Knowledge of how HIV is transmitted is crucial to enabling people to avoid HIV infection. Just 1% of young ever-married women and 6% of young ever-married men have comprehensive knowledge of HIV/AIDS (defined as knowing that both condom use and limiting sexual intercourse to one uninfected partner are HIV prevention methods, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission) (Table 13.15). Among both women and men, the proportion with comprehensive knowledge of HIV increases with age and educational attainment. Urban young people are more likely than rural young people to have comprehensive knowledge of HIV/AIDS; greater knowledge is also more prominent for young men. Knowledge of a source for condoms is relatively common among young ever-married women and men with 26% of young women and 58% of young men knowing a place where they can obtain a condom (Table 13.15). Figure 13.6 Women and men seeking treatment for STIs 43 3 2 53 25 4 2 45 Sought advice or treatment from a clinic/hospital/ private doctor/other health professional Sought advice or medicine from a shop/pharmacy Sought advice or treatment from any other source No advice or treatment Percentage of ever-married women and ever-married men age 15-49 with an STI or STI-Symptoms Women Men 222 • HIV/AIDS-related Knowledge, Attitudes, and Behavior 13.8.2 First Sex Young people who initiate sex at an early age are typically at higher risk of becoming pregnant or contracting an STI than young people who initiate sex at a later age. Consistent condom use can reduce such risks. In Afghanistan, 10% of ever-married women and 2% of ever-married men age 15-24 reported having sex before age 15 (Table 13.16). In contrast, among those age 18-24, 52% of young ever-married women and 22% of young ever-married men report having had sex by age 18 (Figure 13.7). Patterns by background characteristics  Rural and urban young married women are much more likely than their male counterparts to have had sex before age 15 or age 18.  The percentage of young women and men to who have sex before age 15 is higher among those with no education than among those with some education. 13.8.3 Coverage of HIV Testing Services Seeking an HIV test may be difficult for young people because many young people lack experience in accessing health services by themselves and because there are often barriers to young people obtaining services. One percent of young ever-married women and young ever-married men has been tested for HIV and received the results of the test (Table 13.17). Testing is more common in urban areas and among educated youths. LIST OF TABLES For more information on HIV/AIDS-related knowledge, attitudes, and behavior, see the following tables:  Table 13.1 Knowledge of AIDS  Table 13.2.1 Source of knowledge on HIV/AIDS: Women  Table 13.2.2 Source of knowledge on HIV/AIDS: Men  Table 13.3 Knowledge of HIV prevention methods  Table 13.4.1 Comprehensive knowledge about HIV/AIDS: Women  Table 13.4.2 Comprehensive knowledge about HIV/AIDS: Men  Table 13.5 Knowledge of prevention of mother to child transmission of HIV  Table 13.6.1 Accepting attitudes toward those living with HIV/AIDS: Women  Table 13.6.2 Accepting attitudes toward those living with HIV/AIDS: Men  Table 13.7 Attitudes toward negotiating safer sexual relations with husband  Table 13.8 Adult support of education about condom use to prevent AIDS  Table 13.9.1 Coverage of prior HIV testing: Women  Table 13.9.2 Coverage of prior HIV testing: Men  Table 13.10 Male circumcision Figure 13.7 Early Sexual Initiation 10 52 2 22 Sex by age 15 Sex by age 18 Women Men Percentage of ever-married women and ever-married men age 15-24 who had sex by age 15 and percentage of ever- married women and ever-married men age 18-24 who had HIV/AIDS-related Knowledge, Attitudes, and Behavior • 223  Table 13.11 Place of circumcision  Table 13.12 Age at circumcision  Table 13.13 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms  Table 13.14 Prevalence of medical injections  Table 13.15 Comprehensive knowledge about AIDS and of a source of condoms among young people  Table 13.16 Age at first sexual intercourse among young people  Table 13.17 Recent HIV tests among youth 224 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.1 Knowledge of AIDS Percentage of ever-married women and ever-married men age 15-49 who have heard of AIDS, by background characteristics, Afghanistan 2015 Women Men Background characteristic Has heard of AIDS Number of respondents Has heard of AIDS Number of respondents Age 15-24 22.3 7,915 57.3 1,305 15-19 19.0 1,825 50.8 142 20-24 23.2 6,089 58.1 1,162 25-29 24.5 6,299 57.7 2,422 30-39 25.2 8,765 59.8 3,943 40-49 22.4 6,482 57.8 3,091 Marital status Married 23.8 28,671 58.5 10,679 Divorced/Separated/ Widowed 19.2 790 45.9 81 Residence Urban 39.2 6,870 72.6 2,479 Rural 18.9 22,591 54.2 8,281 Province1 Kabul 39.5 3,658 68.1 1,350 Kapisa 22.2 205 76.5 63 Parwan 20.0 625 71.0 220 Wardak 32.8 382 39.8 171 Logar 66.1 472 64.9 204 Nangarhar 23.4 794 63.8 273 Laghman 46.6 583 76.0 227 Panjsher 8.8 54 59.7 18 Baghlan 15.9 839 47.6 281 Bamyan 4.5 303 33.8 94 Ghazni 21.9 1,328 43.9 619 Paktika 1.5 792 23.6 322 Paktya 20.0 542 93.5 206 Khost 18.4 851 91.5 334 Kunarha 9.0 559 68.4 151 Nooristan 0.6 222 19.0 66 Badakhshan 7.3 1,004 35.1 316 Takhar 15.8 1,105 53.6 296 Kunduz 35.0 1,232 60.3 479 Samangan 2.8 330 33.1 125 Balkh 22.3 1,781 48.7 616 Sar-E-Pul 7.7 654 45.9 195 Ghor 21.4 715 47.1 322 Daykundi 0.8 329 32.5 77 Urozgan 3.4 230 11.5 92 Kandahar 18.2 2,227 57.6 874 Jawzjan 22.0 614 65.1 218 Faryab 16.2 2,114 70.8 706 Helmand 6.1 875 79.3 355 Badghis 3.6 650 31.4 231 Herat 55.5 2,316 77.7 863 Farah 14.7 777 38.9 295 Nimroz 9.5 278 15.7 93 Education No education 18.6 24,604 43.9 5,447 Primary 33.8 2,330 63.0 1,987 Secondary 57.8 1,971 76.5 2,632 More than secondary 83.7 556 90.7 695 Wealth quintile Lowest 12.3 5,904 43.3 2,029 Second 16.8 6,001 50.2 2,233 Middle 17.9 5,888 54.0 2,160 Fourth 27.9 6,010 67.3 2,260 Highest 44.2 5,657 77.0 2,078 Total 23.7 29,461 58.4 10,760 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 225 Table 13.2.1 Source of knowledge on HIV/AIDS: Women Percentage of ever-married women 15-49 by source of knowledge on HIV/AIDS, according to background characteristics, Afghanistan 2015 Background characteristic Radio Television News- paper/ magazine Poster/ billboards Internet Health profes- sionals Friends/ relatives Other Number of women Age <20 8.5 10.4 1.9 0.6 0.7 2.4 7.5 3.0 1,825 20-34 8.2 15.5 1.5 0.7 0.7 3.1 10.0 3.6 16,690 35-49 8.4 15.1 1.3 0.6 0.6 3.0 9.0 3.2 10,945 Residence Urban 11.0 31.4 3.4 1.4 2.2 5.0 14.3 5.6 6,870 Rural 7.5 10.0 0.9 0.4 0.2 2.4 8.0 2.8 22,591 Province1 Kabul 12.1 31.4 3.2 1.4 2.4 4.0 12.3 4.1 3,658 Kapisa 8.4 15.5 1.0 0.3 0.0 1.7 6.1 3.3 205 Parwan 14.7 12.0 1.9 0.0 0.4 0.9 2.6 5.0 625 Wardak 5.7 6.2 0.1 2.2 0.0 0.7 26.3 5.7 382 Logar 50.6 23.7 1.9 0.0 0.2 0.2 17.5 6.2 472 Nangarhar 9.9 12.2 1.2 0.4 0.1 3.7 16.4 4.9 794 Laghman 34.9 17.0 1.1 0.4 0.6 8.4 20.5 6.2 583 Panjsher 2.8 5.7 0.9 0.5 0.2 0.1 5.8 2.5 54 Baghlan 2.7 14.9 0.9 0.1 1.1 0.1 5.5 1.4 839 Bamyan 0.7 1.6 0.9 0.0 0.0 0.6 2.1 0.9 303 Ghazni 5.8 5.1 0.8 0.3 0.1 0.1 18.4 3.5 1,328 Paktika 1.4 0.1 0.0 0.0 0.0 0.1 0.1 0.1 792 Paktya 16.2 3.6 0.4 0.0 0.0 0.6 5.8 1.4 542 Khost 13.5 7.7 0.2 0.1 0.0 0.8 10.4 2.2 851 Kunarha 4.1 2.7 0.3 0.0 2.0 1.5 2.6 0.9 559 Nooristan 0.2 0.1 0.0 0.0 0.0 0.1 0.5 0.4 222 Badakhshan 1.8 3.8 0.8 0.7 0.2 2.1 3.9 3.5 1,004 Takhar 7.2 10.1 0.3 0.0 0.0 1.1 4.9 2.1 1,105 Kunduz 19.2 27.1 5.2 2.2 1.6 2.3 13.8 2.9 1,232 Samangan 1.0 2.7 0.5 0.3 0.1 1.6 0.8 1.1 330 Balkh 1.0 18.3 1.0 0.0 0.4 2.5 9.8 4.9 1,781 Sar-E-Pul 1.2 6.2 0.5 0.2 1.2 2.1 3.7 3.5 654 Ghor 4.0 11.6 2.3 2.6 0.1 7.8 9.3 12.7 715 Daykundi 0.2 0.6 0.0 0.0 0.0 0.1 0.5 0.1 329 Urozgan 2.0 1.5 0.9 0.0 0.5 1.1 2.0 0.5 230 Kandahar 8.6 5.8 0.7 0.1 0.6 5.1 15.0 1.6 2,227 Jawzjan 8.0 15.1 2.3 0.1 0.1 1.0 16.6 7.0 614 Faryab 0.4 11.9 1.6 1.6 0.3 7.3 3.6 5.5 2,114 Helmand 3.9 3.6 0.1 0.2 0.0 1.1 1.1 0.6 875 Badghis 0.1 1.5 0.0 0.1 0.0 0.4 1.9 2.3 650 Herat 12.1 43.8 2.8 1.0 1.2 6.4 12.5 2.2 2,316 Farah 5.9 4.3 0.2 0.1 0.1 1.3 8.5 3.5 777 Nimroz 0.0 6.6 0.1 0.0 0.0 0.4 3.1 2.6 278 Education No education 7.0 10.2 0.4 0.2 0.2 1.9 8.5 1.9 24,604 Primary 11.7 26.1 1.5 1.0 0.3 3.8 10.9 4.1 2,330 Secondary 14.9 45.4 7.4 2.2 3.6 11.2 16.7 15.3 1,971 More than secondary 26.9 71.7 28.3 14.0 14.0 20.2 20.2 27.8 556 Wealth quintile Lowest 3.3 6.9 0.5 0.3 0.0 1.6 5.9 2.2 5,904 Second 6.6 7.9 0.5 0.4 0.2 1.9 7.5 1.9 6,001 Middle 7.1 8.6 0.7 0.1 0.2 1.5 7.9 2.4 5,888 Fourth 11.4 16.0 1.4 0.4 0.7 4.0 11.2 4.0 6,010 Highest 13.2 36.5 4.4 2.2 2.6 6.3 15.0 6.7 5,657 Total 8.3 15.0 1.5 0.6 0.7 3.0 9.5 3.4 29,461 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 226 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.2.2 Source of knowledge on HIV/AIDS: Men Percentage of ever-married men 15-49 by source of knowledge on HIV/AIDS, according to background characteristics, Afghanistan 2015 Background characteristic Radio Television News- paper/ magazine Poster/ billboards Internet Health profes- sionals Friends/ relatives Other Number of men Age <20 13.9 12.5 3.0 4.0 2.7 13.1 21.8 28.8 142 20-34 20.6 23.0 6.9 2.9 4.4 11.7 28.8 24.3 5,592 35-49 21.7 27.0 6.6 2.7 2.9 10.1 28.3 24.4 5,026 Residence Urban 30.2 44.6 15.0 5.4 9.9 13.2 26.9 24.8 2,479 Rural 18.3 18.8 4.2 2.1 1.8 10.3 29.0 24.3 8,281 Province1 Kabul 29.9 46.2 19.2 6.2 11.2 11.7 21.1 22.1 1,350 Kapisa 53.9 47.7 13.2 6.2 3.2 17.0 56.6 55.9 63 Parwan 29.8 21.2 6.5 2.7 1.4 7.3 48.5 41.4 220 Wardak 25.2 10.9 8.4 0.8 2.7 6.1 19.5 20.5 171 Logar 35.6 6.6 8.7 0.5 1.3 1.7 11.5 9.9 204 Nangarhar 38.8 30.0 8.9 1.3 4.2 22.2 29.7 25.1 273 Laghman 36.9 18.4 7.7 5.1 3.1 14.0 36.5 17.1 227 Panjsher 34.3 35.6 14.7 2.2 3.3 9.1 41.9 38.2 18 Baghlan 3.8 9.1 1.8 0.1 0.9 6.2 6.6 17.2 281 Bamyan 8.4 8.7 4.3 2.3 1.4 4.6 5.1 7.1 94 Ghazni 38.0 27.9 3.4 2.4 2.7 5.4 24.0 16.9 619 Paktika 18.7 10.3 3.3 1.5 4.4 2.3 6.9 7.5 322 Paktya 48.5 10.6 5.0 0.6 1.3 28.4 59.7 54.1 206 Khost 15.2 10.0 3.0 2.8 3.1 38.6 43.2 42.1 334 Kunarha 11.4 4.7 2.6 0.0 1.5 7.0 4.7 4.6 151 Nooristan 5.0 0.5 4.6 0.2 1.0 1.0 9.9 10.6 66 Badakhshan 15.0 15.9 7.8 2.9 3.1 10.3 16.5 19.5 316 Takhar 8.7 17.9 3.5 0.0 1.8 7.4 28.2 13.2 296 Kunduz 27.9 38.5 3.4 0.1 0.7 7.9 34.0 23.8 479 Samangan 18.9 9.9 2.4 0.1 0.2 1.1 6.5 1.6 125 Balkh 14.0 23.9 7.1 3.5 3.3 8.1 26.0 12.5 616 Sar-E-Pul 11.8 19.5 4.0 0.5 0.8 4.1 34.5 24.6 195 Ghor 6.5 14.3 9.3 1.4 1.5 25.0 17.5 19.9 322 Daykundi 6.2 10.3 2.6 0.1 0.0 0.1 1.6 3.2 77 Urozgan 2.0 1.2 0.0 0.0 0.6 0.7 1.7 1.0 92 Kandahar 12.4 5.7 2.5 1.2 2.4 14.0 38.1 28.3 874 Jawzjan 40.2 32.7 4.7 1.1 6.2 7.8 36.7 34.2 218 Faryab 3.9 42.2 3.7 4.6 0.1 17.8 36.5 40.7 706 Helmand 41.7 16.9 9.6 19.7 6.7 24.5 43.7 40.2 355 Badghis 9.2 15.4 1.0 1.2 0.1 5.6 9.4 20.0 231 Herat 19.8 46.9 6.9 0.8 5.7 2.3 50.1 36.5 863 Farah 9.8 8.9 0.4 0.1 0.6 2.4 18.4 19.2 295 Nimroz 1.4 6.2 1.9 0.0 0.2 0.4 3.6 0.8 93 Education No education 12.5 15.0 0.4 0.5 0.2 5.7 25.1 17.4 5,447 Primary 21.1 24.5 2.9 1.2 1.2 11.1 32.1 26.8 1,987 Secondary 33.1 36.0 14.8 6.6 6.7 18.4 32.9 32.9 2,632 More than secondary 41.9 58.7 36.4 11.6 25.8 23.6 27.6 39.7 695 Wealth quintile Lowest 11.9 14.3 4.3 0.7 1.1 7.2 22.3 18.3 2,029 Second 19.3 16.6 3.5 2.9 1.8 9.3 28.1 22.9 2,233 Middle 18.2 15.9 2.8 1.0 1.0 10.6 29.7 23.6 2,160 Fourth 23.2 28.1 6.0 3.0 2.7 13.9 33.9 28.2 2,260 Highest 32.5 49.1 17.3 6.7 11.9 13.6 27.7 28.7 2,078 Total 21.1 24.7 6.7 2.9 3.6 11.0 28.5 24.4 10,760 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 227 Table 13.3 Knowledge of HIV prevention methods Percentage of ever-married women and ever-married men age 15-49 who, in response to prompted questions, say that people can reduce the risk of getting HIV by using condoms every time they have sexual intercourse, and by having one sex partner who is not infected and has no other partners, by background characteristics, Afghanistan 2015 Percentage of ever-married women who say HIV can be prevented by: Percentage of ever-married men who say HIV can be prevented by: Background characteristic Using condoms1 Limiting sexual intercourse to one uninfected partner2 Using condoms and limiting sexual intercourse to one uninfected partner1,2 Number of women Using condoms1 Limiting sexual intercourse to one uninfected partner2 Using condoms and limiting sexual intercourse to one uninfected partner1,2 Number of men Age 15-24 11.5 12.9 8.6 7,915 40.4 47.4 36.6 1,305 15-19 10.1 12.6 7.8 1,825 27.8 37.9 24.9 142 20-24 11.9 12.9 8.9 6,089 41.9 48.6 38.0 1,162 25-29 13.0 13.4 9.3 6,299 38.2 47.8 34.1 2,422 30-39 13.7 14.5 10.1 8,765 38.3 47.7 32.5 3,943 40-49 10.9 13.0 8.3 6,482 36.8 45.1 32.1 3,091 Marital status Married 12.5 13.6 9.2 28,671 38.2 47.0 33.3 10,679 Divorced/Separated/Widowed 8.5 8.9 6.7 790 26.5 35.0 26.4 81 Residence Urban 21.8 22.3 15.3 6,870 47.5 57.0 41.1 2,479 Rural 9.5 10.8 7.3 22,591 35.3 43.9 30.9 8,281 Province Kabul 23.6 22.7 16.4 3,658 41.8 52.7 36.3 1,350 Kapisa 7.5 7.3 4.5 205 69.2 72.6 67.4 63 Parwan 15.4 14.4 12.7 625 53.3 51.6 47.0 220 Wardak 14.7 15.2 10.0 382 25.2 36.2 24.5 171 Logar 40.5 53.6 38.0 472 32.8 50.5 27.5 204 Nangarhar 12.8 13.5 10.1 794 34.5 59.5 33.6 273 Laghman 32.4 40.6 29.0 583 53.6 63.4 47.8 227 Panjsher 1.4 2.0 1.1 54 18.0 19.2 14.3 18 Baghlan 4.9 8.8 4.6 839 11.9 5.8 2.3 281 Bamyan 2.9 2.9 2.5 303 17.6 23.9 15.9 94 Ghazni 8.1 9.6 4.4 1,328 22.2 31.9 15.9 619 Paktika 1.4 1.5 1.4 792 18.4 18.8 15.7 322 Paktya 8.1 13.8 6.7 542 88.2 81.7 78.5 206 Khost 8.7 8.6 6.0 851 69.1 79.4 65.4 334 Kunarha 3.1 3.1 2.3 559 44.7 51.6 39.3 151 Nooristan 0.1 0.2 0.1 222 7.9 7.3 4.0 66 Badakhshan 3.0 4.1 2.6 1,004 13.1 25.9 10.1 316 Takhar 2.6 7.1 1.7 1,105 36.9 41.8 33.5 296 Kunduz 19.0 22.9 15.8 1,232 45.1 52.4 38.9 479 Samangan 1.9 2.3 1.4 330 24.8 26.2 19.8 125 Balkh 15.5 14.4 11.5 1,781 40.6 34.9 31.1 616 Sar-E-Pul 6.1 4.6 4.0 654 20.3 37.5 17.1 195 Ghor 12.5 20.4 12.1 715 37.8 38.1 32.0 322 Daykundi 0.2 0.6 0.1 329 14.5 18.6 12.3 77 Urozgan 1.5 1.1 1.1 230 5.6 6.6 5.2 92 Kandahar 5.2 6.5 2.4 2,227 26.4 46.4 22.8 874 Jawzjan 16.4 15.2 13.0 614 40.0 61.6 38.1 218 Faryab 10.9 10.9 7.3 2,114 40.9 60.3 31.5 706 Helmand 4.9 4.7 3.9 875 37.8 50.2 33.1 355 Badghis 2.4 2.9 2.0 650 29.1 30.5 28.4 231 Herat 22.4 21.8 14.9 2,316 66.7 73.6 64.0 863 Farah 9.3 13.1 8.6 777 31.0 37.2 30.3 295 Nimroz 4.8 4.3 3.7 278 11.7 12.2 9.6 93 Education No education 8.6 9.9 6.2 24,604 26.3 34.9 23.1 5,447 Primary 19.2 20.2 14.3 2,330 38.0 47.4 31.5 1,987 Secondary 39.0 39.3 31.2 1,971 53.5 63.5 47.3 2,632 More than secondary 54.8 54.4 39.7 556 72.5 77.3 64.6 695 Wealth quintile Lowest 5.2 6.8 4.2 5,904 28.3 32.8 23.8 2,029 Second 7.8 8.9 5.9 6,001 34.1 41.1 30.4 2,233 Middle 8.5 10.1 6.1 5,888 32.9 43.4 28.9 2,160 Fourth 15.2 16.2 11.3 6,010 43.7 53.9 37.3 2,260 Highest 25.6 26.0 18.5 5,657 51.4 63.2 45.6 2,078 Total 12.4 13.5 9.1 29,461 38.1 47.0 33.2 10,760 1 Using condoms every time they have sexual intercourse. 2 Partner who has no other partners. 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 228 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.4.1 Comprehensive knowledge about HIV/AIDS: Women Percentage of ever-married women age 15-49 who say that a healthy-looking person can have HIV and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of HIV, and the percentage with a comprehensive knowledge about AIDS by background characteristics, Afghanistan 2015 Background characteristic Percentage of respondents who say that: Percentage who say that a healthy looking person can have HIV and who reject the two most common local miscon- ceptions1 Percentage with a compre- hensive knowledge about AIDS2 Number of women A healthy- looking person can have HIV HIV cannot be transmitted by mosquito bites HIV cannot be transmitted by supernatural means A person cannot become infected by sharing food with a person who has AIDS Age 15-24 9.8 7.5 13.5 8.9 2.0 1.0 7,915 15-19 9.3 5.3 9.2 9.0 1.2 0.6 1,825 20-24 10.0 8.1 14.7 8.9 2.2 1.2 6,089 25-29 10.5 9.6 15.0 9.7 2.3 1.2 6,299 30-39 9.4 8.5 15.7 9.2 2.0 1.1 8,765 40-49 9.7 7.3 13.1 7.9 2.1 1.3 6,482 Marital status Married 9.9 8.3 14.4 9.0 2.1 1.1 28,671 Divorced/Separated/Widowed 7.3 4.3 13.1 6.3 1.7 1.7 790 Residence Urban 15.9 15.1 24.8 16.4 3.4 1.7 6,870 Rural 8.0 6.1 11.2 6.7 1.7 1.0 22,591 Province3 Kabul 14.7 15.8 24.7 16.4 2.9 1.4 3,658 Kapisa 7.1 10.3 11.7 10.7 2.6 0.6 205 Parwan 7.2 13.7 17.1 12.6 3.2 2.7 625 Wardak 6.7 17.8 17.9 18.1 4.8 3.9 382 Logar 30.7 39.8 56.5 47.0 28.5 23.2 472 Nangarhar 11.2 13.0 18.0 12.1 5.0 2.4 794 Laghman 26.2 9.7 33.2 17.0 1.5 0.8 583 Panjsher 1.1 6.0 6.6 6.9 0.5 0.3 54 Baghlan 4.4 3.9 5.0 3.5 0.8 0.5 839 Bamyan 2.0 0.4 2.6 1.2 0.2 0.0 303 Ghazni 13.3 3.7 6.4 4.8 0.7 0.6 1,328 Paktika 0.8 1.0 1.2 0.5 0.0 0.0 792 Paktya 6.0 6.4 11.7 7.1 0.7 0.5 542 Khost 4.1 7.8 7.4 6.8 1.3 0.1 851 Kunarha 1.5 0.9 1.9 1.2 0.2 0.2 559 Nooristan 0.2 0.3 0.3 0.1 0.0 0.0 222 Badakhshan 2.5 4.1 5.6 0.8 0.2 0.1 1,004 Takhar 0.8 5.1 6.1 5.0 0.2 0.0 1,105 Kunduz 17.8 7.6 13.0 9.2 2.4 1.7 1,232 Samangan 0.4 2.3 2.0 1.6 0.0 0.0 330 Balkh 8.1 9.0 16.5 9.7 2.3 1.4 1,781 Sar-E-Pul 2.6 1.4 2.6 1.4 0.0 0.0 654 Ghor 4.8 1.7 9.3 6.6 0.0 0.0 715 Daykundi 0.2 0.6 0.4 0.1 0.0 0.0 329 Urozgan 1.6 0.1 2.0 0.0 0.0 0.0 230 Kandahar 9.7 7.7 12.2 6.6 2.1 0.5 2,227 Jawzjan 7.5 5.1 5.5 3.0 0.1 0.1 614 Faryab 10.7 8.6 11.3 2.9 0.8 0.0 2,114 Helmand 0.9 3.2 4.2 3.7 0.3 0.3 875 Badghis 2.3 1.7 2.2 1.7 1.2 0.9 650 Herat 23.6 12.2 39.3 22.3 4.0 1.4 2,316 Farah 7.6 2.9 7.2 4.9 0.6 0.2 777 Nimroz 3.0 1.2 3.5 2.1 0.5 0.1 278 Education No education 7.4 5.7 10.7 6.3 1.4 0.7 24,604 Primary 13.2 12.5 22.1 15.1 3.9 2.4 2,330 Secondary 26.2 24.1 38.1 23.8 5.5 3.2 1,971 More than secondary 42.3 42.7 60.5 45.8 13.6 9.9 556 Wealth quintile Lowest 4.8 2.7 6.3 3.9 0.9 0.4 5,904 Second 6.9 4.3 9.8 5.7 1.3 0.9 6,001 Middle 7.7 5.7 10.7 6.6 1.7 1.1 5,888 Fourth 11.4 11.3 17.5 10.2 2.5 1.2 6,010 Highest 18.8 17.4 28.4 18.7 4.1 2.2 5,657 Total 9.8 8.2 14.4 8.9 2.1 1.2 29,461 1 Two most common local misconceptions: HIV can be transmitted by mosquito bites and by sharing food with a person who has AIDS. 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about transmission or prevention of the AIDS virus. 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 229 Table 13.4.2 Comprehensive knowledge about HIV/AIDS: Men Percentage of ever-married men age 15-49 who say that a healthy-looking person can have HIV and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of HIV, and the percentage with a comprehensive knowledge about AIDS by background characteristics, Afghanistan 2015 Background characteristic Percentage of respondents who say that: Percentage who say that a healthy looking person can have HIV and who reject the two most common local miscon- ceptions1 Percentage with a compre- hensive knowledge about AIDS2 Number of men A healthy- looking person can have HIV HIV cannot be transmitted by mosquito bites HIV cannot be transmitted by super- natural means A person cannot become infected by sharing food with a person who has AIDS Age 15-24 27.3 22.3 34.2 20.7 8.8 6.3 1,305 15-19 22.2 17.7 27.5 14.5 6.5 4.3 142 20-24 28.0 22.9 35.0 21.4 9.1 6.5 1,162 25-29 29.8 23.1 33.2 23.2 8.0 5.2 2,422 30-39 31.6 23.6 34.4 23.6 7.8 5.3 3,943 40-49 27.5 23.2 35.0 22.1 7.2 3.6 3,091 Marital status Married 29.5 23.3 34.3 22.7 7.8 5.0 10,679 Divorced/Separated/Widowed 29.5 19.8 36.2 19.1 1.0 1.0 81 Residence Urban 39.2 29.4 44.9 32.4 10.5 7.9 2,479 Rural 26.6 21.4 31.1 19.8 6.9 4.1 8,281 Province3 Kabul 31.7 28.0 43.7 32.1 10.6 6.6 1,350 Kapisa 23.2 24.0 60.0 21.3 4.9 4.8 63 Parwan 26.9 5.0 58.8 8.5 3.0 2.1 220 Wardak 14.6 4.9 11.9 20.7 1.5 1.2 171 Logar 42.4 49.7 52.3 43.4 34.4 12.7 204 Nangarhar 29.5 19.4 57.1 36.7 10.5 8.8 273 Laghman 30.2 15.4 62.6 35.6 1.5 0.8 227 Panjsher 28.6 47.4 51.9 45.1 21.1 1.4 18 Baghlan 27.2 13.8 30.3 8.6 3.5 0.0 281 Bamyan 14.8 6.8 6.9 5.1 0.6 0.4 94 Ghazni 26.2 28.9 28.5 23.2 10.9 4.3 619 Paktika 13.8 18.5 19.0 11.7 5.6 4.4 322 Paktya 23.4 44.1 76.8 52.0 9.6 9.6 206 Khost 61.8 36.5 54.5 53.1 17.9 13.8 334 Kunarha 26.4 36.7 42.6 22.9 10.7 9.7 151 Nooristan 12.4 5.5 3.6 3.0 1.9 1.4 66 Badakhshan 5.9 8.3 16.4 9.5 0.8 0.6 316 Takhar 27.8 25.1 35.0 14.2 5.0 2.5 296 Kunduz 21.2 30.2 25.5 27.9 4.7 3.3 479 Samangan 16.9 21.7 22.5 16.1 7.0 4.5 125 Balkh 23.4 10.8 25.5 6.3 2.0 1.5 616 Sar-E-Pul 22.7 10.0 27.7 10.8 1.8 0.2 195 Ghor 7.8 5.2 28.1 4.0 0.3 0.2 322 Daykundi 9.8 11.5 22.7 10.1 1.4 0.7 77 Urozgan 3.5 0.4 0.7 2.3 0.2 0.0 92 Kandahar 38.7 35.5 45.7 22.8 13.8 7.5 874 Jawzjan 48.5 21.4 41.6 11.9 3.9 2.6 218 Faryab 55.5 25.1 27.3 15.0 1.9 0.1 706 Helmand 21.4 24.4 28.8 21.7 2.7 2.0 355 Badghis 15.4 17.5 19.4 11.2 7.7 7.7 231 Herat 37.1 28.3 26.5 39.9 14.9 12.3 863 Farah 27.8 14.5 24.0 14.1 5.3 4.5 295 Nimroz 5.4 0.8 5.5 4.4 0.0 0.0 93 Education No education 17.8 16.6 22.7 15.3 4.2 2.4 5,447 Primary 27.9 22.6 35.9 22.4 5.8 2.6 1,987 Secondary 45.6 32.1 49.0 30.6 12.5 8.4 2,632 More than secondary 64.1 42.9 65.4 51.7 23.3 18.6 695 Wealth quintile Lowest 15.0 14.2 21.2 13.0 4.1 2.8 2,029 Second 23.2 20.9 27.3 17.0 5.4 3.6 2,233 Middle 27.6 21.2 33.2 20.5 7.2 4.1 2,160 Fourth 36.8 26.8 41.8 25.1 10.1 5.4 2,260 Highest 44.3 32.8 47.6 38.1 11.9 8.8 2,078 Total 29.5 23.2 34.3 22.7 7.8 4.9 10,760 1 Two most common local misconceptions: HIV can be transmitted by mosquito bites and by sharing food with a person who has AIDS. 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about transmission or prevention of the AIDS virus. 3 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 230 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.5 Knowledge of prevention of mother to child transmission of HIV Percentage of ever-married women and ever-married men age 15-49 who know that HIV can be transmitted from mother to child by breastfeeding and that the risk of mother-to-child transmission (MTCT) of HIV can be reduced by mother taking special drugs during pregnancy, by background characteristics, Afghanistan 2015 Women Men Percentage who know that: Percentage who know that: Background characteristic HIV can be transmitted by breast- feeding Risk of MTCT can be reduced by mother taking special drugs during pregnancy HIV can be transmitted by breastfeeding and risk of MTCT can be reduced by mother taking special drugs during pregnancy Number of women HIV can be transmitted by breast- feeding Risk of MTCT can be reduced by mother taking special drugs during pregnancy HIV can be transmitted by breastfeeding and risk of MTCT can be reduced by mother taking special drugs during pregnancy Number of men Age 15-24 14.2 8.2 6.6 7,915 36.3 21.2 15.8 1,305 15-19 12.4 9.3 7.7 1,825 32.3 24.5 17.3 142 20-24 14.7 7.9 6.3 6,089 36.8 20.8 15.6 1,162 25-29 15.3 8.2 6.8 6,299 39.1 20.4 16.9 2,422 30-39 15.5 8.5 6.5 8,765 37.9 20.8 16.5 3,943 40-49 15.1 6.9 5.5 6,482 38.0 18.5 14.5 3,091 Marital status Married 15.0 8.0 6.4 28,671 38.0 20.1 15.9 10,679 Divorced/Separated/Widowed 15.0 7.6 7.3 790 36.4 15.5 14.1 81 Currently pregnant Pregnant 12.4 7.5 5.7 6,412 na na na na Not pregnant or not sure 15.7 8.1 6.6 23,049 na na na na Residence Urban 26.0 14.9 12.0 6,870 47.9 28.4 23.8 2,479 Rural 11.7 5.9 4.7 22,591 35.0 17.6 13.6 8,281 Province1 Kabul 27.6 17.9 14.3 3,658 46.5 28.8 25.1 1,350 Kapisa 8.2 5.1 4.3 205 70.5 14.6 14.4 63 Parwan 15.5 9.0 7.2 625 64.9 13.3 12.8 220 Wardak 9.9 1.5 1.5 382 30.0 9.9 7.9 171 Logar 19.1 14.5 7.0 472 21.3 30.2 10.3 204 Nangarhar 14.1 8.5 7.0 794 42.9 10.7 10.4 273 Laghman 34.6 29.5 26.7 583 49.0 34.5 29.5 227 Panjsher 5.7 3.0 2.1 54 38.2 6.9 6.1 18 Baghlan 8.5 1.6 1.6 839 26.2 9.3 9.0 281 Bamyan 2.8 2.6 2.0 303 14.3 6.7 5.3 94 Ghazni 13.9 2.9 1.4 1,328 21.5 16.9 6.5 619 Paktika 0.1 0.9 0.0 792 10.9 8.2 2.0 322 Paktya 11.1 6.9 5.0 542 41.5 33.5 17.9 206 Khost 6.0 4.6 3.9 851 56.0 45.6 42.7 334 Kunarha 5.5 2.3 1.9 559 9.6 3.5 2.5 151 Nooristan 0.2 0.0 0.0 222 10.1 4.0 3.0 66 Badakhshan 3.0 3.1 1.6 1,004 22.0 3.7 2.4 316 Takhar 6.4 3.3 2.7 1,105 35.4 18.0 15.9 296 Kunduz 11.1 5.3 4.8 1,232 40.9 21.6 18.2 479 Samangan 1.5 0.8 0.5 330 16.5 10.8 6.9 125 Balkh 17.2 6.6 5.6 1,781 39.2 17.4 17.2 616 Sar-E-Pul 6.8 3.9 3.9 654 31.1 10.7 9.3 195 Ghor 21.0 19.9 19.6 715 33.4 35.9 25.3 322 Daykundi 0.2 0.0 0.0 329 11.5 5.5 4.6 77 Urozgan 1.2 0.1 0.1 230 2.7 0.0 0.0 92 Kandahar 6.0 2.5 1.9 2,227 43.1 20.4 17.7 874 Jawzjan 8.7 2.9 2.9 614 63.0 4.7 4.7 218 Faryab 13.6 4.8 3.0 2,114 70.1 26.2 26.0 706 Helmand 1.6 1.0 0.1 875 37.6 31.3 25.3 355 Badghis 2.4 1.1 1.0 650 24.3 16.8 15.3 231 Herat 49.1 20.3 17.5 2,316 36.6 12.9 6.9 863 Farah 5.3 9.8 4.4 777 21.3 26.5 15.8 295 Nimroz 5.4 1.1 1.1 278 4.2 5.5 3.0 93 Education No education 11.2 5.9 4.6 24,604 26.1 12.4 9.4 5,447 Primary 22.0 11.3 8.9 2,330 39.0 21.9 16.5 1,987 Secondary 40.5 22.9 18.7 1,971 53.8 29.3 24.0 2,632 More than secondary 63.2 35.6 30.2 556 69.1 39.9 34.5 695 Wealth quintile Lowest 8.6 4.4 4.1 5,904 25.1 12.5 9.5 2,029 Second 9.7 5.1 3.9 6,001 30.9 16.5 12.3 2,233 Middle 10.9 5.3 3.9 5,888 35.4 15.4 11.7 2,160 Fourth 16.6 8.2 6.6 6,010 46.2 22.4 17.2 2,260 Highest 29.9 17.4 13.8 5,657 52.0 33.7 29.1 2,078 Total 15.0 8.0 6.4 29,461 38.0 20.1 15.9 10,760 na = Not applicable. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 231 Table 13.6.1 Accepting attitudes toward those living with HIV/AIDS: Women Among ever-married women age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by background characteristics, Afghanistan 2015 Percentage of women who: Percentage expressing acceptance attitudes on all four indicators Number of women who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent's home Would buy fresh vegetables from shopkeeper who has HIV Say that a female teacher who has HIV but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with HIV Age 15-24 34.3 30.3 26.8 69.1 5.6 1,763 15-19 34.8 31.5 35.9 66.7 4.9 347 20-24 34.2 30.0 24.6 69.7 5.7 1,416 25-29 29.5 32.1 27.9 72.3 8.4 1,542 30-39 35.4 32.1 25.7 70.5 4.4 2,212 40-49 34.1 27.8 27.3 70.8 5.8 1,454 Marital status Married 33.2 30.4 27.0 70.3 5.8 6,818 Divorced/Separated/ Widowed 50.3 47.7 19.1 86.5 9.2 152 Residence Urban 30.7 20.4 22.6 69.9 3.5 2,695 Rural 35.4 37.3 29.5 71.1 7.3 4,275 Province1 Kabul 30.2 23.6 31.1 61.4 5.4 1,445 Kapisa 18.3 46.6 57.1 84.2 1.4 46 Parwan 57.7 66.8 58.5 91.8 43.9 125 Wardak 41.6 58.0 65.8 68.2 11.6 125 Logar 17.3 57.7 58.8 69.5 3.9 312 Nangarhar 17.6 49.1 49.2 84.2 3.7 186 Laghman 12.8 8.3 6.3 84.4 0.1 272 Panjsher 68.9 78.4 83.2 28.5 3.1 5 Baghlan 14.5 43.0 45.0 81.6 0.0 133 Bamyan (8.8) (21.1) (25.8) (84.6) (1.4) 14 Ghazni 15.6 22.6 15.2 41.6 3.2 291 Paktika * * * * * 12 Paktya 12.7 14.3 11.0 34.4 0.1 108 Khost 7.7 24.4 22.0 63.2 0.8 156 Kunarha 34.0 20.7 15.5 17.4 0.1 50 Nooristan * * * * * 1 Badakhshan 26.6 28.1 39.2 59.8 14.0 73 Takhar 7.4 6.7 12.1 87.1 0.9 174 Kunduz 41.1 13.3 14.4 62.3 1.0 432 Samangan (6.6) (40.0) (49.9) (33.9) (0.0) 9 Balkh 17.5 14.8 12.4 69.9 2.7 398 Sar-E-Pul 37.0 14.7 32.7 61.5 0.0 51 Ghor 3.5 31.3 67.1 92.5 0.3 153 Daykundi * * * * * 3 Urozgan (32.7) (0.0) (13.8) (38.9) (0.0) 8 Kandahar 34.1 1.8 3.3 72.5 0.2 405 Jawzjan 61.4 54.6 38.9 80.6 27.9 135 Faryab 13.4 21.3 12.9 87.1 1.7 342 Helmand 10.9 2.5 38.4 91.3 0.0 53 Badghis (59.7) (1.2) (30.2) (5.0) (0.0) 23 Herat 65.6 55.7 23.6 83.5 11.8 1,286 Farah 73.4 39.2 30.8 34.3 2.2 114 Nimroz 11.4 12.6 17.9 62.8 6.1 26 Education No education 35.2 30.2 24.9 69.6 5.4 4,576 Primary 34.4 33.4 29.8 70.7 7.8 788 Secondary 29.3 30.4 31.0 72.0 5.1 1,140 More than secondary 26.3 32.8 29.9 76.6 9.0 465 Wealth quintile Lowest 39.9 41.2 30.0 73.6 8.4 729 Second 45.0 39.4 31.2 69.9 9.8 1,009 Middle 31.4 33.7 27.9 69.1 5.3 1,053 Fourth 27.2 30.0 24.9 71.1 4.4 1,678 Highest 32.3 23.5 24.9 70.3 4.7 2,502 Total 33.6 30.8 26.8 70.6 5.9 6,970 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 232 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.6.2 Accepting attitudes toward those living with HIV/AIDS: Men Among ever-married men age 15-49 who have heard of HIV/AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by background characteristics, Afghanistan 2015 Percentage of men who: Percentage expressing acceptance attitudes on all four indicators Number of men who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent's home Would buy fresh vegetables from shopkeeper who has HIV Say that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with HIV Age 15-24 39.5 28.4 29.0 62.5 4.4 747 15-19 48.4 27.2 21.5 51.3 2.2 72 20-24 38.6 28.5 29.8 63.7 4.6 675 25-29 40.1 29.4 32.8 66.3 6.8 1,397 30-39 37.5 25.7 26.2 67.5 5.3 2,356 40-49 37.5 26.2 26.6 70.5 5.3 1,787 Marital status Married 38.4 26.9 28.1 67.6 5.5 6,250 Divorced/Separated/ Widowed (31.7) (31.9) (31.7) (52.8) (10.6) 37 Residence Urban 46.3 28.5 38.6 65.4 8.6 1,799 Rural 35.1 26.3 23.9 68.3 4.3 4,488 Province1 Kabul 40.0 25.2 36.6 65.6 4.3 919 Kapisa 2.6 28.7 14.9 98.1 0.0 48 Parwan 25.0 10.4 20.0 54.0 6.6 157 Wardak 47.1 26.7 22.1 81.4 5.5 68 Logar 14.7 57.9 21.6 65.9 1.1 132 Nangarhar 31.0 24.5 21.8 79.9 6.0 174 Laghman 34.4 19.6 8.2 73.2 1.5 172 Panjsher 6.7 30.6 30.6 84.5 0.0 11 Baghlan 14.7 47.9 47.1 88.8 2.6 134 Bamyan 23.3 18.9 16.0 85.3 1.5 32 Ghazni 33.2 46.5 31.7 49.0 1.6 272 Paktika 58.3 50.3 51.8 31.7 5.7 76 Paktya 37.8 35.3 31.1 64.9 3.9 192 Khost 34.8 7.3 5.6 97.1 1.2 306 Kunarha 31.8 17.1 14.7 61.8 1.0 103 Nooristan 32.3 21.9 10.3 43.8 3.3 13 Badakhshan 66.9 19.6 21.7 9.0 0.2 111 Takhar 18.0 16.1 9.4 53.7 0.3 159 Kunduz 46.7 28.8 44.4 54.0 3.8 289 Samangan 13.7 6.9 37.4 80.3 0.3 41 Balkh 8.2 6.8 14.6 76.6 0.4 300 Sar-E-Pul 39.2 9.7 8.0 84.0 2.5 89 Ghor 19.9 33.8 10.9 80.8 0.0 152 Daykundi (8.1) (20.5) (15.5) (61.9) (0.0) 25 Urozgan (12.3) (0.0) (0.0) (67.6) (0.0) 11 Kandahar 74.8 29.5 45.4 65.3 16.0 503 Jawzjan 22.7 2.2 2.9 80.0 0.0 142 Faryab 27.1 32.7 26.4 72.9 6.4 500 Helmand 18.9 5.5 1.1 81.6 0.0 281 Badghis 74.2 6.0 22.1 54.9 0.2 73 Herat 57.3 43.2 48.0 67.7 17.8 670 Farah 73.2 61.1 39.3 23.7 6.6 115 Nimroz (6.6) (0.0) (2.5) (28.3) (0.0) 15 Education No education 37.7 20.3 22.9 65.9 3.4 2,392 Primary 37.4 24.6 24.0 66.7 3.1 1,253 Secondary 38.9 30.0 30.8 69.0 7.4 2,013 More than secondary 40.7 47.5 47.3 70.4 13.0 630 Wealth quintile Lowest 37.7 23.8 22.8 67.9 4.8 878 Second 29.3 26.5 25.6 66.8 3.1 1,121 Middle 33.3 23.7 20.8 69.7 2.4 1,166 Fourth 37.9 23.8 24.4 68.9 4.9 1,521 Highest 49.0 34.4 41.6 64.8 10.6 1,601 Total 38.3 27.0 28.1 67.5 5.5 6,287 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 233 Table 13.7 Attitudes toward negotiating safer sexual relations with husband Percentage of ever-married women and ever-married men age 15-49 who believe that a woman is justified in refusing to have sexual intercourse with her husband if she knows that he has sexual intercourse with other women, and percentage who believe that a woman is justified in asking that they use a condom if she knows that her husband has a sexually transmitted infection (STI), by background characteristics, Afghanistan 2015 Women Men Woman is justified in: Woman is justified in: Background characteristic Refusing to have sexual intercourse with her husband if she knows he has sex with other women Asking that they use a condom if she knows that her husband has an STI Number of women Refusing to have sexual intercourse with her husband if she knows he has sex with other women Asking that they use a condom if she knows that her husband has an STI Number of men Age 15-24 52.7 57.1 7,915 71.1 75.9 1,305 15-19 52.5 55.0 1,825 63.9 74.3 142 20-24 52.8 57.8 6,089 72.0 76.1 1,162 25-29 53.0 59.5 6,299 68.9 78.0 2,422 30-39 55.0 59.8 8,765 69.5 76.8 3,943 40-49 54.7 57.3 6,482 68.0 75.5 3,091 Marital status Married 54.2 58.7 28,671 69.2 76.7 10,679 Divorced/Separated/ Widowed 40.8 50.7 790 55.8 64.0 81 Residence Urban 62.9 65.8 6,870 75.7 82.1 2,479 Rural 51.1 56.2 22,591 67.2 74.9 8,281 Province1 Kabul 61.3 59.3 3,658 75.8 80.9 1,350 Kapisa 78.1 40.3 205 95.8 97.2 63 Parwan 42.9 50.6 625 82.3 84.7 220 Wardak 75.0 56.3 382 75.8 54.3 171 Logar 64.3 62.1 472 62.9 63.5 204 Nangarhar 50.5 66.3 794 66.2 77.5 273 Laghman 53.3 47.5 583 74.6 88.0 227 Panjsher 69.8 67.0 54 87.0 86.4 18 Baghlan 53.8 52.4 839 43.0 51.8 281 Bamyan 72.6 68.6 303 63.5 46.8 94 Ghazni 58.2 58.9 1,328 61.3 82.6 619 Paktika 56.0 61.5 792 82.3 82.2 322 Paktya 48.7 64.5 542 81.0 93.4 206 Khost 65.7 64.8 851 94.0 91.4 334 Kunarha 15.8 15.7 559 46.7 48.9 151 Nooristan 6.5 37.4 222 52.1 29.0 66 Badakhshan 46.4 38.0 1,004 67.0 65.5 316 Takhar 50.7 35.8 1,105 84.7 77.1 296 Kunduz 27.9 26.1 1,232 52.4 71.8 479 Samangan 56.8 34.6 330 60.8 59.8 125 Balkh 87.3 90.2 1,781 86.2 86.9 616 Sar-E-Pul 77.4 58.0 654 81.9 89.5 195 Ghor 32.2 61.2 715 52.6 77.8 322 Daykundi 14.3 52.8 329 24.4 31.3 77 Urozgan 58.8 32.5 230 13.2 13.2 92 Kandahar 49.1 53.2 2,227 47.0 46.7 874 Jawzjan 82.7 83.0 614 89.9 96.8 218 Faryab 45.3 79.3 2,114 67.3 97.9 706 Helmand 55.0 54.5 875 76.3 72.1 355 Badghis 27.0 20.9 650 75.9 74.6 231 Herat 51.9 78.4 2,316 79.9 96.6 863 Farah 49.5 52.0 777 55.1 62.9 295 Nimroz 71.3 75.6 278 82.1 88.6 93 Education No education 51.9 55.8 24,604 62.9 68.5 5,447 Primary 64.2 68.4 2,330 73.8 83.5 1,987 Secondary 61.9 75.0 1,971 74.6 84.0 2,632 More than secondary 67.4 75.8 556 83.6 92.0 695 Wealth quintile Lowest 51.4 55.4 5,904 60.3 73.0 2,029 Second 50.0 54.1 6,001 66.0 73.3 2,233 Middle 48.5 51.0 5,888 69.0 71.5 2,160 Fourth 55.7 63.3 6,010 70.6 78.5 2,260 Highest 64.2 68.8 5,657 79.7 86.8 2,078 Total 53.9 58.5 29,461 69.1 76.6 10,760 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 234 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.8 Adult support of education about condom use to prevent AIDS Percentage of ever-married women and ever-married men age 18-49 who agree that children age 12-14 years should be taught about using a condom to avoid AIDS, by background characteristics, Afghanistan 2015 Women Men Background characteristic Percentage who agree Number Percentage who agree Number Age 18-24 5.4 7,476 15.0 1,284 18-19 5.0 1,387 15.1 122 20-24 5.5 6,089 14.9 1,162 25-29 5.8 6,299 16.6 2,422 30-39 6.3 8,765 19.2 3,943 40-49 5.2 6,482 17.1 3,091 Marital status Married 5.7 28,237 17.4 10,659 Divorced/separated/ widowed 4.7 785 30.1 81 Residence Urban 11.2 6,794 21.2 2,478 Rural 4.0 22,229 16.4 8,261 Province1 Kabul 12.4 3,622 25.9 1,350 Kapisa 3.4 205 36.5 63 Parwan 10.3 621 53.0 220 Wardak 2.3 381 9.9 171 Logar 32.3 472 39.2 204 Nangarhar 8.1 781 8.9 273 Laghman 4.8 567 16.1 227 Panjsher 2.4 54 11.0 18 Baghlan 2.2 829 26.9 281 Bamyan 1.0 303 7.1 94 Ghazni 2.0 1,302 3.6 619 Paktika 0.8 792 10.6 322 Paktya 6.6 540 63.5 205 Khost 1.5 843 11.6 333 Kunarha 0.4 555 9.4 150 Nooristan 0.0 221 1.8 66 Badakhshan 0.2 987 2.7 316 Takhar 0.9 1,096 9.6 296 Kunduz 2.6 1,229 14.7 479 Samangan 1.0 325 4.1 125 Balkh 9.3 1,766 10.1 614 Sar-E-Pul 3.3 639 9.9 195 Ghor 6.4 697 12.0 317 Daykundi 0.0 320 1.5 77 Urozgan 0.0 230 0.2 92 Kandahar 2.2 2,206 2.9 874 Jawzjan 3.4 612 4.4 218 Faryab 3.0 2,070 16.3 703 Helmand 0.3 856 19.5 353 Badghis 2.5 614 14.9 229 Herat 11.9 2,288 36.9 863 Farah 9.0 719 32.8 292 Nimroz 2.4 264 7.9 93 Education No education 3.9 24,316 10.9 5,440 Primary 10.8 2,242 18.8 1,984 Secondary 18.6 1,909 25.3 2,620 More than secondary 19.0 556 36.5 695 Wealth quintile Lowest 2.9 5,807 12.2 2,020 Second 3.0 5,871 16.7 2,227 Middle 3.9 5,815 16.5 2,158 Fourth 6.1 5,927 18.6 2,257 Highest 12.8 5,601 23.4 2,077 Total 18-49 5.7 29,023 17.5 10,739 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 235 Table 13.9.1 Coverage of prior HIV testing: Women Percentage of ever-married women age 15-49 who know where to obtain an HIV test, percent distribution of women age 15-49 by testing status and by whether they received the results of the last test, the percentage of women ever tested, and the percentage of women age 15-49 who were tested in the past 12 months and received the results of the last test, according to background characteristics, Afghanistan 2015 Percentage who know where to get an HIV test Percent distribution of women by testing status and by whether they received the results of the last test Percentage who have been tested for HIV in the past 12 months and received the results of the last test Background characteristic Ever tested and received results Ever tested, did not receive results Never tested1 Total Percentage ever tested Number of women Age 15-24 8.5 0.6 0.0 99.4 100.0 0.6 0.5 7,915 15-19 8.5 1.4 0.0 98.6 100.0 1.4 1.2 1,825 20-24 8.6 0.3 0.0 99.6 100.0 0.4 0.2 6,089 25-29 9.2 0.5 0.2 99.3 100.0 0.7 0.4 6,299 30-39 8.7 0.5 0.0 99.4 100.0 0.6 0.3 8,765 40-49 8.5 0.2 0.1 99.7 100.0 0.3 0.2 6,482 Marital status Married 8.8 0.5 0.1 99.4 100.0 0.6 0.4 28,671 Divorced/Separated/ Widowed 6.3 0.0 0.0 100.0 100.0 0.0 0.0 790 Residence Urban 13.4 1.4 0.3 98.3 100.0 1.7 1.1 6,870 Rural 7.3 0.2 0.0 99.8 100.0 0.2 0.1 22,591 Province2 Kabul 10.4 1.8 0.3 97.8 100.0 2.2 1.6 3,658 Kapisa 3.0 0.6 0.1 99.4 100.0 0.6 0.2 205 Parwan 4.5 0.0 0.2 99.8 100.0 0.2 0.0 625 Wardak 6.9 0.0 0.1 99.9 100.0 0.1 0.0 382 Logar 8.8 0.0 0.0 100.0 100.0 0.0 0.0 472 Nangarhar 9.0 0.3 0.4 99.3 100.0 0.7 0.0 794 Laghman 31.3 0.4 0.2 99.3 100.0 0.7 0.2 583 Panjsher 0.4 0.0 0.0 100.0 100.0 0.0 0.0 54 Baghlan 2.0 0.0 0.0 100.0 100.0 0.0 0.0 839 Bamyan 2.9 0.0 0.0 100.0 100.0 0.0 0.0 303 Ghazni 4.8 0.4 0.1 99.5 100.0 0.5 0.3 1,328 Paktika 0.1 0.0 0.0 100.0 100.0 0.0 0.0 792 Paktya 6.4 0.0 0.0 100.0 100.0 0.0 0.0 542 Khost 0.7 0.0 0.0 100.0 100.0 0.0 0.0 851 Kunarha 4.2 0.1 0.0 99.9 100.0 0.1 0.0 559 Nooristan 0.1 0.0 0.0 100.0 100.0 0.0 0.0 222 Badakhshan 1.5 0.1 0.0 99.9 100.0 0.1 0.0 1,004 Takhar 1.3 0.0 0.0 100.0 100.0 0.0 0.0 1,105 Kunduz 8.2 0.9 0.0 99.1 100.0 0.9 0.6 1,232 Samangan 1.4 0.0 0.0 100.0 100.0 0.0 0.0 330 Balkh 7.4 0.6 0.1 99.3 100.0 0.7 0.4 1,781 Sar-E-Pul 1.1 0.3 0.0 99.7 100.0 0.3 0.1 654 Ghor 15.1 0.0 0.0 100.0 100.0 0.0 0.0 715 Daykundi 0.2 0.0 0.0 100.0 100.0 0.0 0.0 329 Urozgan 0.2 0.0 0.0 100.0 100.0 0.0 0.0 230 Kandahar 5.9 0.2 0.0 99.8 100.0 0.2 0.1 2,227 Jawzjan 1.9 0.0 0.1 99.9 100.0 0.1 0.0 614 Faryab 13.6 0.2 0.0 99.8 100.0 0.2 0.2 2,114 Helmand 3.1 0.0 0.1 99.9 100.0 0.1 0.0 875 Badghis 0.4 0.0 0.0 100.0 100.0 0.0 0.0 650 Herat 34.7 0.9 0.0 99.1 100.0 0.9 0.7 2,316 Farah 2.6 0.6 0.0 99.4 100.0 0.6 0.4 777 Nimroz 3.2 0.0 0.0 100.0 100.0 0.0 0.0 278 Education No education 6.3 0.2 0.0 99.8 100.0 0.2 0.2 24,604 Primary 12.5 1.3 0.1 98.7 100.0 1.3 1.0 2,330 Secondary 25.1 1.6 0.3 98.0 100.0 2.0 1.1 1,971 More than secondary 43.6 5.4 0.4 94.1 100.0 5.9 3.8 556 Wealth quintile Lowest 4.6 0.0 0.0 100.0 100.0 0.0 0.0 5,904 Second 6.1 0.2 0.0 99.8 100.0 0.2 0.1 6,001 Middle 6.4 0.1 0.0 99.9 100.0 0.1 0.1 5,888 Fourth 10.8 0.4 0.1 99.5 100.0 0.5 0.3 6,010 Highest 15.9 1.8 0.3 97.9 100.0 2.1 1.3 5,657 Total 8.7 0.5 0.1 99.4 100.0 0.6 0.4 29,461 1 Includes don't know/missing responses. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 236 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.9.2 Coverage of prior HIV testing: Men Percentage of ever-married men age 15-49 who know where to obtain an HIV test, percent distribution of men age 15-49 by testing status and by whether they received the results of the last test, the percentage of men ever tested, and the percentage of men age 15-49 who were tested in the past 12 months and received the results of the last test, according to background characteristics, Afghanistan 2015 Percent distribution of women/men by testing status and by whether they received the results of the last test Percentage who have been tested for HIV in the past 12 months and received the results of the last test Background characteristic Percentage who know where to get an HIV test Ever tested and received results Ever tested, did not receive results Never tested1 Total Percentage ever tested Number of men Age 15-24 27.0 1.8 0.3 97.9 100.0 2.1 0.7 1,305 15-19 25.7 0.5 0.0 99.5 100.0 0.5 0.0 142 20-24 27.2 2.0 0.3 97.7 100.0 2.3 0.8 1,162 25-29 30.5 3.6 1.2 95.2 100.0 4.8 1.8 2,422 30-39 31.0 5.4 1.0 93.5 100.0 6.5 2.2 3,943 40-49 28.6 4.3 0.3 95.4 100.0 4.6 1.4 3,091 Marital status Married 29.7 4.3 0.7 95.0 100.0 5.0 1.7 10,679 Divorced/Separated/ Widowed 26.5 0.0 3.0 97.0 100.0 3.0 0.0 81 Residence Urban 36.3 8.0 1.7 90.3 100.0 9.7 4.8 2,479 Rural 27.7 3.1 0.5 96.4 100.0 3.6 0.8 8,281 Province1 Kabul 34.3 8.1 2.1 89.8 100.0 10.2 5.1 1,350 Kapisa 30.5 2.1 0.9 97.0 100.0 3.0 1.0 63 Parwan 39.1 0.5 0.0 99.5 100.0 0.5 0.0 220 Wardak 16.4 1.7 0.1 98.2 100.0 1.8 0.8 171 Logar 25.9 11.4 1.0 87.6 100.0 12.4 9.9 204 Nangarhar 37.0 4.2 0.0 95.8 100.0 4.2 1.1 273 Laghman 36.1 0.5 0.0 99.5 100.0 0.5 0.0 227 Panjsher 1.8 0.0 0.0 100.0 100.0 0.0 0.0 18 Baghlan 14.1 1.4 0.0 98.6 100.0 1.4 0.6 281 Bamyan 13.3 2.1 0.0 97.9 100.0 2.1 1.0 94 Ghazni 30.1 0.0 0.0 100.0 100.0 0.0 0.0 619 Paktika 11.9 0.6 0.0 99.4 100.0 0.6 0.2 322 Paktya 79.9 2.4 0.9 96.7 100.0 3.3 0.1 206 Khost 42.0 1.1 0.3 98.6 100.0 1.4 0.6 334 Kunarha 57.1 0.0 0.0 100.0 100.0 0.0 0.0 151 Nooristan 4.7 0.1 0.0 99.9 100.0 0.1 0.1 66 Badakhshan 11.5 0.0 0.0 100.0 100.0 0.0 0.0 316 Takhar 19.2 1.7 0.2 98.0 100.0 2.0 0.4 296 Kunduz 7.9 2.2 1.4 96.4 100.0 3.6 1.5 479 Samangan 10.4 0.1 0.0 99.9 100.0 0.1 0.1 125 Balkh 16.9 3.2 0.0 96.8 100.0 3.2 1.8 616 Sar-E-Pul 9.4 3.3 0.6 96.1 100.0 3.9 1.5 195 Ghor 29.9 2.3 0.0 97.7 100.0 2.3 1.1 322 Daykundi 3.6 0.2 0.0 99.8 100.0 0.2 0.2 77 Urozgan 0.2 0.0 0.0 100.0 100.0 0.0 0.0 92 Kandahar 25.3 2.1 0.4 97.4 100.0 2.6 1.0 874 Jawzjan 26.4 5.6 0.0 94.4 100.0 5.6 1.4 218 Faryab 67.8 15.8 3.3 80.8 100.0 19.2 1.4 706 Helmand 38.9 1.1 0.3 98.7 100.0 1.3 1.1 355 Badghis 19.8 0.0 0.0 100.0 100.0 0.0 0.0 231 Herat 33.7 10.5 1.1 88.4 100.0 11.6 3.4 863 Farah 27.5 1.2 0.1 98.7 100.0 1.3 0.3 295 Nimroz 14.9 0.0 0.0 100.0 100.0 0.0 0.0 93 Education No education 17.2 2.1 0.2 97.6 100.0 2.4 0.9 5,447 Primary 29.6 5.6 1.5 92.9 100.0 7.1 1.6 1,987 Secondary 46.0 5.9 1.2 92.8 100.0 7.2 2.6 2,632 More than secondary 66.1 10.7 0.9 88.4 100.0 11.6 5.1 695 Wealth quintile Lowest 18.2 2.8 0.1 97.1 100.0 2.9 1.0 2,029 Second 23.7 2.8 0.2 97.0 100.0 3.0 0.5 2,233 Middle 25.7 2.3 0.2 97.5 100.0 2.5 0.5 2,160 Fourth 36.4 3.5 1.1 95.4 100.0 4.6 1.2 2,260 Highest 44.3 10.2 2.1 87.7 100.0 12.3 5.5 2,078 Total 29.7 4.3 0.8 95.0 100.0 5.0 1.7 10,760 1 Includes don't know/missing responses. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 237 Table 13.10 Male circumcision Percentage of ever-married men age 15-49 who report having been circumcised, and percent distribution of circumcised men by type of practitioner who performed the circumcision, according to background characteristics, Afghanistan 2015 Among those circumcised who performed the circumcision Background characteristic Percentage circum- cised Number of men Traditional practitioner/ family/ friend Health worker/ profes- sional Other Don't know Missing Total Number of circum- cised men Age 15-19 99.6 142 32.9 26.7 26.9 13.6 0.0 100.0 142 20-24 99.3 1,162 37.2 28.1 19.6 15.0 0.1 100.0 1,154 25-29 99.1 2,422 39.0 25.7 18.4 16.8 0.1 100.0 2,401 30-34 99.2 2,008 43.9 19.8 21.4 14.7 0.3 100.0 1,992 35-39 99.1 1,935 42.4 21.4 20.0 16.1 0.1 100.0 1,918 40-44 99.0 1,402 46.5 13.2 22.3 18.0 0.0 100.0 1,388 45-49 99.0 1,688 50.6 12.3 21.8 15.3 0.0 100.0 1,671 Residence Urban 99.2 2,479 28.3 39.4 18.7 13.6 0.0 100.0 2,459 Rural 99.1 8,281 47.5 14.7 21.1 16.7 0.1 100.0 8,206 Province1 Kabul 99.2 1,350 17.6 43.7 23.7 14.7 0.4 100.0 1,339 Kapisa 100.0 63 0.4 5.3 90.3 2.6 1.4 100.0 63 Parwan 99.1 220 2.1 7.5 89.0 1.2 0.2 100.0 218 Wardak 97.3 171 39.1 26.2 20.4 13.9 0.4 100.0 167 Logar 95.3 204 46.4 13.7 7.4 32.1 0.5 100.0 194 Nangarhar 99.3 273 41.6 49.8 1.2 7.2 0.2 100.0 271 Laghman 98.6 227 65.8 19.1 3.4 11.3 0.3 100.0 224 Panjsher 98.8 18 22.7 32.5 22.1 22.8 0.0 100.0 18 Baghlan 98.7 281 40.6 23.6 23.5 11.8 0.5 100.0 277 Bamyan 99.3 94 66.1 13.3 8.9 11.7 0.0 100.0 93 Ghazni 99.6 619 37.6 22.0 3.0 37.4 0.0 100.0 616 Paktika 98.9 322 30.8 36.8 14.1 18.2 0.0 100.0 319 Paktya 100.0 206 45.2 32.3 17.1 5.5 0.0 100.0 206 Khost 96.2 334 35.0 14.7 26.1 24.2 0.0 100.0 322 Kunarha 95.5 151 56.4 9.2 8.9 25.4 0.0 100.0 144 Nooristan 98.6 66 52.7 1.0 17.8 28.3 0.3 100.0 65 Badakhshan 99.8 316 48.5 2.2 24.1 25.2 0.0 100.0 315 Takhar 99.4 296 28.5 3.0 55.0 13.5 0.0 100.0 294 Kunduz 98.6 479 80.7 6.7 2.4 10.2 0.0 100.0 473 Samangan 100.0 125 88.4 6.6 1.4 3.6 0.0 100.0 125 Balkh 97.8 616 19.8 10.3 54.0 16.0 0.0 100.0 602 Sar-E-Pul 99.9 195 89.8 4.8 0.2 5.2 0.0 100.0 195 Ghor 99.7 322 41.9 13.3 43.0 1.8 0.0 100.0 321 Daykundi 100.0 77 32.5 8.7 17.6 41.3 0.0 100.0 77 Urozgan 99.2 92 36.1 4.8 0.0 59.1 0.0 100.0 91 Kandahar 99.8 874 54.2 31.3 0.0 14.5 0.0 100.0 872 Jawzjan 100.0 218 87.6 6.8 2.8 2.8 0.0 100.0 218 Faryab 100.0 706 83.8 1.2 14.2 0.8 0.0 100.0 706 Helmand 99.1 355 29.3 22.6 6.1 42.0 0.0 100.0 352 Badghis 100.0 231 64.0 2.0 33.8 0.2 0.0 100.0 231 Herat 100.0 863 24.1 26.4 35.3 14.2 0.0 100.0 863 Farah 99.9 295 54.0 15.6 1.2 29.2 0.0 100.0 295 Nimroz 99.6 93 16.1 19.3 37.2 27.4 0.0 100.0 93 Education No education 99.0 5,447 45.8 13.3 22.5 18.3 0.0 100.0 5,391 Primary 99.3 1,987 42.9 21.6 20.7 14.7 0.0 100.0 1,973 Secondary 99.2 2,632 40.7 27.8 17.6 13.6 0.3 100.0 2,611 More than secondary 99.6 695 30.8 43.3 15.5 10.2 0.2 100.0 692 Wealth quintile Lowest 99.2 2,029 48.0 8.8 28.4 14.8 0.0 100.0 2,013 Second 99.1 2,233 48.0 13.2 22.0 16.7 0.1 100.0 2,212 Middle 98.9 2,160 46.6 15.4 17.8 20.0 0.2 100.0 2,136 Fourth 99.1 2,260 44.4 21.5 16.4 17.7 0.0 100.0 2,241 Highest 99.3 2,078 27.8 43.2 18.6 10.2 0.2 100.0 2,064 Total 99.1 10,760 43.1 20.4 20.5 16.0 0.1 100.0 10,666 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 238 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.11 Place of circumcision Percent distribution of circumcised men age 15-49 by place of circumcision, according to background characteristics, Afghanistan 2015 Background characteristic Health facility Home of a health worker/ profes- sional Circum- cision done at home Ritual site Other home/ place Don't know/ missing Total Number of circum- cised men Age 15-19 30.2 8.0 49.2 0.0 0.0 12.7 100.0 142 20-24 22.1 14.1 46.9 0.4 2.6 13.8 100.0 1,154 25-29 16.8 13.3 54.4 0.5 2.0 13.0 100.0 2,401 30-34 13.6 13.8 57.6 0.3 1.7 13.0 100.0 1,992 35-39 13.0 12.8 57.5 0.2 4.2 12.3 100.0 1,918 40-44 6.8 15.9 60.3 0.8 1.5 14.6 100.0 1,388 45-49 7.8 10.4 65.0 0.6 2.7 13.4 100.0 1,671 Residence Urban 23.6 14.2 51.5 0.4 1.7 8.6 100.0 2,459 Rural 10.6 12.9 58.8 0.5 2.6 14.6 100.0 8,206 Province1 Kabul 22.0 11.0 56.7 0.6 2.5 7.2 100.0 1,339 Kapisa 1.3 0.8 91.9 0.0 1.7 4.3 100.0 63 Parwan 0.7 1.3 93.4 0.4 2.1 2.1 100.0 218 Wardak 17.7 5.0 65.8 0.7 3.7 7.0 100.0 167 Logar 26.8 6.9 26.1 1.2 5.7 33.2 100.0 194 Nangarhar 35.2 37.5 20.6 0.2 0.2 6.2 100.0 271 Laghman 14.6 32.2 40.9 0.0 2.0 10.3 100.0 224 Panjsher 8.3 5.5 64.5 0.0 3.3 18.4 100.0 18 Baghlan 14.6 7.7 68.3 0.4 0.2 8.8 100.0 277 Bamyan 5.2 1.5 78.8 4.8 0.9 8.8 100.0 93 Ghazni 15.7 9.6 34.5 0.0 1.5 38.7 100.0 616 Paktika 33.3 35.3 17.0 0.0 0.9 13.5 100.0 319 Paktya 54.2 38.6 1.6 0.0 0.0 5.7 100.0 206 Khost 12.4 3.2 55.7 0.0 1.7 27.0 100.0 322 Kunarha 6.2 24.5 49.4 0.0 0.1 19.8 100.0 144 Nooristan 0.3 3.2 72.0 0.7 4.2 19.6 100.0 65 Badakhshan 0.3 6.9 73.8 0.1 3.2 15.7 100.0 315 Takhar 1.2 0.5 86.6 0.0 0.0 11.8 100.0 294 Kunduz 1.7 5.4 78.2 3.7 3.1 7.9 100.0 473 Samangan 2.1 4.0 86.5 0.5 1.5 5.4 100.0 125 Balkh 4.3 3.7 72.8 0.0 3.0 16.2 100.0 602 Sar-E-Pul 2.4 4.2 93.0 0.0 0.4 0.0 100.0 195 Ghor 8.7 3.5 83.9 0.4 1.5 2.0 100.0 321 Daykundi 2.7 0.2 62.7 0.0 0.6 33.8 100.0 77 Urozgan 4.2 37.0 0.5 0.0 0.0 58.3 100.0 91 Kandahar 30.7 50.3 5.6 0.0 4.2 9.1 100.0 872 Jawzjan 0.7 1.5 94.6 0.0 1.1 2.1 100.0 218 Faryab 0.4 0.6 89.9 0.0 8.7 0.3 100.0 706 Helmand 20.6 29.3 8.4 0.0 1.0 40.7 100.0 352 Badghis 1.3 1.2 97.4 0.0 0.1 0.0 100.0 231 Herat 7.8 3.3 78.3 0.0 1.1 9.6 100.0 863 Farah 10.1 7.1 48.7 2.7 2.1 29.2 100.0 295 Nimroz 5.2 5.1 56.6 2.0 3.5 27.5 100.0 93 Education No education 9.4 14.6 57.1 0.6 3.1 15.2 100.0 5,391 Primary 11.9 11.0 63.1 0.4 2.5 11.1 100.0 1,973 Secondary 18.3 13.6 54.8 0.3 1.0 11.8 100.0 2,611 More than secondary 33.3 6.6 48.6 0.1 2.0 9.5 100.0 692 Wealth quintile Lowest 4.1 4.2 76.7 0.7 2.5 11.8 100.0 2,013 Second 9.4 12.1 61.5 0.5 1.2 15.4 100.0 2,212 Middle 12.3 17.8 48.2 0.4 3.7 17.6 100.0 2,136 Fourth 15.6 17.9 50.0 0.1 2.5 13.9 100.0 2,241 Highest 26.4 13.4 50.3 0.6 2.3 7.1 100.0 2,064 Total 13.6 13.2 57.1 0.5 2.4 13.2 100.0 10,666 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 239 Table 13.12 Age at circumcision Percent distribution of circumcised men age 15-49 by age at circumcision, according to background characteristics, Afghanistan 2015 Background characteristic During childhood (<5 years) 5-13 ≥ 14 Don't know/ missing Total Number of circumcised men Age 15-19 65.8 24.7 0.0 9.5 100.0 142 20-24 60.6 26.3 0.0 13.0 100.0 1,154 25-29 53.9 33.1 1.0 11.9 100.0 2,401 30-34 52.3 35.0 0.2 12.5 100.0 1,992 35-39 54.0 33.7 0.0 12.3 100.0 1,918 40-44 51.8 33.3 0.1 14.8 100.0 1,388 45-49 47.0 39.8 0.2 13.0 100.0 1,671 Residence Urban 55.6 32.3 1.0 11.0 100.0 2,459 Rural 52.4 34.3 0.1 13.2 100.0 8,206 Province1 Kabul 59.2 24.9 1.6 14.3 100.0 1,339 Kapisa 35.7 58.0 0.0 6.3 100.0 63 Parwan 54.0 42.8 0.0 3.2 100.0 218 Wardak 72.3 18.3 0.0 9.4 100.0 167 Logar 54.7 30.3 0.0 15.0 100.0 194 Nangarhar 68.9 26.5 0.0 4.6 100.0 271 Laghman 77.8 11.8 0.0 10.4 100.0 224 Panjsher 56.0 34.3 0.5 9.3 100.0 18 Baghlan 44.0 54.1 0.2 1.8 100.0 277 Bamyan 45.9 44.1 0.8 9.3 100.0 93 Ghazni 77.5 11.1 0.0 11.4 100.0 616 Paktika 86.5 3.5 0.0 10.0 100.0 319 Paktya 76.7 8.2 0.0 15.1 100.0 206 Khost 36.1 12.5 0.9 50.5 100.0 322 Kunarha 44.4 2.5 0.0 53.1 100.0 144 Nooristan 78.7 18.9 0.0 2.4 100.0 65 Badakhshan 24.2 59.6 0.0 16.2 100.0 315 Takhar 25.0 56.3 0.9 17.8 100.0 294 Kunduz 47.8 38.2 0.0 14.0 100.0 473 Samangan 40.1 56.7 0.2 3.1 100.0 125 Balkh 52.6 32.2 0.6 14.6 100.0 602 Sar-E-Pul 12.2 65.6 0.0 22.2 100.0 195 Ghor 45.3 52.7 0.0 2.0 100.0 321 Daykundi 45.2 48.9 1.1 4.9 100.0 77 Urozgan 40.3 0.6 0.0 59.1 100.0 91 Kandahar 65.4 29.9 0.0 4.7 100.0 872 Jawzjan 49.0 47.3 0.1 3.6 100.0 218 Faryab 11.6 87.2 0.1 1.0 100.0 706 Helmand 60.1 25.2 0.0 14.7 100.0 352 Badghis 76.5 22.7 0.0 0.8 100.0 231 Herat 41.8 38.6 0.0 19.6 100.0 863 Farah 91.0 2.3 0.0 6.7 100.0 295 Nimroz 71.5 10.4 0.0 18.1 100.0 93 Education No education 53.2 32.1 0.1 14.5 100.0 5,391 Primary 46.5 39.7 0.1 13.7 100.0 1,973 Secondary 55.6 33.9 0.9 9.6 100.0 2,611 More than secondary 62.4 29.8 0.1 7.7 100.0 692 Wealth quintile Lowest 44.9 43.7 0.2 11.2 100.0 2,013 Second 53.0 33.3 0.0 13.6 100.0 2,212 Middle 55.6 31.1 0.1 13.3 100.0 2,136 Fourth 55.9 30.0 0.1 14.0 100.0 2,241 Highest 55.9 31.6 1.2 11.3 100.0 2,064 Total 53.1 33.8 0.3 12.7 100.0 10,666 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 240 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.13 Self-reported prevalence of sexually-transmitted infections (STIs) and STI symptoms Among ever-married women and ever-married men age 15-49 who ever had sexual intercourse, the percentage reporting having an STI and/or symptoms of an STI in the past 12 months, by background characteristics, Afghanistan 2015 Percentage of women who reported having in the past 12 months: Percentage of men who reported having in the past 12 months: Background characteristic STI Bad smelling/ abnormal genital discharge Genital sore/ulcer STI/ genital discharge/ sore or ulcer Number of women who ever had sexual intercourse STI Bad smelling/ abnormal discharge from penis Genital sore/ulcer STI/ abnormal discharge from penis/ sore or ulcer Number of men who ever had sexual intercourse Age 15-24 1.3 9.9 6.0 11.8 7,905 1.6 5.1 2.7 6.9 1,301 15-19 1.6 8.2 7.5 11.7 1,823 0.0 3.4 0.7 3.4 142 20-24 1.2 10.4 5.5 11.8 6,082 1.7 5.3 3.0 7.3 1,159 25-29 2.5 13.8 7.3 15.8 6,273 1.7 4.0 4.1 7.2 2,388 30-39 2.4 14.6 8.4 16.5 8,758 2.0 6.0 3.8 8.7 3,927 40-49 2.7 14.8 9.5 16.6 6,472 2.1 6.1 4.2 8.4 3,075 Marital status Married 2.2 13.5 7.9 15.4 28,631 1.9 5.5 3.9 8.1 10,612 Divorced/Separated/ Widowed 0.8 3.5 2.0 3.9 777 0.7 0.1 0.9 0.9 79 Male circumcision Circumcised na na na na na 1.9 5.5 3.8 8.1 10,607 Not circumcised na na na na na 4.4 7.2 6.4 18.0 49 Don’t know na na na na na (1.4) (3.5) (1.2) (4.7) 35 Residence Urban 1.7 11.9 6.3 14.1 6,849 1.4 6.6 3.8 8.6 2,470 Rural 2.3 13.6 8.2 15.4 22,559 2.0 5.1 3.9 7.9 8,221 Province1 Kabul 1.8 11.4 7.6 14.5 3,650 0.6 7.0 5.0 9.5 1,348 Kapisa 0.2 1.8 2.5 3.0 205 3.6 6.3 5.2 12.2 62 Parwan 4.4 25.9 23.8 30.5 624 1.4 0.1 0.3 1.7 219 Wardak 1.0 14.5 10.1 15.9 381 0.0 1.9 1.0 2.7 171 Logar 3.0 41.6 15.0 45.2 472 3.4 20.7 3.2 23.4 204 Nangarhar 0.5 13.3 12.2 19.1 793 0.8 2.1 1.7 3.0 273 Laghman 4.5 11.0 19.6 21.3 583 2.0 3.6 8.6 10.2 227 Panjsher 0.2 3.9 3.8 4.3 54 2.1 25.2 22.2 25.2 18 Baghlan 2.8 14.3 13.2 17.2 837 0.6 3.9 1.2 5.1 276 Bamyan 0.4 4.6 2.3 4.6 302 0.0 2.6 2.8 3.2 91 Ghazni 0.6 3.8 5.5 8.5 1,321 1.3 3.4 4.1 6.5 611 Paktika 1.7 16.6 8.0 18.4 786 3.1 6.8 3.4 9.1 321 Paktya 3.6 43.5 10.8 47.3 533 0.8 4.8 0.8 4.8 205 Khost 3.9 14.5 4.2 16.2 850 4.3 2.5 2.0 7.7 333 Kunarha 0.4 1.2 1.3 1.5 559 2.1 0.0 1.4 3.5 144 Nooristan 0.1 5.1 4.6 7.2 222 0.1 8.9 2.8 10.9 65 Badakhshan 0.1 0.2 0.3 0.3 1,004 0.1 1.5 0.0 1.6 316 Takhar 1.7 6.4 3.5 9.4 1,105 0.0 0.5 0.0 0.5 296 Kunduz 4.5 10.6 7.6 11.5 1,232 10.7 19.2 26.9 35.2 479 Samangan 2.2 3.2 1.7 3.4 330 3.6 14.1 13.3 15.0 125 Balkh 0.8 8.2 2.9 9.2 1,776 0.0 2.4 1.3 2.4 604 Sar-E-Pul 0.9 4.2 3.8 4.3 654 0.0 1.3 0.3 1.6 195 Ghor 6.3 42.6 41.9 42.7 715 3.8 3.5 3.5 5.8 322 Daykundi 0.0 0.2 0.0 0.2 328 0.0 2.3 1.6 2.3 77 Urozgan 0.0 7.7 4.0 10.6 229 0.0 2.2 1.6 3.4 90 Kandahar 0.2 33.5 9.7 33.8 2,225 1.8 11.0 1.2 12.4 874 Jawzjan 0.0 0.8 0.7 1.0 614 1.0 3.9 6.9 9.0 218 Faryab 0.2 0.6 1.0 1.8 2,113 0.0 0.5 0.7 1.2 686 Helmand 0.2 0.4 0.6 0.8 871 1.0 1.6 0.7 2.1 354 Badghis 0.0 3.1 2.8 3.1 650 0.0 1.1 0.5 1.1 231 Herat 8.6 25.8 13.4 26.8 2,316 3.7 5.0 2.5 8.7 860 Farah 1.3 7.9 5.5 8.6 776 4.6 11.4 9.0 15.8 295 Nimroz 13.2 15.0 5.8 16.8 276 0.0 0.4 0.0 0.4 93 Education No education 2.2 14.1 8.2 15.9 24,557 2.1 6.5 4.2 9.0 5,420 Primary 2.5 10.3 5.8 12.2 2,328 1.5 4.0 4.2 7.8 1,972 Secondary 1.7 7.7 5.7 10.6 1,969 2.0 4.6 2.6 6.5 2,606 More than secondary 2.6 6.8 4.2 10.4 554 1.3 4.6 4.3 7.6 693 Wealth quintile Lowest 2.0 12.0 8.6 12.7 5,898 3.7 5.6 5.1 9.3 2,021 Second 2.1 12.4 8.1 14.7 5,995 1.7 5.3 4.1 8.3 2,212 Middle 2.1 16.3 8.2 18.3 5,876 1.3 4.8 3.3 7.1 2,157 Fourth 2.7 12.9 6.9 14.7 6,003 1.3 5.5 3.2 7.3 2,227 Highest 2.0 12.5 6.9 15.2 5,636 1.5 6.3 3.6 8.6 2,073 Total 2.2 13.2 7.7 15.1 29,408 1.9 5.5 3.8 8.1 10,691 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 241 Table 13.14 Prevalence of medical injections Percentage of ever-married women and ever-married men age 15-49 who received at least one medical injection in the last 12 months, the average number of medical injections per person in the last 12 months, and among those who received a medical injection, the percentage of last medical injections for which the syringe and needle were taken from a new, unopened package, by background characteristics, Afghanistan 2015 Women Men Background characteristic Percentage who received a medical injection in the last 12 months Average number of medical injections per person in the last 12 months Number of respondents For last injection, syringe and needle taken from a new, unopened package Number of respondents receiving medical injections in the last 12 months Percentage who received a medical injection in the last 12 months Average number of medical injections per person in the last 12 months Number of respondents For last injection, syringe and needle taken from a new, unopened package Number of respondents receiving medical injections in the last 12 months Age 15-24 29.9 2.1 7,915 89.6 2,364 26.8 1.8 1,305 95.4 350 15-19 27.3 1.6 1,825 90.1 498 17.1 0.7 142 (94.4) 24 20-24 30.6 2.2 6,089 89.4 1,865 28.0 1.9 1,162 95.5 326 25-29 34.9 2.4 6,299 88.6 2,199 26.5 2.6 2,422 94.9 641 30-39 37.1 3.5 8,765 90.6 3,256 31.9 2.5 3,943 94.1 1,258 40-49 38.1 4.0 6,482 91.3 2,469 34.5 3.2 3,091 91.4 1,067 Marital status Married 35.0 3.0 28,671 90.1 10,028 30.7 2.6 10,679 93.6 3,283 Divorced/ Separated/ Widowed 32.8 3.4 790 91.3 259 41.6 6.4 81 (86.2) 34 Residence Urban 40.0 3.9 6,870 91.1 2,748 29.1 2.6 2,479 94.7 722 Rural 33.4 2.7 22,591 89.7 7,539 31.3 2.7 8,281 93.2 2,594 Province1 Kabul 35.1 3.8 3,658 82.5 1,284 31.1 2.5 1,350 96.4 420 Kapisa 41.6 3.3 205 85.4 85 32.3 3.3 63 92.3 20 Parwan 30.4 2.7 625 91.0 190 43.4 2.5 220 97.3 96 Wardak 34.7 5.5 382 82.2 133 12.9 1.0 171 97.2 22 Logar 24.7 1.1 472 51.6 116 40.8 1.9 204 89.1 83 Nangarhar 45.0 2.8 794 98.0 357 44.0 4.3 273 95.6 120 Laghman 47.9 1.7 583 85.9 279 41.4 2.2 227 98.6 94 Panjsher 12.2 1.4 54 93.5 7 10.4 0.7 18 * 2 Baghlan 33.7 4.0 839 80.6 283 65.8 4.8 281 99.7 185 Bamyan 26.0 1.9 303 74.6 79 19.2 2.6 94 (92.0) 18 Ghazni 35.1 3.1 1,328 94.8 466 14.1 1.2 619 98.7 87 Paktika 11.3 0.7 792 96.8 90 2.9 0.2 322 * 9 Paktya 37.2 3.1 542 86.2 202 56.6 3.6 206 97.8 116 Khost 39.0 3.2 851 40.3 332 55.1 5.1 334 87.5 184 Kunarha 35.7 4.8 559 89.5 199 42.4 3.0 151 87.0 64 Nooristan 16.6 0.2 222 89.7 37 12.9 0.4 66 65.9 9 Badakhshan 12.9 0.7 1,004 87.3 130 22.0 3.5 316 84.8 69 Takhar 30.8 3.2 1,105 94.6 341 20.6 2.5 296 (100.0) 61 Kunduz 29.0 2.5 1,232 86.7 357 39.0 4.7 479 75.9 187 Samangan 41.5 3.5 330 95.0 137 6.2 0.8 125 * 8 Balkh 44.3 3.0 1,781 98.8 788 20.0 1.3 616 100.0 123 Sar-E-Pul 33.7 6.3 654 97.9 220 29.9 1.9 195 95.9 58 Ghor 22.7 1.5 715 90.1 162 30.0 1.6 322 59.9 97 Daykundi 12.8 0.6 329 96.2 42 22.8 2.1 77 (97.7) 18 Urozgan 3.8 0.2 230 (86.9) 9 4.9 0.4 92 * 5 Kandahar 39.6 2.9 2,227 91.4 881 25.2 2.1 874 89.4 220 Jawzjan 17.6 2.7 614 95.6 108 12.9 1.0 218 (96.2) 28 Faryab 64.6 5.6 2,114 96.9 1,364 61.0 6.3 706 98.3 431 Helmand 18.8 3.3 875 95.7 165 19.3 1.1 355 98.8 69 Badghis 8.7 0.8 650 92.3 56 11.0 1.2 231 (97.6) 26 Herat 46.6 2.9 2,316 98.8 1,080 33.7 3.8 863 99.2 291 Farah 34.6 1.1 777 95.2 269 29.5 0.9 295 96.8 87 Nimroz 11.8 0.6 278 95.7 33 11.1 0.5 93 * 10 Education No education 34.2 3.0 24,604 89.8 8,425 29.1 2.7 5,447 92.4 1,584 Primary 38.2 3.1 2,330 91.7 889 36.2 2.6 1,987 92.7 720 Secondary 38.1 3.1 1,971 90.0 751 30.7 2.7 2,632 96.2 807 More than secondary 40.0 2.9 556 94.9 223 29.6 2.0 695 94.3 206 Wealth quintile Lowest 29.8 2.3 5,904 92.6 1,759 31.5 2.8 2,029 91.0 640 Second 31.1 2.4 6,001 91.5 1,868 27.5 2.1 2,233 91.8 615 Middle 33.9 2.9 5,888 89.0 1,996 30.8 2.5 2,160 94.1 665 Fourth 38.0 3.3 6,010 87.7 2,283 32.8 3.2 2,260 94.8 742 Highest 42.1 4.1 5,657 90.5 2,381 31.5 2.7 2,078 95.5 655 Total 34.9 3.0 29,461 90.1 10,287 30.8 2.6 10,760 93.5 3,316 Note: Medical injections are those given by a doctor, nurse, pharmacist, dentist, or other health worker. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 242 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.15 Comprehensive knowledge about AIDS and of a source of condoms among young people Percentage of ever-married women and ever-married men age 15-24 with comprehensive knowledge about AIDS and percentage with knowledge of a source of condoms, by background characteristics, Afghanistan 2015 Women Men Background characteristic Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of respondents Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of respondents Age 15-19 0.6 22.6 1,825 4.3 56.2 142 15-17 0.4 17.3 438 * * 21 18-19 0.7 24.3 1,387 5.0 55.9 122 20-24 1.2 27.0 6,089 6.5 57.9 1,162 20-22 1.0 25.7 3,839 8.5 60.4 615 23-24 1.4 29.4 2,250 4.3 55.2 547 Residence Urban 1.7 30.9 1,794 12.6 70.2 205 Rural 0.8 24.6 6,120 5.1 55.4 1,100 Education No education 0.5 19.7 5,651 3.2 40.4 559 Primary 2.1 37.5 982 2.5 60.7 205 Secondary 1.9 42.8 1,075 8.0 72.2 439 More than secondary 5.5 58.1 206 23.6 84.6 101 Total 1.0 26.0 7,915 6.3 57.8 1,305 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission or prevention of the AIDS virus. The components of comprehensive knowledge are presented in Tables 13.2, 13.3.1 and 13.3.2. 2 For this table, the following responses are not considered a source for condoms: friends, family members, and home. HIV/AIDS-related Knowledge, Attitudes, and Behavior • 243 Table 13.16 Age at first sexual intercourse among young people Percentage of ever-married women and ever-married men age 15-24 who had sexual intercourse before age 15 and percentage of ever-married women and ever-married men age 18-24 who had sexual intercourse before age 18, by background characteristics, Afghanistan 2015 Women age 15-24 Women age 18-24 Men age 15-24 Men age 18-24 Background characteristic Percentage who had sexual intercourse before age 15 Number of respondents Percentage who had sexual intercourse before age 18 Number of respondents Percentage who had sexual intercourse before age 15 Number of respondents Percentage who had sexual intercourse before age 18 Number of respondents Age 15-19 10.7 1,825 na na 7.0 142 na na 15-17 15.9 438 na na * 21 na na 18-19 9.1 1,387 74.8 1,387 5.8 122 48.2 122 20-24 10.0 6,089 46.6 6,089 1.6 1,162 19.5 1,162 20-22 9.1 3,839 47.8 3,839 2.2 615 23.1 615 23-24 11.5 2,250 44.5 2,250 0.8 547 15.5 547 Knows condom source1 Yes 11.5 2,060 55.6 1,984 2.5 753 23.8 742 No 9.7 5,854 50.4 5,492 1.8 551 20.1 543 Residence Urban 10.0 1,794 50.2 1,718 2.2 205 23.4 204 Rural 10.2 6,120 52.3 5,758 2.1 1,100 22.0 1,080 Education No education 10.8 5,651 52.3 5,363 2.4 559 21.1 552 Primary 13.7 982 54.0 894 2.6 205 23.6 202 Secondary 4.8 1,075 49.3 1,013 2.2 439 23.7 428 More than secondary 2.9 206 40.4 206 0.0 101 19.6 101 Total 10.2 7,915 51.8 7,476 2.2 1,305 22.2 1,284 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not available. 1 For this table, the following responses are not considered a source for condoms: friends, family members, and home. 244 • HIV/AIDS-related Knowledge, Attitudes, and Behavior Table 13.17 Recent HIV tests among youth Among ever-married women and ever-married men age 15-24 who have had sexual intercourse in the past 12 months, the percentage who were tested for HIV in the past 12 months and received the results of the last test, by background characteristics, Afghanistan 2015 Women age 15-24 who have had sexual intercourse in the past 12 months: Men age 15-24 who have had sexual intercourse in the past 12 months: Background characteristic Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of women Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of men Age 15-19 1.2 1,783 0.0 142 15-17 0.0 423 * 21 18-19 1.6 1,360 0.0 121 20-24 0.2 5,956 0.8 1,152 20-22 0.3 3,754 0.8 611 23-24 0.2 2,203 0.7 540 Knows condom source1 Yes 0.8 2,020 1.0 751 No 0.3 5,718 0.3 543 Residence Urban 1.4 1,754 1.9 202 Rural 0.2 5,985 0.5 1,092 Education No education 0.1 5,530 0.1 552 Primary 2.0 957 0.1 205 Secondary 0.5 1,049 1.6 436 More than secondary 3.0 203 1.2 101 Total 0.5 7,739 0.7 1,293 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 For this table, the following responses are not considered a source for condoms: friends, family members, and home. Adult and Maternal Mortality • 245 ADULT AND MATERNAL MORTALITY 14 Key Findings  Adult mortality: For women and men who have reached age 15, the probability of dying before age 50 is 12% and 8%, respectively.  Pregnancy-related mortality: The pregnancy- related mortality ratio was 1,291 maternal deaths per 100,000 live births for the seven-year period before the survey.  Lifetime risk of maternal death: The lifetime risk of maternal death indicates that 1 in 14 women in Afghanistan will die from either pregnancy or childbearing. dult and maternal mortality indicators can assess the health status of a population, especially in developing countries such as Afghanistan. Estimation of these mortality rates requires complete and accurate data on adult and maternal deaths. In the 2015 AfDHS, data were collected on the survivorship of the respondents’ siblings to obtain an estimate of adult mortality. Questions that determine if deaths among female siblings were maternity-related facilitate the estimation of maternal mortality, a key indicator of maternal health and well-being. In agreement with the International Classification of Disease (ICD-10) definition of maternal mortality, the 2015 AfDHS results reflect pregnancy-related mortality, which accounts for deaths of women while they are pregnant, during delivery, or within 42 days of termination of pregnancy, irrespective of the cause of death (WHO 2011). The maternal mortality module used in the DHS surveys measures the timing of maternal deaths but does not have information on the cause of death. The data collected in the 2015 AfDHS questionnaire are based on information about deaths during the two months after a birth rather than the recommended 42 days following a birth. This chapter includes results estimated from sibling history data collected in the sibling survival module (commonly referred to as the maternal mortality module) that is part of the Woman’s Questionnaire. In addition to adult mortality rates for five-year age groups, the chapter includes a summary measure (35q15) that represents the probability of dying between exact ages 15 and 50—that is, between the women’s 15th and 50th birthdays. 14.1 DATA To obtain a sibling history, each respondent was asked to provide the total number of her mother’s live births. The respondent was then asked to provide a list of all of the children born to her mother, starting with the first born. The respondent was asked if each of these siblings was still alive at the time of the survey. The current age of living siblings was collected. For deceased siblings, the age at death and number of years since the person’s death were collected. Interviewers were instructed that when a respondent could not provide precise information on age at death or years since death, approximate but quantitative answers were acceptable. For sisters who died at age 12 or above, three questions were used to determine whether the death was maternity-related: “Was [NAME OF SISTER] pregnant when she died?” A 246 • Adult and Maternal Mortality and, if not, “Did she die during childbirth?” and, if not, “Did she die within two months after the end of a pregnancy or childbirth?” Estimation of adult and pregnancy-related mortality by either direct or indirect means requires reasonably accurate reporting of the respondent’s number of sisters and brothers, the number who have died, and for pregnancy-related mortality, the number of sisters who died of pregnancy- related causes. Table 14.1 shows the number of siblings reported by the respondents and the completeness of data on current age, age at death, and years since death. Overall, the sibling history data collected in the 2015 AfDHS were complete. For 99% of deceased siblings, the age at death, years since death or year of death were reported. There were very few siblings for whom survival status was not reported (0.05%). Among surviving siblings, current age (used to estimate exposure to death) was reported for all but 278 siblings (0.2%). Instead of excluding siblings with missing data from further analysis, information on the birth order of siblings was used in conjunction with other information to impute the missing data.1 The sex ratio for enumerated siblings (the ratio of brothers to sisters multiplied by 100) is 108.6 (Appendix Table C.9) 14.2 DIRECT ESTIMATES OF ADULT MORTALITY Adult mortality rate The number of adult deaths per 1,000 population age 15-49. Adult mortality rates by 5-year age groups are calculated as follows: the number of deaths to respondent’s siblings in each age group is divided by the number of person- years of exposure to the risk of dying in that age group during a specified period prior to the survey. The number of deaths is the number of siblings (brothers or sisters) reported as having died within the specified period. The person-years of exposure in each age group are calculated for both surviving and dead siblings based on their current age (living siblings) or age at death and years since death (dead siblings). Sample: Siblings (both living and dead) who were age 15-49 in the specified 7-year period preceding the survey by sex and 5-year age groups One way to assess the quality of the data used to estimate pregnancy-related mortality is to evaluate the plausibility and stability of overall adult mortality. If estimated rates of overall adult mortality are implausible, rates based on a subset of deaths (pregnancy-related deaths in particular) may have serious problems. The reported ages at death and years since death of the respondents’ brothers and sisters were used to make direct estimates of adult mortality. Because of the differentials in exposure to the risk of dying, age- and sex-specific death rates are presented in this report. Table 14.2 and Figure 14.1 show age-specific mortality rates among women and men (age 15-49) for the 7 years before the 2015 AfDHS. To ensure a sufficiently large number of adult deaths to generate a robust estimate, the rates are calculated for the seven-year period before the survey (mid-2008 to mid-2015). Nevertheless, age-specific mortality rates obtained in this manner are subject to considerable sampling variation. Use of this seven-year period was a compromise between the desire for the most recent data and the need to minimize the level of sampling error. 1 The imputation procedure was based on the assumption that the reported birth ordering of siblings in the history was correct. The first step was to calculate birth dates for each living sibling with a reported age and each dead sibling with complete information on both age at death and years since death. For a sibling missing these data, a birth date was imputed within the range defined by the birth dates of the bracketing siblings. In the case of living siblings, an age was then calculated from the imputed birth date. In the case of dead siblings, if either age at death or years since death were reported, that information was combined with the birth date to produce the missing information. If both pieces of information were missing, the distribution of the ages at death for siblings for whom years since death were not reported but age at death was reported was used as a basis for imputing age at death. Adult and Maternal Mortality • 247 Table 14.2 and Figure 14.1 show age-specific mortality rates for women and men age 15-49 for the seven-year period before the survey. The levels of adult mortality among women (3.53 deaths per 1,000 populations) are higher than among men (2.43 deaths per 1,000 population). Generally, mortality is low among men and women age 15- 19, and increases steadily through age 35-39. A sudden increase in female mortality occurs after age 40. The highest mortality rate among women is for women age 40-44. The probability of dying between exact ages 15 and 50 (35q15) is also much higher, at 119, for women than for men, at 84 (Table 14.3). Here, 35q15 is the probability of a 15-year-old woman or man dying before age 50, if they experience the age specific deaths rates in Table 14.2. 14.3 DIRECT ESTIMATES OF PREGNANCY-RELATED MORTALITY Pregnancy-related mortality rate The number of pregnancy-related deaths per 1,000 women age 15-49. Pregnancy-related mortality rates by 5-year age groups are calculated by dividing the number of pregnancy-related deaths to female siblings of respondents in each age group by the total person-years of exposure of the sisters to the risk of dying in that age group during the 7 years prior to the survey. The number of deaths is the number of sisters reported as having died during pregnancy or delivery, or in the 2 months following the delivery in the specified period by their age group at the time of death. The person-years of exposure in each age group are calculated for both surviving and dead sisters based on their reported current age (living sisters) or age at death and years since death (dead sisters). Sample: Sisters (both living and dead) age 15-49 in the specified period, by 5-year age groups. Pregnancy-related mortality ratio The number of pregnancy-related deaths per 100,000 live births. The pregnancy-related mortality ratio is calculated by dividing the age-standardized pregnancy-related mortality rate for women age 15-49 for the specified period by the general fertility rate (GFR) for the same period. Pregnancy-related deaths are a subset of all female deaths, and are defined as any deaths that occur during pregnancy or childbirth, or within 2 months after the birth or termination of a pregnancy. Estimates of pregnancy-related mortality are therefore based solely on the timing of the death in relationship to the pregnancy. Two methods are used to estimate pregnancy-related mortality in developing countries: the indirect sisterhood method (Graham et al. 1989) and a direct variant of the sisterhood method (Rutenberg and Sullivan 1991; Stanton et al. 1997). Age-specific estimates of pregnancy-related mortality from reported survivorship of sisters are shown in Table 14.4 for the seven-year period before the 2015 survey. Table 14.4 shows that the pregnancy-related mortality rate among women age 15-49 is 2.36 deaths per 1,000 woman-years of exposure. By five-year age groups, the pregnancy-related mortality rate is highest Figure 14.1 Adult mortality rates among women and men age 15-49 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Deaths per 1,000 population Age in years Women Men 248 • Adult and Maternal Mortality among women age 25-29 (2.90), followed by those age 30-34 (2.81). The percentage of female deaths that are pregnancy-related deaths varies by age and ranges from 41.4% among women age 45-49 to79% among women age 25 -29. The estimated age-specific mortality rates display a plausible pattern, which is generally higher during the peak childbearing ages than in the younger and older age groups. The pregnancy-related mortality ratio (PRM) is estimated at 1,291 deaths per 100,000 live births during the seven-year period before the survey (with a 95% confidence interval of 1,071 – 1,512). For every 1,000 live births in Afghanistan during the 7 years before the 2015AfDHS, approximately 13 women died during pregnancy, during childbirth, or within 2 months after childbirth. The lifetime risk of pregnancy-related death (0.073) indicates that of 1,000 women age 15, about 73 would die before age 50 during pregnancy, childbirth, or within two months of childbirth. The pregnancy-related mortality estimates appear to be higher than expected, given findings of other data sources from Afghanistan and its neighbors, as well as expert knowledge of the relationship of maternal mortality to overall adult mortality. In particular, the share of adult female deaths that are pregnancy related appear to be overestimated. Further analyses are being conducted to better understand these estimates, and additional analyses are encouraged. LIST OF TABLES For more information on adult and pregnancy-related mortality, see the following tables:  Table 14.1 Completeness of information on siblings  Table 14.2 Adult mortality rates  Table 14.3 Adult mortality probabilities  Table 14.4 Pregnancy-related mortality rates Adult and Maternal Mortality • 249 Table 14.1 Completeness of information on siblings Completeness of data on survival status of sisters and brothers reported by interviewed women, age of living siblings, and age at death (AD) and years since death (YSD) of dead siblings (unweighted), Afghanistan 2015 Sisters Brothers All siblings Number Percent Number Percent Number Percent All siblings 82,109 100.0 91,073 100.0 173,182 100.0 Living 73,037 89.0 81,368 89.3 154,405 89.2 Dead 9,031 11.0 9,662 10.6 18,693 10.8 Survival status unknown 41 0.0 43 0.0 84 0.0 Living siblings 73,037 100.0 81,368 100.0 154,405 100.0 Age reported 72,903 99.8 81,224 99.8 154,127 99.8 Age missing 134 0.2 144 0.2 278 0.2 Dead siblings 9,031 100.0 9,662 100.0 18,693 100.0 AD and YSD reported 8,948 99.1 9,536 98.7 18,484 98.9 Missing only AD 56 0.6 83 0.9 139 0.7 Missing only YSD 7 0.1 21 0.2 28 0.1 Missing AD and YSD 20 0.2 22 0.2 42 0.2 Table 14.2 Adult mortality rates Direct estimates of female and male mortality rates for the 7 years preceding the survey, by five-year age groups, Afghanistan 2015 Age Deaths Exposure years Mortality rates1 FEMALE 15-19 233 75,899 3.07 20-24 323 87,485 3.69 25-29 299 81,903 3.65 30-34 245 66,445 3.68 35-39 170 49,870 3.40 40-44 130 31,288 4.16 45-49 69 18,444 3.73 15-49 1,467 411,334 3.53a MALE 15-19 144 79,474 1.81 20-24 251 90,933 2.77 25-29 212 88,387 2.40 30-34 215 73,239 2.94 35-39 134 55,681 2.40 40-44 88 35,651 2.47 45-49 63 21,822 2.87 15-49 1,107 445,186 2.43a 1 Expressed per 1,000 population. a Age-adjusted rate. Table 14.3 Adult mortality probabilities Probability of dying between the ages of 15 and 50 for women and men for the 7 years preceding the survey, Afghanistan 2015 Women Men Survey 35q151 35q151 2015 AfDHS 119 CI: (104 -135 ) 84 CI: (76 - 93 ) CI: Confidence interval. 1 The probability of dying between exact ages 15 and 50, expressed per 1,000 persons at age 15. 250 • Adult and Maternal Mortality Table 14.4 Pregnancy-related mortality rates Direct estimates of pregnancy-related mortality rates for the 7 years preceding the survey, by 5-year age groups, Afghanistan 2015 Age Percentage of female deaths that are pregnancy-related Number of pregnancy- related deaths Exposure years Pregnancy- related mortality rate1 15-19 64.2 149 75,899 1.97 20-24 69.9 225 87,485 2.58 25-29 79.4 237 81,903 2.90 30-34 76.2 186 66,445 2.81 35-39 61.3 104 49,870 2.08 40-44 60.5 79 31,288 2.51 45-49 41.4 28 18,444 1.54 15-49 68.8 1,009 411,334 2.36a General fertility rate (GFR)2 183a CI: (176 - 189) Pregnancy-related mortality ratio3 1,291 CI: (1,071-1,512) Lifetime risk of maternal death4 0.073 CI: Confidence interval. 1 Expressed per 1,000 woman-years of exposure. 2 Expressed per 1,000 woman age 15-49. 3 Expressed per 100,000 live births; calculated as the age-adjusted pregnancy-related mortality rate multiplied by 100 divided by age-adjusted general fertility rate. 4 Calculated as 1-(1-PRM ratio)TFR where TFR represents the total fertility rate for the 7 years preceding the survey. a Age-adjusted rate. Women’s Empowerment • 251 WOMEN’S EMPOWERMENT 15 Key Findings  Employment and control over earnings: Only 13% of currently married women are employed as compared with 97% of currently married men. About 2 in 5 currently married women who receive cash earnings report deciding for themselves how their own earnings will be used, and one- third say they decide on the use of their earnings with their husband.  Ownership of assets: Seventeen percent of women independently own a house and another 10% own land, while almost half of the men own a house and about a third own land.  Participation in decision making: Only 5% of women make decisions alone about their own health care, while 44% report that their husbands make the decisions for them.  Attitude towards wife beating: Eighty percent of women and 72% of men believe that a husband is justified in beating his wife in at least 1 of 5 specified circumstances, particularly if she goes out without telling her husband (67% and 61%, respectively). his chapter explores women’s empowerment in terms of employment, earnings, control over earnings, and the magnitude of earnings relative to those of their partners. In addition, responses to specific questions are used to define two different indicators of women’s empowerment: women’s participation in household decision making and women’s attitudes towards wife beating. 15.1 MARRIED WOMEN’S AND MEN’S EMPLOYMENT Employment Respondents are considered employed if they have done any work other than housework in the 12 months before the survey. Sample: Currently married women and men age 15-49 Earning cash for employment Respondents are asked if they are paid for their labor in cash or in kind. Only those who receive payment in cash only or in cash and in kind are considered to have earned cash for their employment. Sample: Currently married women and men age 15-49 employed in the 12 months before the survey Men are more likely to be employed than women. Thirteen percent of currently married women reported being employed at any time in the 12 months before the survey compared with 97% of currently married men. (Table 15.1). T 252 • Women’s Empowerment Not all women and men receive earnings for the work they do. However, among those who receive earnings, not all receive cash. Among the employed, cash (cash and in-kind) is the most common form of payment for both women and men (66% and 91%, respectively). However, men are more likely to be paid cash for their work and women are most likely not to receive earnings for the work they do as compared with men (28% and 5%, respectively). Patterns by background characteristics  Employment does not vary with age among currently married women and men. More than one in ten currently married women are employed in all age groups and more than nine in ten currently married men are employed in most age groups from 20-49. (Figure 15.1).  Currently married women age 45-49 are more likely to be paid in cash (76%), while younger women age 15-19 are the least likely to be paid in cash (54%). More than 90% of currently married men age 20 and above are paid in cash, while younger men age 15-19 (72%) are slightly less likely to be paid in cash. 15.2 CONTROL OVER WOMEN’S EARNINGS Control over one’s own cash earnings Respondents are considered to have control over their own earnings if they participate in decisions alone or jointly with their husband about how their own earnings will be used. Sample: Currently married women age 15-49 who received cash earnings for employment during the 12 months before the survey To assess women’s autonomy, currently married women who earned cash for their work in the 12 months before the survey were asked to identify the main decision maker for the use of their earnings. Women gain direct access to economic resources when they are paid for work in cash. However, this access is meaningless unless women can also participate in decisions about the use of their earnings. Forty-one percent of currently married women who receive cash earnings reported deciding for themselves about the use of their earnings, while one third reported that they decided jointly with their husband (Table 15.2.1, Figure 15.2). Twenty-three percent of women reported that their husband decides how their earnings will be used. In couples in which both women and men earned cash, 65% of women reported that they earn less than their husbands and 8% report earning more (Table 15.2.1). Figure 15.1 Women's and men's employment by age Figure 15.2 Control over women's earnings 10 13 13 11 15 14 13 87 94 97 98 98 98 96 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Percentage of currently married women and men who were employed at any time in the past 12 months Age in years Currently married men Currently married women Mainly wife 41% Wife and husband jointly 34% Mainly husband 23% Other 2% Percent distribution of currently married women with cash earnings in the last 12 months Women’s Empowerment • 253 Patterns by background characteristics  Women age 45-49 (48%) are more likely to make independent decisions about their earnings than women age 30-34 (36%), while women age 15-19 (41%) are more likely to make joint decisions with husbands on their earnings than women age 40-49 (37%).  Women with 3-4 children (51%) are more likely to make independent decision on their earnings.  Making joint decisions increases with education, from 31% of women with no education to 54% of women with more than secondary education.  Women in the lowest wealth quintile are less likely to have independent control over their cash earnings than women in the higher wealth quintiles. 15.3 CONTROL OVER MEN’S EARNINGS Among married men who receive cash earnings, 68% report that they decide alone how to spend those earnings. Only 23% reported that they decide jointly with their wives on how to spend their earnings. Married women were also asked who decides how their husband’s earnings are used; 62% reported that this decision was made alone by their husbands, while 31% reported that they make joint decisions about spending with their husband (Table 15.2.2). When husbands have no cash earnings or the husbands are unemployed, women more often make the decisions on spending their earnings (49%). For more details, see Table 15.3. 15.4 WOMEN’S AND MEN’S OWNERSHIP OF ASSETS Ownership of a house or land Respondents who own a house or land, whether alone or jointly with someone else. Sample: Women and men age 15-49 Thirty-nine percent of women own a house, either alone or jointly with someone; similarly, 25% of women report that they own land, either alone or jointly (Table 15.4.1, Figure 15.3). Joint ownership of these assets is more common among women than independent ownership: 19% of women own a house jointly and 13% of women own land jointly with someone. The vast majority of men (81%) own a house, while more than half of men own land (Table 15.4.2). Figure 15.3 Ownership of assets 31 10 49 17 23 13 30 19 2 2 2 4 44 74 19 61 Men Women LAND Men Women HOUSE Percent distribution of women and men age 15-49 by house and land ownership Alone Jointly Alone and jointly Do not own a house Own: 254 • Women’s Empowerment Patterns by background characteristics  Ownership of house and land alone increases with age for men. While 17% of men age 15-19 own a house alone, 70% of men age 45-49 own a house alone and 44% own land (Table 15.4.2).  Women’s ownership of either asset, either alone or jointly, is higher in rural areas than in urban areas: 19% of rural women own a house alone compared with 11% of urban women. This pattern is similar for men’s ownership of a house or land (Table 15.4.1 and Table 15.4.2). 15.5 WOMEN’S PARTICIPATION IN DECISION MAKING Participation in major household decisions Women are considered to participate in household decisions if they make decisions alone or jointly with their husband in all three of the following areas: (1) the woman’s health care, (2) major household purchases, and (3) visits to the woman’s family or relatives. Sample: Currently married women age 15-49 The 2015 AfDHS sought information from currently married women on their participation in three types of household decisions: the respondent’s health care; major household purchases; and visits to family or relatives. Only 5% of women make decisions independently on their own heath care while the majority either decide with their husbands (43%), only their husbands (44%), or someone else (4%) makes the decision for them (Table 15.5). More than four in ten women participate in each individual decision jointly with their husband (Table 15.6.1). More women participate in joint decisions to visit their family or relatives (54%) than in decisions about their own health care (48%). One third of women participate in all three decisions, while 36% do not participate in any of the three decisions (Figure 15.4). The 2015 AfDHS also collected information from currently married men on their participation in two types of household decisions: their own health care and major household purchases. Information on men’s participation in decision making is shown in Table 15.6.2. Patterns by background characteristics  Participation in all three types of decision making, either solely or jointly with their husband, increases steadily with age, from 26% of women age 15-19 to 40% of women age 40-49.  Women’s participation in all three decisions increases substantially with education while the proportion participating in none of these decisions decreases with increasing levels of education. One in two currently married women with more than secondary education participate in all three decisions as compared with 31% of women with no education. Figure 15.4 Women's participation in decision making 48 42 54 33 36 Woman's own health care Major household purchases Visits to family or relatives Participate in all 3 decisions Participate in none of these decisions Percentage of currently married women age 15-49 participating in select decisions Women’s Empowerment • 255  Women in the wealthiest households (29%) are less likely to participate in all three decisions than women in the poorest households (41%). 15.6 ATTITUDES TOWARD WIFE BEATING Attitudes toward wife beating Respondents are asked if they agree that a husband is justified in hitting or beating his wife under each of the following five circumstances: she burns the food, she argues with him, she goes out without telling him, she neglects the children, and she refuses to have sex with him. If respondents answer “yes” in at least one circumstance, they are considered to have attitudes that justify wife beating. Sample: Women and men age 15-49 Eighty percent of women believe that a husband is justified in beating his wife for at least one of five specified circumstances (Table 15.7.1). This figure among men is 72% (Table 15.7.2, Figure 15.5). For each of the specified circumstances, men were less likely than women to agree that wife beating was justified. Patterns by background characteristics  Among women and men, attitudes towards wife beating are more acceptable in rural areas (82% of women and 76% of men) than in urban areas (74% of women and 60% of men) where wife beating is justified for at least one of the specified reasons (Table 15.7.1 and Table 15.7.2).  Women’s tolerance of wife beating decreases with education. About four in five women with no education or primary education agree with wife beating in at least one of five specified circumstances as compared with 61% of women with more than secondary education. The pattern among men is similar to the pattern among women (Table 15.7.2). LIST OF TABLES For more information on women’s empowerment and demographic and health outcomes, see the following tables:  Table 15.1 Employment and cash earnings of currently married women and men  Table 15.2.1 Control over women's cash earnings and relative magnitude of women's cash earnings  Table 15.2.2 Control over men's cash earnings  Table 15.3 Women's control over their own earnings and over those of their husbands  Table 15.4.1 Ownership of assets: Women  Table 15.4.2 Ownership of assets: Men Figure 15.5 Attitudes towards wife beating 18 59 67 48 33 80 9 46 61 26 20 72 Burns the food Argues with him Goes out without telling him Neglects the children Refuses sexual intercourse Any of these reasons Percentage of women and men age 15-49 who agree that a husband is justified in beating his wife for specific reasons Women Men 256 • Women’s Empowerment  Table 15.5 Participation in decision making  Table 15.6.1 Women's participation in decision making by background characteristics  Table 15.6.2 Men's participation in decision making by background characteristics  Table 15.7.1 Attitude toward wife beating: Women  Table 15.7.2 Attitude toward wife beating: Men  Table 15.8 Indicators of women's empowerment  Table 15.9 Current use of contraception by women's empowerment  Table 15.10 Ideal number of children and unmet need for family planning by women's empowerment  Table 15.11 Reproductive health care by women's empowerment  Table 15.12 Early childhood mortality rates by women's status Women’s Empowerment • 257 Table 15.1 Employment and cash earnings of currently married women and men Percentage of currently married women and men age 15-49 who were employed at any time in the past 12 months and the percent distribution of currently married women and men employed in the past 12 months by type of earnings, according to age, Afghanistan 2015 Among currently married respondents: Percent distribution of currently married respondents employed in the past 12 months, by type of earnings Age Percentage employed in past 12 months Number of respondents Cash only Cash and in-kind In-kind only Not paid Missing/ don't know Total Number of women WOMEN 15-19 10.0 1,812 45.7 7.8 4.2 42.2 0.1 100.0 182 20-24 12.9 6,028 46.7 8.2 4.4 40.2 0.6 100.0 779 25-29 13.1 6,193 63.4 4.8 6.6 24.8 0.4 100.0 809 30-34 11.3 4,226 62.6 8.8 6.7 21.7 0.2 100.0 476 35-39 14.8 4,375 65.5 5.3 4.1 24.3 0.8 100.0 646 40-44 14.2 2,977 62.8 5.3 3.6 26.9 1.4 100.0 424 45-49 12.7 3,060 67.2 8.5 4.2 19.6 0.4 100.0 389 Total 12.9 28,671 59.6 6.7 5.0 28.1 0.6 100.0 3,705 MEN 15-19 87.1 142 45.0 27.0 2.3 24.1 1.6 100.0 124 20-24 93.7 1,160 64.9 25.4 4.4 5.0 0.3 100.0 1,087 25-29 96.9 2,410 71.5 19.9 4.4 4.0 0.2 100.0 2,336 30-34 98.3 1,992 65.8 25.6 3.8 4.7 0.1 100.0 1,960 35-39 97.5 1,925 71.0 21.5 4.4 3.1 0.0 100.0 1,877 40-44 98.1 1,385 63.6 25.9 6.2 4.2 0.1 100.0 1,359 45-49 95.8 1,664 61.9 27.4 5.9 4.8 0.1 100.0 1,595 Total 96.8 10,679 66.8 23.9 4.7 4.5 0.1 100.0 10,337 258 • Women’s Empowerment Table 15.2.1 Control over women's cash earnings and relative magnitude of women's cash earnings Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 12 months preceding the survey by person who decides how wife's cash earnings are used and by whether she earned more or less than her husband, according to background characteristics, Afghanistan 2015 Person who decides how the wife's cash earnings are used: Wife's cash earnings compared with husband's cash earnings: Background characteristic Mainly wife Wife and husband jointly Mainly husband Other Missing Total More Less About the same Husband has no earnings Don't know/ Missing Total Number of women Age 15-19 40.1 40.9 15.5 2.7 0.8 100.0 6.0 73.9 4.5 7.0 8.6 100.0 97 20-24 39.9 28.8 23.5 5.2 2.5 100.0 6.4 64.2 10.2 5.9 13.3 100.0 428 25-29 39.0 28.9 28.8 2.2 1.1 100.0 9.5 62.5 9.3 4.1 14.6 100.0 552 30-34 36.3 39.7 20.6 0.9 2.5 100.0 5.8 67.6 8.0 5.5 13.2 100.0 340 35-39 41.2 33.1 24.6 0.5 0.7 100.0 5.7 74.7 6.7 4.3 8.5 100.0 458 40-44 42.1 36.7 18.7 0.5 2.1 100.0 10.5 56.3 17.3 6.0 9.9 100.0 288 45-49 48.3 36.6 13.9 0.1 1.1 100.0 13.0 61.1 3.7 13.7 8.4 100.0 295 Number of living children 0 29.0 33.6 31.8 1.6 4.1 100.0 5.7 54.0 8.3 13.1 18.9 100.0 242 1-2 31.2 37.4 24.0 5.8 1.6 100.0 12.0 60.3 11.0 7.2 9.5 100.0 498 3-4 50.6 27.8 19.6 1.1 0.9 100.0 10.4 68.0 7.7 3.0 11.0 100.0 761 5+ 40.8 35.9 21.6 0.3 1.4 100.0 5.0 68.7 8.9 6.3 11.1 100.0 957 Residence Urban 40.3 41.0 15.5 2.1 1.0 100.0 11.5 66.2 10.9 4.3 7.1 100.0 661 Rural 40.8 30.7 25.0 1.7 1.8 100.0 6.9 65.0 8.2 6.8 13.1 100.0 1,797 Education No education 40.6 30.7 25.2 2.2 1.3 100.0 6.6 65.4 7.0 7.2 13.8 100.0 1,797 Primary 42.4 30.9 23.7 1.3 1.8 100.0 9.4 71.5 9.8 1.7 7.5 100.0 212 Secondary 50.7 37.8 9.1 0.3 2.1 100.0 9.5 69.3 12.6 4.1 4.6 100.0 227 More than secondary 29.4 54.2 13.2 0.4 2.8 100.0 18.0 55.2 19.4 3.7 3.7 100.0 222 Wealth quintile Lowest 23.4 34.0 36.4 4.0 2.3 100.0 7.7 51.4 6.6 8.0 26.3 100.0 437 Second 32.7 38.6 24.4 1.5 2.7 100.0 9.4 54.6 11.2 7.6 17.2 100.0 439 Middle 54.9 25.5 18.9 0.0 0.7 100.0 6.5 71.3 7.6 7.1 7.5 100.0 499 Fourth 53.0 25.4 16.6 3.4 1.7 100.0 4.1 76.7 9.7 5.8 3.7 100.0 553 Highest 35.6 44.7 18.9 0.2 0.6 100.0 13.3 68.2 9.1 2.9 6.5 100.0 529 Total 40.7 33.5 22.5 1.8 1.6 100.0 8.1 65.3 8.9 6.1 11.5 100.0 2,458 Note: Provincial-level estimates not shown separately due to few cases of women earning cash for employment. Women’s Empowerment • 259 Table 15.2.2 Control over men's cash earnings Percent distributions of currently married men age 15-49 who receive cash earnings and of currently married women age 15-49 whose husbands receive cash earnings, by person who decides how husband's cash earnings are used, according to background characteristics, Afghanistan 2015 Men Women Background characteristic Mainly wife Hus- band and wife jointly Mainly hus- band Other Missing Total Number Mainly wife Hus- band and wife jointly Mainly hus- band Other Missing Total Number Age 15-19 6.2 14.3 37.7 41.8 0.0 100.0 89 1.7 26.4 63.3 8.4 0.2 100.0 1,698 20-24 2.1 25.3 51.0 20.1 1.5 100.0 981 2.6 26.9 59.7 10.5 0.5 100.0 5,811 25-29 1.8 22.0 65.2 10.8 0.2 100.0 2,136 1.9 27.6 64.0 6.2 0.3 100.0 6,036 30-34 1.5 22.4 69.5 6.3 0.3 100.0 1,792 1.0 32.9 62.6 3.2 0.2 100.0 4,128 35-39 1.8 20.2 74.8 2.9 0.3 100.0 1,735 2.2 34.0 61.0 1.8 1.0 100.0 4,272 40-44 1.3 26.6 71.0 1.1 0.0 100.0 1,216 3.0 35.4 60.8 0.6 0.2 100.0 2,864 45-49 0.7 23.3 75.1 0.6 0.3 100.0 1,423 1.5 37.6 59.9 0.7 0.3 100.0 2,762 Number of living children 0 3.5 22.1 56.9 17.0 0.6 100.0 865 1.9 28.5 57.9 11.4 0.4 100.0 2,689 1-2 1.7 24.6 61.0 12.2 0.5 100.0 2,503 2.7 28.1 60.0 8.6 0.6 100.0 6,875 3-4 1.5 25.5 67.1 5.5 0.3 100.0 2,546 1.4 30.0 63.7 4.3 0.6 100.0 7,328 5+ 1.1 19.7 77.3 1.7 0.2 100.0 3,458 2.0 34.1 62.2 1.6 0.2 100.0 10,679 Residence Urban 1.3 29.2 64.6 4.6 0.4 100.0 2,317 3.1 33.5 59.4 3.5 0.6 100.0 6,472 Rural 1.7 20.7 69.5 7.7 0.4 100.0 7,055 1.7 30.2 62.3 5.5 0.4 100.0 21,099 Province1 Kabul 1.8 35.5 60.4 1.6 0.7 100.0 1,232 3.2 33.6 56.9 5.3 1.1 100.0 3,484 Kapisa 0.5 2.2 88.1 9.3 0.0 100.0 54 2.8 20.3 69.7 7.3 0.0 100.0 193 Parwan 0.0 4.5 78.0 17.4 0.0 100.0 215 0.9 52.4 38.7 7.1 0.9 100.0 576 Wardak 1.0 58.9 23.7 16.4 0.0 100.0 80 1.4 29.8 51.3 17.0 0.5 100.0 363 Logar 14.2 19.6 65.0 1.2 0.0 100.0 195 4.6 23.2 71.7 0.5 0.0 100.0 464 Nangarhar 0.8 7.4 78.1 13.7 0.0 100.0 249 0.2 23.8 50.9 24.2 0.8 100.0 712 Laghman 0.1 2.2 81.2 16.4 0.0 100.0 202 4.1 53.3 33.5 9.1 0.0 100.0 552 Panjsher 0.0 67.0 31.4 0.0 1.6 100.0 15 2.1 77.9 17.5 1.6 0.9 100.0 48 Baghlan 0.0 12.4 82.3 5.2 0.0 100.0 205 1.5 50.2 45.5 2.9 0.0 100.0 815 Bamyan 2.1 20.5 68.0 9.4 0.0 100.0 33 0.7 58.2 24.6 15.9 0.5 100.0 287 Ghazni 2.0 45.7 47.3 3.0 2.0 100.0 569 1.0 39.4 58.8 0.1 0.6 100.0 1,296 Paktika 5.0 0.3 62.1 31.9 0.7 100.0 279 1.2 0.8 80.1 17.6 0.2 100.0 756 Paktya 0.4 36.9 49.4 12.7 0.6 100.0 196 1.7 3.5 91.7 2.1 1.0 100.0 475 Khost 2.3 17.1 50.8 29.4 0.4 100.0 294 2.0 59.8 12.0 26.3 0.0 100.0 797 Kunarha 10.0 34.1 41.3 14.6 0.0 100.0 115 1.6 69.6 20.8 8.0 0.0 100.0 529 Nooristan 3.0 10.7 69.1 16.7 0.5 100.0 59 0.8 22.8 71.3 4.8 0.2 100.0 199 Badakhshan 0.1 69.1 29.8 1.0 0.0 100.0 267 0.4 80.1 18.8 0.7 0.0 100.0 882 Takhar 0.9 5.6 91.2 2.2 0.0 100.0 266 1.8 37.7 60.0 0.2 0.2 100.0 989 Kunduz 0.5 3.4 93.2 3.0 0.0 100.0 451 0.5 21.4 73.9 3.6 0.5 100.0 1,172 Samangan 0.1 4.4 95.4 0.0 0.0 100.0 100 1.2 46.2 43.1 9.5 0.0 100.0 299 Balkh 0.0 28.6 61.3 10.1 0.0 100.0 491 1.8 29.9 62.0 6.0 0.2 100.0 1,648 Sar-E-Pul 2.3 43.8 51.7 1.9 0.3 100.0 164 3.9 28.5 65.0 2.6 0.0 100.0 593 Ghor 0.0 8.7 65.0 25.9 0.4 100.0 197 0.5 22.2 76.0 1.3 0.0 100.0 688 Daykundi 0.0 23.2 75.3 0.0 1.6 100.0 35 2.4 68.0 29.1 0.5 0.0 100.0 282 Urozgan 0.0 3.7 90.9 5.5 0.0 100.0 79 0.4 2.0 97.3 0.0 0.3 100.0 228 Kandahar 0.1 8.8 83.4 7.6 0.2 100.0 854 1.4 6.3 89.6 2.4 0.3 100.0 2,156 Jawzjan 0.2 13.6 82.5 3.7 0.0 100.0 202 0.4 62.6 28.1 8.9 0.0 100.0 598 Faryab 0.0 1.5 94.5 4.0 0.0 100.0 672 6.4 5.4 84.8 2.1 1.3 100.0 1,896 Helmand 10.4 8.5 80.0 1.2 0.0 100.0 301 0.0 0.5 98.8 0.6 0.1 100.0 870 Badghis 0.0 16.8 76.3 3.2 3.7 100.0 149 1.0 34.7 63.2 1.1 0.0 100.0 634 Herat 0.8 48.3 50.9 0.0 0.0 100.0 822 1.5 34.8 63.5 0.1 0.1 100.0 2,134 Farah 0.5 14.4 80.9 4.3 0.0 100.0 231 1.2 19.0 78.9 0.9 0.0 100.0 690 Nimroz 0.0 59.7 40.3 0.0 0.0 100.0 89 4.7 47.7 44.0 3.2 0.4 100.0 247 Education No education 1.0 21.2 71.3 6.2 0.3 100.0 4,672 1.6 29.4 63.6 4.9 0.5 100.0 22,990 Primary 1.7 23.4 68.6 6.0 0.3 100.0 1,764 4.1 35.7 55.0 5.1 0.2 100.0 2,174 Secondary 2.5 21.6 67.0 8.7 0.3 100.0 2,318 3.7 39.5 50.0 6.6 0.2 100.0 1,880 More than secondary 2.1 38.0 49.7 8.6 1.6 100.0 618 3.8 48.3 43.5 4.5 0.0 100.0 527 Wealth quintile Lowest 0.4 23.1 69.4 6.4 0.6 100.0 1,465 0.8 36.6 59.4 3.1 0.1 100.0 5,479 Second 3.1 17.4 71.0 8.1 0.4 100.0 1,926 1.6 28.6 64.8 4.8 0.2 100.0 5,595 Middle 1.2 19.9 70.9 7.8 0.3 100.0 1,941 1.1 26.5 66.4 5.5 0.4 100.0 5,506 Fourth 2.1 22.5 67.8 7.4 0.2 100.0 2,075 3.3 30.7 58.1 7.2 0.6 100.0 5,639 Highest 0.9 31.1 62.8 4.8 0.5 100.0 1,965 3.1 32.5 59.4 4.2 0.8 100.0 5,352 Total 1.6 22.8 68.3 6.9 0.4 100.0 9,372 2.0 31.0 61.6 5.0 0.4 100.0 27,571 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 260 • Women’s Empowerment Table 15.3 Women's control over their own earnings and over those of their husbands Percent distribution of currently married women age 15-49 with cash earnings in the last 12 months by person who decides how the wife's cash earnings are used and percent distribution of currently married women age 15-49 whose husbands have cash earnings by person who decides how the husband's cash earnings are used, according to the relation between wife's and husband's cash earnings, Afghanistan 2015 Person who decides how the wife's cash earnings are used: Person who decides how husband's cash earnings are used: Women's earnings relative to husband's earnings Mainly wife Wife and hus- band jointly Mainly hus- band Other Missing Total Number Mainly wife Wife and hus- band jointly Mainly hus- band Other Missing Total Number of women More than husband 15.0 59.4 25.6 0.0 0.0 100.0 200 1.8 55.9 40.6 1.7 0.0 100.0 200 Less than husband 49.3 28.6 21.0 1.1 0.0 100.0 1,606 4.1 26.8 66.7 2.4 0.0 100.0 1,606 Same as husband 15.2 59.2 24.3 1.3 0.0 100.0 218 1.0 63.9 32.5 2.6 0.0 100.0 218 Husband has no cash earnings or did not work 49.3 26.7 18.8 4.4 0.8 100.0 151 na na na na na na na Woman worked but has no cash earnings na na na na na na na 6.2 21.2 70.0 2.3 0.3 100.0 1,211 Woman did not work na na na na na na na 1.7 31.3 61.3 5.3 0.4 100.0 24,053 Total1 40.7 33.5 22.5 1.8 1.6 100.0 2,458 2.0 31.0 61.6 5.0 0.4 100.0 27,571 na = Not applicable. 1 Includes cases where a woman does not know whether she earned more or less than her husband. Women’s Empowerment • 261 Table 15.4.1 Ownership of assets: Women Percent distribution of ever-married women age 15-49 by ownership of housing and land, according to background characteristics, Afghanistan 2015 Percentage who own a house: Percentage who own land: Background characteristic Alone Jointly Alone and jointly Percent age who do not own a house Missing Total Alone Jointly Alone and jointly Percent age who do not own land Missing Total Number Age 15-19 12.3 24.7 1.7 61.3 0.1 100.0 6.8 17.2 1.3 74.3 0.4 100.0 1,825 20-24 12.3 22.3 2.6 62.6 0.2 100.0 7.4 16.1 1.8 74.4 0.3 100.0 6,089 25-29 15.7 19.9 3.7 60.3 0.3 100.0 9.6 13.2 2.0 74.7 0.5 100.0 6,299 30-34 17.8 17.0 3.2 61.8 0.2 100.0 11.0 12.8 2.6 73.4 0.3 100.0 4,302 35-39 19.5 16.6 4.5 58.9 0.6 100.0 9.8 12.0 2.7 74.8 0.6 100.0 4,463 40-44 20.9 13.7 5.0 60.1 0.3 100.0 11.2 10.6 2.8 75.0 0.4 100.0 3,113 45-49 20.0 16.3 4.4 59.2 0.1 100.0 11.5 12.2 2.4 73.7 0.3 100.0 3,369 Residence Urban 10.5 14.5 3.4 70.9 0.7 100.0 4.1 4.7 0.8 89.5 0.9 100.0 6,870 Rural 18.6 20.0 3.6 57.6 0.2 100.0 11.3 16.1 2.7 69.7 0.3 100.0 22,591 Province1 Kabul 14.1 18.5 3.9 62.5 1.0 100.0 5.8 6.3 0.7 86.0 1.2 100.0 3,658 Kapisa 3.1 0.8 0.0 96.1 0.0 100.0 2.4 0.8 0.0 96.5 0.3 100.0 205 Parwan 1.4 3.4 5.2 89.8 0.1 100.0 0.5 2.4 3.4 93.6 0.1 100.0 625 Wardak 6.2 8.9 4.8 80.1 0.0 100.0 5.2 6.3 5.9 82.6 0.0 100.0 382 Logar 76.0 18.2 0.1 5.2 0.5 100.0 44.1 31.3 0.0 23.8 0.8 100.0 472 Nangarhar 36.4 41.6 0.2 21.5 0.2 100.0 11.2 30.8 0.7 57.1 0.2 100.0 794 Laghman 52.2 41.8 1.1 5.0 0.0 100.0 31.4 42.0 0.8 25.4 0.3 100.0 583 Panjsher 63.6 4.6 0.0 31.8 0.0 100.0 15.4 3.0 0.7 80.8 0.2 100.0 54 Baghlan 8.0 2.6 2.9 86.4 0.0 100.0 6.4 2.5 4.0 86.8 0.3 100.0 839 Bamyan 0.0 1.2 1.1 97.6 0.1 100.0 0.0 0.0 1.1 98.8 0.1 100.0 303 Ghazni 20.4 25.7 1.2 51.9 0.7 100.0 2.5 19.1 0.9 76.7 0.8 100.0 1,328 Paktika 5.5 3.4 0.3 90.2 0.7 100.0 28.7 2.3 0.4 67.9 0.7 100.0 792 Paktya 3.1 91.7 0.2 3.8 1.3 100.0 0.8 69.2 0.3 28.3 1.3 100.0 542 Khost 55.8 29.7 7.9 6.6 0.0 100.0 44.4 24.0 3.7 27.9 0.0 100.0 851 Kunarha 25.0 62.7 0.3 11.9 0.0 100.0 15.6 53.1 0.4 30.9 0.0 100.0 559 Nooristan 43.6 54.1 0.5 1.7 0.1 100.0 42.6 53.9 1.1 2.4 0.1 100.0 222 Badakhshan 24.9 6.8 1.9 66.4 0.0 100.0 15.7 5.6 0.8 77.6 0.3 100.0 1,004 Takhar 4.6 20.3 0.2 74.9 0.0 100.0 3.0 17.4 0.2 79.3 0.1 100.0 1,105 Kunduz 24.1 6.6 0.2 68.9 0.2 100.0 10.8 13.8 0.2 75.1 0.2 100.0 1,232 Samangan 12.2 8.6 0.3 78.8 0.2 100.0 7.5 9.0 0.4 82.8 0.2 100.0 330 Balkh 3.2 8.2 8.2 80.1 0.3 100.0 2.8 1.6 2.8 92.6 0.3 100.0 1,781 Sar-E-Pul 38.4 13.0 1.2 47.4 0.0 100.0 12.3 10.3 3.7 73.7 0.1 100.0 654 Ghor 1.3 14.9 4.2 79.6 0.0 100.0 1.1 13.0 4.1 81.8 0.0 100.0 715 Daykundi 1.5 5.2 18.8 74.5 0.0 100.0 0.7 5.1 19.5 74.6 0.1 100.0 329 Urozgan 31.8 66.7 0.1 1.2 0.2 100.0 29.2 65.8 0.1 4.7 0.2 100.0 230 Kandahar 1.1 10.5 0.1 88.1 0.3 100.0 0.2 7.5 0.1 91.9 0.3 100.0 2,227 Jawzjan 58.8 11.7 0.2 29.3 0.0 100.0 4.9 0.4 0.3 94.3 0.0 100.0 614 Faryab 2.0 32.6 11.0 54.2 0.1 100.0 1.7 12.1 7.0 78.8 0.4 100.0 2,114 Helmand 58.6 13.9 7.8 19.4 0.2 100.0 45.7 12.3 7.3 34.1 0.6 100.0 875 Badghis 0.8 28.4 14.6 56.3 0.0 100.0 0.4 22.9 13.0 63.4 0.1 100.0 650 Herat 2.7 4.2 2.7 90.3 0.0 100.0 0.6 6.5 0.3 92.5 0.2 100.0 2,316 Farah 23.1 16.3 0.3 60.3 0.0 100.0 21.9 13.7 0.1 64.1 0.1 100.0 777 Nimroz 16.5 20.2 2.0 61.1 0.2 100.0 2.7 2.5 0.3 93.9 0.6 100.0 278 Education No education 17.4 18.5 3.4 60.4 0.3 100.0 10.4 14.2 2.4 72.6 0.4 100.0 24,604 Primary 14.2 20.4 3.7 61.6 0.1 100.0 5.1 9.2 1.5 83.8 0.3 100.0 2,330 Secondary 12.2 19.5 5.0 62.8 0.5 100.0 6.0 9.4 1.4 82.9 0.3 100.0 1,971 More than secondary 11.8 19.2 5.2 63.5 0.4 100.0 4.3 9.9 1.7 82.5 1.5 100.0 556 Wealth quintile Lowest 11.5 12.2 4.7 71.6 0.1 100.0 7.1 11.7 4.2 76.8 0.1 100.0 5,904 Second 21.9 19.6 3.9 54.6 0.1 100.0 13.3 17.5 2.7 66.3 0.1 100.0 6,001 Middle 18.8 23.1 2.8 55.1 0.3 100.0 11.9 18.8 2.1 66.8 0.3 100.0 5,888 Fourth 19.2 21.7 3.0 55.8 0.2 100.0 10.1 12.8 1.3 75.4 0.3 100.0 6,010 Highest 11.9 16.8 3.7 66.8 0.9 100.0 5.2 5.8 0.9 87.1 1.1 100.0 5,657 Total 16.7 18.7 3.6 60.7 0.3 100.0 9.6 13.4 2.3 74.4 0.4 100.0 29,461 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 262 • Women’s Empowerment Table 15.4.2 Ownership of assets: Men Percent distribution of ever-married men age 15-49 by ownership of housing and land, according to background characteristics, Afghanistan 2015 Percentage who own a house: Percentage who own land: Background characteristic Alone Jointly Alone and jointly Percent- age who do not own a house Missing Total Alone Jointly Alone and jointly Percent age who do not own land Missing Total Number Age 15-19 17.3 34.9 2.7 45.0 0.0 100.0 15.6 31.9 1.1 51.3 0.0 100.0 142 20-24 30.8 39.8 2.5 26.6 0.3 100.0 19.6 29.1 1.6 49.2 0.5 100.0 1,162 25-29 35.6 39.4 1.4 23.5 0.2 100.0 22.5 27.9 0.9 48.5 0.2 100.0 2,422 30-34 44.5 35.1 2.0 18.3 0.1 100.0 29.3 27.3 1.6 41.7 0.2 100.0 2,008 35-39 50.9 26.8 2.2 19.8 0.3 100.0 32.2 22.8 3.1 41.4 0.5 100.0 1,935 40-44 65.5 18.8 2.5 13.0 0.2 100.0 41.1 15.6 2.7 40.4 0.2 100.0 1,402 45-49 70.2 14.7 3.1 12.0 0.1 100.0 44.2 13.8 2.1 39.7 0.2 100.0 1,688 Residence Urban 35.0 29.9 1.3 33.6 0.3 100.0 11.4 13.8 0.2 74.1 0.4 100.0 2,479 Rural 52.6 29.7 2.5 15.0 0.2 100.0 36.8 26.1 2.4 34.5 0.2 100.0 8,281 Province1 Kabul 38.9 24.2 1.5 35.4 0.0 100.0 12.6 14.1 0.4 72.9 0.0 100.0 1,350 Kapisa 66.2 11.0 0.0 22.9 0.0 100.0 56.1 11.7 0.3 31.9 0.0 100.0 63 Parwan 53.6 10.8 0.6 34.7 0.4 100.0 37.0 7.9 0.6 54.0 0.5 100.0 220 Wardak 36.4 35.8 1.4 26.0 0.4 100.0 26.6 35.9 0.2 36.6 0.7 100.0 171 Logar 78.7 18.7 0.5 1.8 0.2 100.0 58.9 24.8 0.2 16.1 0.0 100.0 204 Nangarhar 34.7 46.4 1.1 17.6 0.2 100.0 13.3 30.0 0.2 56.3 0.2 100.0 273 Laghman 46.1 45.7 1.6 6.5 0.0 100.0 34.2 38.3 2.5 24.9 0.0 100.0 227 Panjsher 74.9 22.5 0.8 1.3 0.5 100.0 68.5 21.5 0.8 8.7 0.5 100.0 18 Baghlan 81.1 8.5 0.0 10.1 0.2 100.0 58.4 19.5 0.0 21.9 0.2 100.0 281 Bamyan 45.9 25.2 0.0 28.9 0.0 100.0 31.7 23.5 0.0 43.0 1.9 100.0 94 Ghazni 42.9 45.3 3.8 7.9 0.2 100.0 31.8 43.8 2.8 21.4 0.2 100.0 619 Paktika 53.1 16.1 0.6 30.1 0.1 100.0 74.3 17.6 0.6 7.1 0.4 100.0 322 Paktya 49.2 47.7 0.2 2.7 0.2 100.0 23.4 51.0 1.8 23.6 0.2 100.0 206 Khost 47.1 36.7 10.6 5.5 0.0 100.0 33.0 25.0 8.0 34.0 0.0 100.0 334 Kunarha 49.1 27.2 4.3 19.4 0.0 100.0 40.4 28.4 0.2 30.9 0.2 100.0 151 Nooristan 56.5 37.9 1.7 3.0 0.9 100.0 54.9 38.3 2.5 3.4 0.9 100.0 66 Badakhshan 66.8 22.1 1.1 10.0 0.0 100.0 39.4 22.6 3.1 35.0 0.0 100.0 316 Takhar 65.2 22.4 0.2 12.2 0.0 100.0 35.9 12.0 0.0 52.2 0.0 100.0 296 Kunduz 62.0 20.7 0.9 16.4 0.0 100.0 42.1 21.8 0.4 35.6 0.0 100.0 479 Samangan 60.9 20.0 1.3 17.9 0.0 100.0 38.1 23.3 0.7 37.9 0.0 100.0 125 Balkh 34.7 37.4 0.2 26.0 1.7 100.0 25.6 23.5 0.4 48.9 1.7 100.0 616 Sar-E-Pul 65.0 14.2 0.4 20.4 0.0 100.0 32.9 11.3 0.4 55.4 0.0 100.0 195 Ghor 61.1 13.8 1.0 24.2 0.0 100.0 55.1 15.5 0.8 28.2 0.4 100.0 322 Daykundi 54.0 25.8 0.0 20.2 0.0 100.0 39.7 28.6 0.0 31.4 0.3 100.0 77 Urozgan 79.1 18.6 0.0 2.1 0.1 100.0 76.2 18.0 0.0 5.8 0.1 100.0 92 Kandahar 42.2 50.2 0.4 7.1 0.2 100.0 19.5 30.1 1.1 48.7 0.6 100.0 874 Jawzjan 62.6 20.4 0.0 17.0 0.0 100.0 34.6 11.9 0.3 53.3 0.0 100.0 218 Faryab 23.6 51.7 9.6 15.1 0.0 100.0 8.4 41.9 10.4 39.3 0.0 100.0 706 Helmand 57.8 8.3 11.8 21.9 0.2 100.0 38.7 9.4 9.7 41.6 0.5 100.0 355 Badghis 54.4 33.3 1.6 10.2 0.5 100.0 42.2 31.2 0.9 25.8 0.0 100.0 231 Herat 46.3 23.4 0.0 30.3 0.0 100.0 21.7 8.6 0.0 69.5 0.2 100.0 863 Farah 55.1 24.6 0.4 19.9 0.0 100.0 50.3 26.0 0.8 23.0 0.0 100.0 295 Nimroz 33.0 13.9 1.3 51.8 0.0 100.0 7.3 3.0 0.3 89.4 0.0 100.0 93 Education No education 52.4 27.5 2.0 17.9 0.2 100.0 34.7 22.3 2.3 40.4 0.3 100.0 5,447 Primary 43.7 33.4 3.2 19.6 0.1 100.0 28.3 22.5 1.9 47.2 0.1 100.0 1,987 Secondary 44.7 32.2 1.9 21.1 0.2 100.0 26.5 26.2 1.4 45.7 0.2 100.0 2,632 More than secondary 47.3 27.8 2.3 22.5 0.1 100.0 25.5 21.9 0.8 51.4 0.4 100.0 695 Wealth quintile Lowest 55.1 25.9 2.6 16.2 0.2 100.0 43.8 25.5 2.2 28.1 0.3 100.0 2,029 Second 55.8 27.8 2.3 14.0 0.1 100.0 42.3 26.2 2.0 29.3 0.2 100.0 2,233 Middle 53.3 28.5 2.2 16.0 0.1 100.0 35.4 24.4 2.5 37.5 0.2 100.0 2,160 Fourth 42.3 32.9 2.5 22.0 0.3 100.0 22.6 22.6 1.7 52.8 0.3 100.0 2,260 Highest 36.5 33.5 1.5 28.5 0.1 100.0 10.4 17.4 1.2 70.6 0.3 100.0 2,078 Total 48.6 29.7 2.2 19.3 0.2 100.0 30.9 23.2 1.9 43.6 0.3 100.0 10,760 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Women’s Empowerment • 263 Table 15.5 Participation in decision making Percent distribution of currently married women and currently married men age 15-49 by person who usually makes decisions about various issues, Afghanistan 2015 Decision Mainly wife Wife and husband jointly Mainly husband Someon e else Other Missing Total Number of women WOMEN Own health care 4.8 42.8 44.2 4.0 3.9 0.4 100.0 28,671 Major household purchases 2.2 39.9 45.8 6.9 4.8 0.4 100.0 28,671 Visits to her family or relatives 5.7 48.0 33.0 8.0 4.8 0.4 100.0 28,671 MEN Own health care 3.0 27.9 61.7 2.1 5.0 0.2 100.0 10,679 Major household purchases 1.9 31.3 54.1 4.5 8.1 0.2 100.0 10,679 264 • Women’s Empowerment Table 15.6.1 Women's participation in decision making by background characteristics Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly with their husband, by background characteristics, Afghanistan 2015 Specific decisions Background characteristic Woman's own health care Making major household purchases Visits to her family or relatives All three decisions None of the three decisions Number of women Age 15-19 40.9 32.7 41.8 25.5 46.1 1,812 20-24 42.8 36.2 44.1 27.6 44.2 6,028 25-29 43.9 38.8 50.2 29.5 39.1 6,193 30-34 48.8 43.1 56.8 33.9 34.4 4,226 35-39 53.0 46.2 59.7 36.3 29.8 4,375 40-44 53.6 49.6 62.9 39.5 28.8 2,977 45-49 53.4 51.5 65.2 39.5 26.7 3,060 Employment (last 12 months)1 Not employed 46.7 42.5 53.0 32.9 37.0 24,904 Employed for cash 58.1 42.4 65.1 34.2 24.0 2,458 Employed not for cash 46.9 35.3 48.1 25.6 38.8 1,226 Number of living children 0 44.2 38.0 47.6 29.0 40.4 2,875 1-2 45.4 37.7 47.6 29.2 40.4 7,165 3-4 45.5 41.0 53.3 31.1 36.9 7,505 5+ 51.3 46.7 59.6 36.9 31.7 11,126 Residence Urban 50.2 43.2 55.9 31.8 32.5 6,673 Rural 46.8 41.8 53.1 32.9 37.2 21,998 Province2 Kabul 43.8 40.4 54.9 28.6 37.1 3,571 Kapisa 29.8 28.3 29.2 27.1 68.6 197 Parwan 59.5 58.6 70.5 51.4 25.9 592 Wardak 31.6 34.8 52.9 21.5 36.3 378 Logar 43.3 32.1 64.2 22.8 25.3 465 Nangarhar 29.6 34.1 50.0 25.9 48.4 769 Laghman 57.6 57.2 57.8 52.4 38.2 567 Panjsher 74.8 78.8 90.7 70.6 7.2 53 Baghlan 62.8 78.6 51.5 48.9 15.4 835 Bamyan 69.6 68.0 73.8 65.9 24.7 295 Ghazni 56.0 58.6 68.2 38.9 19.2 1,319 Paktika 3.2 12.6 18.9 2.2 79.0 779 Paktya 31.7 31.8 35.9 21.2 54.2 529 Khost 63.4 58.4 59.5 55.2 33.5 845 Kunarha 59.8 66.3 68.4 56.3 28.3 549 Nooristan 33.1 26.2 27.9 24.4 64.2 209 Badakhshan 87.3 90.8 93.4 85.7 5.9 968 Takhar 70.7 80.1 83.5 67.6 13.9 1,070 Kunduz 30.9 31.4 47.1 26.4 51.6 1,214 Samangan 47.3 50.0 72.7 46.5 26.8 319 Balkh 62.7 57.6 71.6 49.4 21.0 1,742 Sar-E-Pul 47.2 55.9 70.1 37.7 21.0 644 Ghor 27.9 22.7 61.1 20.3 38.0 708 Daykundi 86.1 82.3 82.5 74.2 6.0 319 Urozgan 3.8 3.7 5.1 3.0 94.4 229 Kandahar 26.7 13.6 14.4 7.1 66.9 2,193 Jawzjan 64.7 39.8 72.6 36.2 16.8 603 Faryab 72.1 36.3 68.2 23.9 9.2 2,030 Helmand 0.2 0.2 0.5 0.2 99.5 874 Badghis 48.8 39.2 48.4 34.0 44.1 640 Herat 49.8 28.5 46.8 18.9 29.8 2,166 Farah 25.7 24.1 35.0 11.7 54.8 717 Nimroz 51.9 45.0 62.5 38.0 30.5 264 Education No education 45.1 40.6 52.1 31.2 38.1 23,921 Primary 56.2 44.8 58.5 34.0 27.5 2,257 Secondary 62.8 52.7 63.7 43.6 25.5 1,951 More than secondary 65.4 58.8 70.0 49.8 21.8 542 Wealth quintile Lowest 53.1 50.1 63.2 41.2 27.8 5,757 Second 46.2 41.2 51.9 31.8 37.7 5,823 Middle 40.5 37.7 47.3 29.3 44.8 5,736 Fourth 47.6 40.7 53.0 31.3 37.2 5,846 Highest 50.7 40.9 53.3 29.3 32.9 5,509 Total 47.6 42.1 53.7 32.6 36.1 28,671 1 Total includes 83 women with missing information on employment status in the last 12 months. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Women’s Empowerment • 265 Table 15.6.2 Men's participation in decision making by background characteristics Percentage of currently married men age 15-49 who usually make specific decisions either alone or jointly with their wife, by background characteristics, Afghanistan 2015 Specific decisions Background characteristic Man's own health Making major household purchases Both decisions Neither of the two decisions Number of men Age 15-19 59.5 54.9 46.7 32.3 142 20-24 80.0 66.6 63.1 16.5 1,160 25-29 85.7 78.2 75.5 11.6 2,410 30-34 92.4 87.4 85.0 5.3 1,992 35-39 92.8 88.9 86.1 4.5 1,925 40-44 92.9 94.9 90.8 3.1 1,385 45-49 95.2 97.4 93.7 1.1 1,664 Employment (last 12 months)1 Not employed 76.2 66.8 64.6 21.5 326 Employed for cash 90.6 86.3 83.2 6.3 9,372 Employed not for cash 87.0 84.4 81.1 9.7 950 Number of living children 0 80.9 68.5 64.7 15.2 1,060 1-2 84.9 77.5 74.1 11.7 2,819 3-4 90.8 87.7 84.8 6.3 2,832 5+ 94.5 94.0 91.0 2.5 3,968 Residence Urban 89.7 88.3 83.8 5.9 2,452 Rural 89.6 84.6 81.8 7.6 8,227 Province2 Kabul 93.7 92.2 90.1 4.1 1,332 Kapisa 81.2 89.9 79.5 8.3 63 Parwan 83.9 80.5 79.6 15.2 218 Wardak 79.0 64.5 64.3 20.8 170 Logar 82.9 83.1 76.7 10.8 203 Nangarhar 92.8 78.5 76.9 5.6 272 Laghman 84.6 83.5 80.7 12.6 226 Panjsher 98.0 99.0 97.5 0.5 18 Baghlan 93.4 94.0 93.0 5.6 281 Bamyan 92.1 83.6 80.9 5.3 93 Ghazni 95.2 91.4 90.4 3.8 617 Paktika 64.9 55.7 55.2 34.6 318 Paktya 86.8 89.0 85.1 9.3 202 Khost 83.4 66.9 66.3 16.0 334 Kunarha 70.0 69.8 67.2 27.5 149 Nooristan 89.1 79.3 79.3 10.9 66 Badakhshan 68.0 96.4 67.3 2.9 311 Takhar 97.8 97.5 96.2 1.0 296 Kunduz 97.7 94.1 92.5 0.6 472 Samangan 100.0 100.0 100.0 0.0 125 Balkh 79.1 81.4 71.5 11.0 613 Sar-E-Pul 86.9 93.9 85.1 4.3 192 Ghor 78.5 79.2 76.8 19.1 315 Daykundi 99.2 99.2 99.2 0.8 77 Urozgan 94.1 94.1 94.1 5.9 92 Zabul 98.7 98.7 98.7 1.3 8 Kandahar 93.0 75.8 75.7 7.0 870 Jawzjan 96.1 70.7 67.8 1.0 218 Faryab 96.9 74.3 73.5 2.3 704 Helmand 85.7 86.6 85.4 13.1 355 Badghis 97.9 91.7 91.3 1.7 230 Herat 95.7 99.8 95.6 0.0 852 Farah 93.2 90.0 88.0 4.7 294 Nimroz 100.0 99.7 99.7 0.0 93 Education No education 91.4 87.9 85.2 5.9 5,411 Primary 89.1 87.0 82.9 6.7 1,969 Secondary 87.1 80.2 77.3 10.1 2,615 More than secondary 87.2 81.0 76.2 8.0 685 Wealth quintile Lowest 89.0 88.1 83.6 6.5 2,018 Second 87.3 84.2 80.3 8.7 2,211 Middle 90.2 85.5 84.2 8.5 2,145 Fourth 90.9 84.3 81.4 6.3 2,253 Highest 91.0 85.2 82.1 5.9 2,052 Total 89.7 85.4 82.3 7.2 10,679 1 Total includes 32 men with missing information on employment status in the last 12 months. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 266 • Women’s Empowerment Table 15.7.1 Attitude toward wife beating: Women Percentage of ever-married women age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Afghanistan 2015 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number of women Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Age 15-19 16.8 57.5 64.4 43.6 33.1 78.3 1,825 20-24 17.5 57.5 68.6 47.4 31.8 80.7 6,089 25-29 18.4 59.9 68.5 50.5 34.8 81.1 6,299 30-34 17.8 60.1 68.5 49.9 33.5 82.0 4,302 35-39 17.6 60.8 66.8 49.1 33.4 81.6 4,463 40-44 19.5 57.4 63.3 47.4 32.4 77.2 3,113 45-49 19.7 60.6 63.4 47.4 34.6 77.4 3,369 Employment (last 12 months)1 Not employed 18.0 59.8 67.0 48.6 33.7 80.1 25,501 Employed for cash 20.8 57.8 66.7 48.1 32.5 80.2 2,618 Employed not for cash 17.0 53.5 68.0 49.3 31.4 86.9 1,244 Number of living children 0 17.0 57.1 65.0 42.4 31.0 77.7 2,948 1-2 18.1 58.6 67.1 49.1 33.0 79.7 7,353 3-4 17.4 58.3 67.9 49.6 32.1 80.7 7,698 5+ 19.0 60.9 66.6 48.8 35.1 80.9 11,463 Marital status Married 18.3 59.5 67.1 48.6 33.5 80.6 28,671 Divorced/separated/ widowed 13.8 51.5 58.5 43.1 29.1 67.6 790 Residence Urban 18.3 54.7 58.9 46.7 27.4 74.0 6,870 Rural 18.1 60.6 69.3 48.9 35.2 82.1 22,591 Province2 Kabul 19.5 52.5 56.1 45.7 28.9 74.9 3,658 Kapisa 4.2 85.4 21.4 27.5 24.1 94.6 205 Parwan 14.0 58.2 68.2 61.0 35.0 76.2 625 Wardak 28.9 72.3 86.4 66.1 39.5 93.8 382 Logar 12.9 47.4 81.2 45.2 33.8 87.4 472 Nangarhar 22.5 73.7 90.1 76.6 53.6 95.5 794 Laghman 30.2 55.3 60.6 40.8 64.0 85.7 583 Panjsher 16.3 42.9 51.8 42.5 7.6 55.6 54 Baghlan 21.5 64.5 74.9 73.2 41.0 91.5 839 Bamyan 33.4 60.3 54.5 62.4 42.6 70.6 303 Ghazni 9.8 55.1 75.3 60.8 28.8 84.1 1,328 Paktika 9.4 46.4 69.1 44.6 23.2 82.9 792 Paktya 34.3 57.2 85.4 32.4 55.8 93.6 542 Khost 5.3 24.3 50.8 26.5 17.9 52.2 851 Kunarha 12.9 57.5 90.1 77.6 43.3 93.9 559 Nooristan 5.8 58.1 68.4 14.4 23.6 85.4 222 Badakhshan 27.5 72.1 74.7 72.5 53.2 77.5 1,004 Takhar 29.6 72.9 56.3 46.6 32.9 83.2 1,105 Kunduz 8.4 23.0 21.0 17.7 6.4 33.1 1,232 Samangan 19.9 59.3 77.8 50.8 36.5 79.7 330 Balkh 21.5 64.0 78.9 61.1 36.6 84.6 1,781 Sar-E-Pul 13.6 52.7 56.1 50.1 34.9 77.0 654 Ghor 30.3 80.5 53.8 36.3 79.1 92.6 715 Daykundi 59.3 71.8 76.3 73.0 67.9 81.9 329 Urozgan 35.8 39.7 42.2 39.4 35.7 44.2 230 Kandahar 30.2 53.1 80.7 51.1 29.2 85.4 2,227 Jawzjan 30.7 86.1 71.7 43.3 53.1 91.6 614 Faryab 7.5 63.6 62.5 35.8 16.4 82.7 2,114 Helmand 13.6 51.0 56.7 23.4 9.9 65.1 875 Badghis 7.2 65.2 68.5 34.2 18.4 80.1 650 Herat 4.5 75.8 78.1 54.4 30.4 90.6 2,316 Farah 18.9 57.7 67.8 36.7 60.1 84.3 777 Nimroz 10.8 82.6 85.6 75.2 20.1 93.2 278 Education No education 19.1 60.2 68.4 48.9 34.2 81.0 24,604 Primary 13.8 56.9 64.1 50.6 35.9 79.8 2,330 Secondary 13.7 55.4 58.2 44.4 26.6 76.0 1,971 More than secondary 10.1 37.7 41.1 33.4 10.8 61.1 556 (Continued…) Women’s Empowerment • 267 Table 15.7.1—Continued Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number of women Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Wealth quintile Lowest 20.9 67.6 69.5 52.8 41.0 84.4 5,904 Second 18.4 60.0 66.3 46.7 34.5 81.2 6,001 Middle 18.4 56.7 70.3 47.4 32.8 80.8 5,888 Fourth 17.4 58.1 72.3 51.3 32.7 81.6 6,010 Highest 15.7 53.5 55.5 43.7 25.6 72.7 5,657 Total 18.2 59.2 66.9 48.4 33.4 80.2 29,461 1 Total includes 98 women with missing information on employment status in the last 12 months. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 268 • Women’s Empowerment Table 15.7.2 Attitude toward wife beating: Men Percentage of ever-married men age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Afghanistan 2015 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number of men Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Age 15-19 8.8 46.3 61.1 25.1 23.2 70.6 142 20-24 9.5 44.1 63.6 24.8 21.1 74.5 1,162 25-29 8.3 45.1 61.2 27.0 18.2 71.2 2,422 30-34 8.2 44.0 59.6 27.1 18.8 69.8 2,008 35-39 9.7 47.3 63.4 26.1 20.0 76.3 1,935 40-44 7.5 43.6 56.6 25.3 21.3 71.0 1,402 45-49 8.1 48.1 62.0 25.7 19.2 72.6 1,688 Employment (last 12 months)1 Not employed 5.2 41.1 54.8 31.8 17.0 67.4 329 Employed for cash 8.4 45.5 60.9 25.6 18.9 72.6 9,443 Employed not for cash 10.7 47.8 65.7 30.6 27.8 73.5 956 Number of living children 0 8.0 41.2 55.8 22.6 19.2 67.0 1,087 1-2 7.9 42.4 58.6 26.0 18.7 69.8 2,831 3-4 7.4 44.6 62.3 26.6 18.3 73.8 2,843 5+ 9.9 49.4 63.3 26.9 21.2 74.7 3,999 Marital status Married 8.5 45.5 61.3 26.1 19.7 72.6 10,679 Divorced/separated/ widowed 6.3 35.1 36.5 29.3 5.0 48.8 81 Residence Urban 4.6 40.4 46.0 19.6 12.0 59.9 2,479 Rural 9.7 47.0 65.6 28.1 21.9 76.1 8,281 Province2 Kabul 3.6 39.4 40.8 22.3 14.0 57.2 1,350 Kapisa 2.0 57.7 57.9 25.0 3.5 77.3 63 Parwan 0.5 20.8 23.6 3.2 2.9 36.5 220 Wardak 4.2 44.5 68.2 39.1 10.3 85.4 171 Logar 29.0 55.6 79.8 50.9 36.3 87.4 204 Nangarhar 1.0 56.8 76.1 21.7 10.7 83.6 273 Laghman 9.7 65.6 62.6 21.2 38.4 91.3 227 Panjsher 1.9 17.4 12.2 6.1 2.4 25.4 18 Baghlan 10.3 54.7 78.5 11.7 16.3 80.9 281 Bamyan 10.4 23.4 29.2 19.1 10.7 38.4 94 Ghazni 8.5 29.9 59.3 39.1 25.9 73.9 619 Paktika 21.0 39.1 78.8 58.0 16.7 88.0 322 Paktya 4.9 36.6 90.0 35.4 15.6 96.7 206 Khost 1.3 13.9 60.8 27.0 2.6 73.7 334 Kunarha 6.4 72.7 78.3 64.2 22.1 84.9 151 Nooristan 13.2 49.1 87.5 50.8 30.5 92.6 66 Badakhshan 7.0 45.2 52.6 35.5 21.0 64.3 316 Takhar 2.2 23.8 23.4 15.4 10.7 34.7 296 Kunduz 29.6 46.2 56.3 21.2 31.5 77.2 479 Samangan 14.8 64.3 80.8 44.0 24.7 90.8 125 Balkh 5.3 30.1 46.2 16.2 18.2 51.0 616 Sar-E-Pul 4.7 53.1 42.8 32.6 32.6 67.3 195 Ghor 24.4 43.8 90.3 68.1 30.4 93.1 322 Daykundi 2.7 6.1 11.3 8.5 3.6 15.3 77 Urozgan 9.9 63.1 53.7 62.2 30.0 66.5 92 Kandahar 13.5 60.1 76.7 29.3 14.2 82.7 874 Jawzjan 0.2 56.0 66.2 7.6 11.1 68.8 218 Faryab 3.8 44.4 69.5 8.3 7.3 76.9 706 Helmand 5.6 50.1 49.3 19.9 22.9 65.2 355 Badghis 5.1 52.8 77.8 22.6 20.0 79.7 231 Herat 6.4 65.1 73.9 11.3 28.3 84.3 863 Farah 8.5 48.3 63.5 31.3 57.0 81.9 295 Nimroz 2.5 56.3 55.9 29.3 15.4 74.3 93 Education No education 10.6 50.2 66.0 29.7 23.2 77.4 5,447 Primary 6.3 41.0 55.9 22.3 17.4 68.1 1,987 Secondary 7.1 42.8 59.5 23.0 15.9 69.6 2,632 More than secondary 4.5 31.4 43.6 20.9 11.9 55.5 695 (Continued…) Women’s Empowerment • 269 Table 15.7.2—Continued Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number of men Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Wealth quintile Lowest 10.4 51.5 70.1 29.8 26.5 78.3 2,029 Second 11.0 48.4 63.0 24.4 25.8 76.1 2,233 Middle 9.8 48.7 66.9 32.5 20.3 76.1 2,160 Fourth 6.3 41.7 59.9 25.0 14.9 71.2 2,260 Highest 5.3 37.1 45.3 19.0 10.6 60.0 2,078 Total 8.5 45.5 61.1 26.1 19.6 72.4 10,760 1 Total includes 32 men with missing information on employment status in the last 12 months. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Table 15.8 Indicators of women's empowerment Percentage of currently married women age 15-49 who participate in all decision making and the percentage who disagree with all of the reasons that justify wife-beating, by value on each of the indicators of women's empowerment, Afghanistan 2015 Empowerment indicator Percentage who participate in all decision making Percentage who disagree with all the reasons justifying wife- beating Number of women Number of decisions in which women participate1 0 na 19.7 10,353 1-2 na 15.8 8,962 3 na 22.6 9,356 Number of reasons for which wife- beating is justified2 0 37.9 na 5,574 1-2 28.8 na 10,068 3-4 33.3 na 9,661 5 33.5 na 3,368 na = Not applicable. 1 See Table 15.6.1 for the list of decisions. 2 See Table 15.7.1 for the list of reasons. 270 • Women’s Empowerment Table 15.9 Current use of contraception by women's empowerment Percent distribution of currently married women age 15-49 by current contraceptive method, according to selected indicators of women's status, Afghanistan 2015 Modern methods Empowerment indicator Any method Any modern method Female steril- ization Male steril- ization Tempo- rary modern female methods1 Male condom Any tradi- tional method Not currently using Total Number of women Number of decisions in which women participate2 0 20.2 18.3 1.4 0.0 13.7 3.1 1.9 79.8 100.0 10,353 1-2 26.8 23.7 2.2 0.0 17.6 3.9 3.0 73.2 100.0 8,962 3 20.9 17.7 2.0 0.1 12.7 2.9 3.2 79.1 100.0 9,356 Number of reasons for which wife- beating is justified3 0 21.0 17.9 2.4 0.1 12.0 3.5 3.1 79.0 100.0 5,574 1-2 23.8 21.2 1.8 0.0 16.1 3.3 2.6 76.2 100.0 10,068 3-4 23.9 21.1 1.9 0.0 15.7 3.4 2.9 76.1 100.0 9,661 5 16.7 14.9 1.1 0.0 11.2 2.6 1.8 83.3 100.0 3,368 Total 22.5 19.8 1.8 0.0 14.6 3.3 2.7 77.5 100.0 28,671 Note: If more than one method is used, only the most effective method is considered in this tabulation. 1 Pill, IUD, injectables, implants, and lactational amenorrhea method. 2 See Table 15.6.1 for the list of decisions. 3 See Table 15.7.1 for the list of reasons. Table 15.10 Ideal number of children and unmet need for family planning by women's empowerment Mean ideal number of children for women 15-49 and the percentage of currently married women age 15-49 with an unmet need for family planning, by indicators of women's empowerment, Afghanistan 2015 Percentage of currently married women with an unmet need for family planning2 Empowerment indicator Mean ideal number of children1 Number of women For spacing For limiting Total Number of women Number of decisions in which women participate3 0 6.0 8,786 18.8 6.4 25.2 10,353 1-2 5.4 7,832 15.3 7.2 22.5 8,962 3 5.4 7,330 18.1 7.5 25.5 9,356 Number of reasons for which wife- beating is justified4 0 5.4 4,578 18.8 7.1 25.9 5,574 1-2 5.7 8,778 15.7 6.9 22.6 10,068 3-4 5.6 8,298 17.8 7.0 24.8 9,661 5 6.1 2,883 19.6 7.2 26.8 3,368 Total 5.6 24,538 17.5 7.0 24.5 28,671 1 Mean excludes respondents who gave non-numeric responses. 2 See Table 7.12.1 for the definition of unmet need for family planning. 3 Restricted to currently married women. See Table 15.6.1 for the list of decisions. 4 See Table 15.7.1 for the list of reasons. Women’s Empowerment • 271 Table 15.11 Reproductive health care by women's empowerment Percentage of ever-married women age 15-49 with a live birth in the five years preceding the survey who received antenatal care, delivery assistance and postnatal care from health personnel for the most recent birth, by indicators of women's empowerment, Afghanistan 2015 Empowerment indicator Percentage receiving antenatal care from a skilled provider1 Percentage receiving delivery care from a skilled provider1 Received postnatal care from health personnel within the first two days since delivery2 Number of women with a child born in the last five years Number of decisions in which women participate3 0 51.1 48.3 32.8 7,376 1-2 63.9 58.6 45.6 6,000 3 62.6 55.9 38.3 6,080 Number of reasons for which wife- beating is justified4 0 61.6 60.6 40.6 3,639 1-2 58.3 52.1 40.1 6,910 3-4 58.6 54.4 39.0 6,708 5 54.6 45.1 28.8 2,376 Total 58.6 53.6 38.5 19,632 1 'Skilled provider' includes doctor, nurse, midwife, or auxiliary nurse/midwife 2 Includes women who received a postnatal checkup from a doctor, nurse, midwife, community health worker or traditional birth attendant (TBA) in the first two days after the birth. Includes women who gave birth in a health facility and those who did not give birth in a health facility. 3 Restricted to currently married women. See Table 15.6.1 for the list of decisions. 4 See Table 15.7.1 for the list of reasons. Table 15.12 Early childhood mortality rates by women's status Infant, child, and under-five mortality rates for the 10-year period preceding the survey, by indicators of women's empowerment, Afghanistan 2015 Empowerment indicator Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Number of decisions in which women participate1 0 51 12 62 1-2 46 13 58 3 51 14 65 Number of reasons for which wife-beating is justified2 0 47 13 59 1-2 47 13 59 3-4 52 11 62 5 56 20 75 1 Restricted to currently married women. See Table 15.6.1 for the list of decisions. 2 See Table 15.7.1 for the list of reasons. Domestic Violence • 273 DOMESTIC VIOLENCE 16 Key Findings  Experience of physical violence: More than half (53%) of the ever-married women age 15-49 have experienced physical violence at least once since age 15, and 31% experienced physical violence within the 12 months before the survey.  Spousal violence: Overall, 56% of ever-married women age 15-49 report ever having experienced emotional, physical, or sexual violence from their spouse, and 52% report having experienced one or more of these forms of violence in the past 12 months.  Physical injuries: Among ever-married women who had experienced spousal physical violence in the past 12 months, 26% reported experiencing physical injuries.  Help seeking behavior: Sixty-one percent of ever- married women who experienced violence never sought help or never told anyone about the violence. omestic violence is a violation of basic human rights that has adverse health, demographic, and economic consequences for women, children, and societies. Domestic violence is a key component of violence against women, which the United Nations defined as “any act of gender- based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or in private life” (United Nations 1993). An increasing amount of research has highlighted the health and psychological burdens, intergenerational effects, and demographic consequences of such violence (United Nations, 2006). Despite the suffering and the health effects of domestic violence, women are often socialized to accept, tolerate, and even rationalize such violence. Afghanistan is committed to addressing the issues related to violence against women, which have a huge impact on the health and welfare of women and children. The National Action Plan for Women of the Afghanistan (NAPWA), which is under the Afghanistan National Development Strategy (ANDS), explicitly recognizes that violence against women is pervasive and that this violence includes forced marriage, trafficking in child marriage, immolation, and physical violence (Afghanistan National Development Strategy Secretariat 2010). The Ministry of Public Health (MoPH) of Afghanistan is committed to implementing the Afghanistan National Development Strategy and has established a Gender Directorate to help meet the gender equality objectives. In addition, the MoPH has developed a five-year National Gender Strategy to promote gender equity across all MoPH policies, strategies, budgets, and programs. In accordance with Article 14 of the Elimination of Violence against Women law (EVAW), the strategy provides free and urgent services (Ministry of Justice 2009). The 2015 AfDHS included a module with questions on women’s experience of domestic violence. In accordance with the World Health Organization’s guidelines for the ethical collection of information on D 274 • Domestic Violence domestic violence, only one eligible woman per household was randomly selected for this module; the module was not implemented if privacy could not be obtained (WHO 2001). A total of 21,324 women received the domestic violence questions. About 4% of women eligible for the domestic violence module could not be successfully interviewed because of privacy concerns or other reasons. 16.1 MEASUREMENT OF VIOLENCE In the 2015 AfDHS, information was obtained from ever-married women on their experience of violence committed by their current and former husbands and by others. More specifically, violence committed by the current husband for currently married women and violence by the most recent husband for formerly married women were measured by asking all ever-married women if their husband ever did the following to them:  Physical spousal violence: Push you, shake you, or throw something at you; slap you; twist your arm or pull your hair; punch you with his fist or with something that could hurt you; kick you, drag you, or beat you up; try to choke you or burn you on purpose; or threaten or attack you with a knife, gun, or any other weapon.  Sexual spousal violence: Physically force you to have sexual intercourse with him even when you did not want to; physically force you to perform any other sexual acts you did not want to; force you with threats or any other way to perform sexual acts that you did not want to do.  Emotional spousal violence: Say or do something to humiliate you in front of others; threaten to hurt or harm you or someone close to you; insult you or make you feel bad about yourself. Women who had been married more than once were also asked about physical and sexual violence committed by any husband other than their most recent husband. In addition, because women can be particularly vulnerable during pregnancy, women who had ever been pregnant were asked about their experience of physical violence during pregnancy. In addition to violence by a spouse, all ever-married women were asked about their experience of physical violence committed by anyone else (other than a current or most recent husband) since they were age 15. In the 2015 AfDHS, women were not asked about their experience of acts of sexual violence committed by anyone other than a current or former spouse. All women reporting any experience of physical or sexual violence were asked whether and from whom they had sought help. 16.2 EXPERIENCE OF PHYSICAL VIOLENCE FROM ANYONE Physical violence by anyone Percentage of ever-married women who have experienced any form of physical violence (by a spouse or anyone else) since age 15 and in the 12 months before the survey. Sample: Ever-married women age 15-49 16.2.1 Prevalence of Physical Violence In Afghanistan, women’s experience of domestic violence cuts across all socioeconomic characteristics. Table 16.1 shows that 53% of ever-married women have experienced physical violence since age 15 with 46% experiencing violence in the 12 months before the survey. A larger percentage of women reported experiencing physical violence “often” in the past year (31%) than “sometimes” (15%) in the previous year. Domestic Violence • 275 Violence during pregnancy is also fairly common. Almost 1 of 5 (16%) ever-married women who have ever been pregnant has experienced physical violence during pregnancy (Table 16.2). Patterns by background characteristics  Experience of physical violence since age 15 increases sharply with age and women’s number of children. For example, 33% of women age 15-19 have experienced physical violence since age 15 compared with 60% of women age 40-49 (Table 16.1).  The likelihood of experiencing physical violence during pregnancy generally increases with number of living children. About one in five ever-married women with 5 or more children has experienced physical violence during pregnancy compared with 7% of women with no children (Figure 16.1).  Women who are employed but are not paid in cash (63%) are more likely than unemployed women (52%) and those who are employed for cash (53%) to have experienced physical violence (Table 16.1).  Women in rural areas (56%) are more likely than those in the urban areas (43%) to report having experienced physical violence.  Women’s experience of physical violence varies greatly by province. Less than 1 in 10 women report experience of physical violence in Helmand (6%) and Badakhshan (7%), compared with more than 9 in 10 women in Ghor (93%) and Herat (91%).  Women who have no education are twice as likely (56%) as women who have secondary education (28%) to report the experience of violence. 16.2.2 Perpetrators of Physical Violence Ever-married women who have experienced physical violence since age 15 most commonly report their husbands as perpetrators of the violence. Ninety-four percent of ever-married women who have experienced physical violence since age 15 reported their current husband as a perpetrator and 3% reported a former husband as a perpetrator. Other perpetrators included mother/stepmother (9%), followed by father/stepfather (8%), father-in-law (7%), mother-in-law (7%), and siblings (4%) (Table 16.3). 16.3 MARITAL CONTROL Marital control Percentage of women whose current husband (if currently married) or most recent husband (if formerly married) demonstrates at least one of the following controlling behaviors: is jealous or angry if she talks to other men; frequently accuses her of being unfaithful; does not permit her to meet her female friends; tries to limit her contact with her family; and insists on knowing where she is at all times. Sample: Ever-married women age 15-49 Attempts by husbands to closely control and monitor their wives’ behavior are important early warning signs, as well as correlates, of violence in a relationship. A series of questions were included in the 2015 Figure 16.1 Violence during pregnancy by number of living children 7 13 16 19 16 0 1-2 3-4 5+ Total Number of living children Percentage among ever-married women age 15-49 who have ever been pregnant 276 • Domestic Violence AfDHS to elicit the degree of marital control exercised by the husband over the respondent. Controlling behaviors most often manifest themselves as extreme possessiveness, jealousy, and attempts to isolate the woman from her family and friends. Because the combination of such behaviors is more significant than the display of any single behavior, the proportion of women whose husbands display at least three of the specified behaviors is highlighted in Table 16.4. The primary controlling behaviors women experienced from their husbands were jealousy or anger if they talked to other men (60%), the husband insisting on knowing where they are at all times (35%), and the husband frequently accusing them of being unfaithful (25%). Nearly a quarter of ever-married women (23%) reported that their husbands display three or more of these controlling behaviors and almost one- third (31%) said that their husband displayed none of these behaviors. (Table 16.4). Patterns by background characteristics  Thirty-nine percent of women who are employed but do not earn cash income report at least three controlling behaviors by their husband compared with 22% of unemployed women and 22% of women employed for cash.  By province, women in Ghor (69%), Herat (59%), Wardak (49%), and Kandahar (49%) are most likely to report that their husbands display three or more of these controlling behaviors, and women in Balkh (3%) and Panjsher (4%) are the least likely.  Women with no education (24%) are more likely to experience three or more of these controlling behaviors from their husbands than women with at least some education (16%-17%) women (Table 16.4). Women who are afraid of their husbands are more likely to experience marital control than are women who are never afraid of their husbands. Thirty-four percent of women who are afraid of their husband most of the time reported experiencing at least three of the controlling behaviors compared with 18% of women who are sometimes afraid and 11% who are never afraid of their husband. 16.4 SPOUSAL VIOLENCE Spousal violence Percentage of women who have experienced any of the specified acts of physical, sexual, or emotional violence committed by their current husband (if currently married) or most recent husband (if formerly married), ever and during the 12 months before the survey. Sample: Ever-married women age 15-49 16.4.1 Prevalence of Spousal Violence Fifty-six percent of ever-married women reported ever experiencing spousal violence (physical, sexual, or emotional) perpetrated by their husband and 52% reported experiencing such violence in the past 12 months, either often (36%) or sometimes (16%) (Table 16.5). Domestic Violence • 277 Fifty-one percent of ever-married women have ever experienced physical violence from their spouse. Slapping is the most common act of physical violence reported by 46% of ever-married women. Forty-one percent of women have experienced being pushed, shaken, or have had something thrown at them, 28% have had their arm twisted or hair pulled, and 22% have been punched with a fist or with something that could hurt them (Figure 16.2). Notably, 3% of ever-married women have been choked or burned on purpose or have been threatened or attacked with a knife, gun, or other weapon. Seven percent of ever-married women have experienced one or more acts of sexual violence by their spouse: 6% have been physically forced to have sexual intercourse with their spouse when they did not want to, 5% have been physically forced to perform other unwanted sexual acts, and 4% have been forced with threats and in other ways to perform unwanted sexual acts. Thirty-seven percent of women reported ever experiencing emotional violence: 34% had been humiliated in front of others and 25% were insulted or made to feel bad about themselves. Fifteen percent of women said that their husband had threatened to hurt or harm them or someone they cared about (Table 16.5). Among ever-married women who have been married more than once, spousal violence could also have been perpetrated by an earlier husband. To capture the totality of women’s experience of spousal physical or sexual violence, ever-married women were also asked about physical and sexual violence committed by their former husband. Overall, 51% of ever-married women have experienced physical or sexual violence by any husband and 46% have experienced physical or sexual violence in the 12 months before the survey (Tables 16.5 and 16.8). Patterns by background characteristics  Women’s experience of spousal (physical, sexual, or emotional) violence increases substantially with age and number of children. Thirty-one percent of ever-married women age 15-19 have ever experienced spousal violence compared with 61% of women age 40-49; 33% of women with no living children have experienced spousal violence compared with 60% of women with 5 or more children (Table 16.6). Figure 16.2 Types of Spousal violence 4 5 6 3 3 17 22 28 46 41 3 4 4 2 2 13 17 22 40 35 Forced her with threats or in any other way to perform sexual acts she did not want to Physically forced her to perform any other sexual acts she did not want to Physically forced her to have sexual intercourse with him when she did not want to Threatened her or attacked her with a knife, gun, or other weapon Tried to choke her or burn her on purpose Kicked her, dragged her, or beat her up Punched her with his fist or with something that could hurt her Twisted her arm or pulled her hair Slapped her Pushed her, shook her, or threw something at her Percentage of ever-married women age 15-49 who have ever experienced specfic acts of violence by their husband Last 12 months Ever 278 • Domestic Violence  Spousal violence is more common among women who are employed but do not earn cash (73%) than among women who are not employed (55%) or are employed for cash (56%).  Rural women are more likely than their urban counterparts to have ever experienced spousal violence (57% and 49%, respectively).  Women’s experience of spousal violence varies greatly by province. About 9 in 10 women have experienced spousal violence in Herat (92%), Ghor (92%), and Wardak (88%) compared with less than 1 in 10 women in Helmand (6%) and Badakhshan (6%) (Figure 16.3).  Women’s experience of spousal violence declines sharply with education: 58% of women with no education have experienced spousal violence compared with 33% of women with more than secondary education. Figure 16.3 Spousal violence by subnational unit Percent of ever-married women age 15-49 who have ever experienced physical, sexual, or emotional violence Patterns by husband’s characteristics and empowerment indicators  Fifty-nine percent of women whose husbands have no education have experienced spousal (physical, sexual, or emotional) violence compared with 44% of women whose husbands have more than secondary education (Table 16.7).  Women who are married to men who have about the same amount of education are less likely (43%) than women married to men with more education (51%) to experience spousal violence. However, violence by educational difference is most common among women in couples where neither husband nor wife has any education (60%). Domestic Violence • 279  Although women whose husbands drink alcohol are a very small proportion of all women interviewed, almost all women (97%) whose husbands get drunk sometimes have ever experienced spousal violence. However, experience of spousal violence is still high, at 55%, among women whose husbands do not drink (Figure 16.4).  Controlling behaviors are strongly associated with spousal violence. Twenty-nine percent of women whose husbands exhibit none of the specified controlling behaviors have experienced physical, sexual, or emotional violence, as compared with 79% to 86% of women whose husbands exhibit at least three controlling behaviors.  Women’s empowerment indicators – participation in household decision making and rejection of wife beating as justified—are both negatively, although non-linearly, associated with women’s likelihood of experiencing spousal violence. For example, 40% of women who reject all reasons for wife beating have experienced spousal violence compared with 56% to 60% of women who accept one or more reasons for wife beating.  A family history of domestic violence is associated with a respondent’s own experience of spousal violence. Among women whose fathers beat their mothers, 75% have experienced physical, sexual, or emotional violence, as compared with 40% of women whose fathers did not beat their mothers.  Women who are afraid of their husbands most of the time are more likely to experience spousal violence (77%) than those who are never afraid (21%). 16.4.2 Onset of Spousal Violence To obtain information on the initiation of spousal physical or sexual violence in the marriage, the 2015 AfDHS asked currently married women who had been married only once and had experienced physical or sexual spousal violence, when in the marriage the first episode of violence took place. Table 16.9 shows the percentages of women who first experienced spousal violence by the exact duration of marriage. Spousal violence tends to be initiated early in marriage. Twenty-nine percent of currently married women experienced spousal physical or sexual violence within the first 2 years of marriage; by 5 years of marriage, 44% have experienced violence. Among women who have been married less than 2 years, 24% have already experienced spousal physical or sexual violence. 16.5 INJURIES DUE TO SPOUSAL VIOLENCE Injuries due to spousal violence Percentage of women who have the following types of injuries from spousal violence: cuts, bruises, or aches; eye injuries, sprains, dislocations, or burns; or deep wounds, broken bones, broken teeth, or any other serious injury. Sample: Ever-married women age 15-49 who have experienced physical or sexual violence committed by their current husband (if currently married) or most recent husband (if formerly married) Figure 16.4 Spousal violence by subnational unit Note: Husbands who drink but never gets drunk are based on less than 25 unweighted cases and therefore suppressed. Figures in parentheses are based on 25-49 unweighted cases. 55 97 (96) Does not drink Gets drunk sometimes Gets drunk very often Percentage of ever-married women who have ever experienced spousal (physical, sexual, or emotional) violence 280 • Domestic Violence Spousal violence has many adverse health consequences for women and is a significant health burden for the country. Overall, 26% of women who have ever experienced physical or sexual violence have experienced injury as a consequence of the violence (Table 16.10). The most common type of injury is cuts, bruises, or aches (23%), followed by eye injuries, sprains, dislocations, or burns (13%). Eight percent of women who have experienced spousal physical or sexual violence report deep wounds, broken bones, broken teeth, or other serious injuries. 16.6 VIOLENCE INITIATED BY WOMEN AGAINST HUSBANDS In cases of domestic violence, either the man or the woman can be the instigator of violent behavior. Ever- married women age 15-49 were asked about instances when they said or did something to physically harm their husband at times when their husbands were not already physically hurting them. Tables 16.11 and 16.12 show that only 1% of ever-married women have ever initiated physical violence against their husband when their husband was not already beating them. This proportion is higher, at 2%, among women who have themselves experienced spousal violence. Very few women who have not experienced spousal violence initiated violence against their husband (0.2%). 16.7 RESPONSE TO VIOLENCE 16.7.1 Help Seeking Behavior to Stop the Violence Overall, only 20% of ever-married women in Afghanistan who have ever experienced any form of physical or sexual violence have sought help from any source; 61% have never sought help and never told anyone about the violence (Table 16.13). Patterns by background characteristics  Ever-married women who have experienced both physical and sexual violence were more likely to seek help (33%) than women who have experienced physical violence only (18%) or sexual violence only (9%) (Figure 16.5).  A much higher proportion of divorced, separated, or widowed women (30%) than currently married women (20%) have ever sought help.  Women in rural areas are more likely to have sought help than women in urban areas (21% versus 16%).  Help seeking varies by province, with a high of 59% of women who have ever experienced physical or sexual violence seeking help in Ghor and 53% in Herat to less than 5% in 0% in Helmand, Khost, Takhar, Kandahar, and Panjsher.  Women in the lowest wealth quintile are more likely to seek help than women in highest wealth quintile (29% versus 14%). Help seeking does not vary greatly by education. 16.7.2 Sources for Help Eight in 10 women who seek help ask their own family for help and about one third (34%) ask their husband’s family for help (Table 16.14). The next most common source of help is neighbors (18%). In Afghanistan, women who seek help to stop the violence are unlikely to seek help from doctors, police, or any other civil or social organization. Figure 16.5 Help seeking by type of violence experienced 18 9 33 Physical only Sexual only Physical and sexual Percentage of ever-married women age 15-49 who have experienced physical or sexual violence and sought help Domestic Violence • 281 LIST OF TABLES  Table 16.1 Experience of physical violence  Table 16.2 Experience of violence during pregnancy  Table 16.3 Persons committing physical violence  Table 16.4 Marital control exercised by husbands  Table 16.5 Forms of spousal violence  Table 16.6 Spousal violence by background characteristics  Table 16.7 Spousal violence by husband's characteristics and empowerment indicators  Table 16.8 Physical or sexual violence in the past 12 months by any husband  Table 16.9 Experience of spousal violence by duration of marriage  Table 16.10 Injuries to women due to spousal violence  Table 16.11 Women's violence against their spouse by background characteristics  Table 16.12 Women's violence against their spouse by husband’s characteristics and empowerment indicators  Table 16.13 Help seeking to stop violence  Table 16.14 Sources for help to stop the violence 282 • Domestic Violence Table 16.1 Experience of physical violence Percentage of ever-married women age 15-49 who have ever experienced physical violence since age 15 and percentage who have experienced violence during the 12 months preceding the survey, by background characteristics, Afghanistan 2015 Percentage who have ever experienced physical violence since age 151 Percentage who have experienced physical violence in the past 12 months Background characteristic Often Sometimes Often or sometimes2 Number of women Age 15-19 32.9 15.7 13.3 29.0 1,280 20-24 46.1 26.0 15.6 41.6 4,434 25-29 53.6 33.6 15.1 48.7 4,525 30-39 55.9 33.9 15.3 49.2 6,388 40-49 60.0 33.8 15.6 49.4 4,696 Marital status Married 52.8 31.0 15.4 46.5 20,793 Divorced/separated/ widowed 58.9 34.9 7.7 42.6 531 Number of living children 0 30.8 16.0 10.8 26.9 2,132 1-2 50.8 28.5 17.3 45.7 5,248 3-4 55.2 34.1 15.0 49.0 5,583 5+ 58.4 34.6 15.3 49.9 8,361 Employment3 Employed for cash 53.4 29.0 19.4 48.4 1,852 Employed not for cash 62.6 25.6 30.5 56.1 951 Not employed 52.4 31.6 14.1 45.6 18,504 Residence Urban 43.1 21.7 15.4 37.2 4,735 Rural 55.7 33.8 15.2 49.0 16,589 Province4 Kabul 42.0 20.8 15.2 36.0 2,410 Kapisa 26.6 7.7 9.1 16.8 152 Parwan 59.4 33.7 17.0 50.7 467 Wardak 87.1 57.7 25.9 83.6 277 Logar 83.5 48.4 27.6 75.9 354 Nangarhar 64.1 39.8 12.0 51.8 569 Laghman 61.2 42.9 9.9 52.9 437 Panjsher 25.7 16.4 6.8 23.3 40 Baghlan 73.7 53.9 18.4 72.3 608 Bamyan 24.5 8.1 8.8 16.9 210 Ghazni 76.7 30.5 35.1 65.6 916 Paktika 51.6 39.5 6.5 46.0 564 Paktya 83.2 61.9 9.0 71.0 399 Khost 22.3 20.4 1.0 21.4 634 Kunarha 45.9 39.3 5.7 45.1 403 Nooristan 53.6 26.6 13.1 39.7 166 Badakhshan 7.2 3.4 2.7 6.1 748 Takhar 44.6 5.4 16.5 22.1 805 Kunduz 41.4 25.5 12.8 38.3 900 Samangan 33.1 7.4 13.4 20.9 244 Balkh 26.2 5.7 12.1 17.8 1,320 Sar-E-Pul 59.9 34.8 17.7 52.5 483 Ghor 93.2 82.3 8.0 90.5 528 Daykundi 17.7 3.4 9.8 13.2 240 Urozgan 46.1 18.6 8.3 26.9 168 Kandahar 71.4 58.1 12.4 70.6 1,630 Jawzjan 29.9 18.5 11.4 29.9 444 Faryab 58.3 11.7 31.9 43.6 1,577 Helmand 5.7 3.4 1.3 4.7 625 Badghis 49.1 28.5 15.3 43.8 470 Herat 91.3 71.4 18.4 89.8 1,748 Farah 52.6 20.9 23.7 44.6 577 Nimroz 18.7 4.0 4.6 8.6 197 Education No education 55.7 33.7 15.3 49.0 17,817 Primary 44.2 19.6 18.4 38.0 1,664 Secondary 35.2 16.4 13.2 29.6 1,443 More than secondary 27.8 17.3 8.3 25.7 399 (Continued…) Domestic Violence • 283 Table 16.1—Continued Percentage who have ever experienced physical violence since age 151 Percentage who have experienced physical violence in the past 12 months Background characteristic Often Sometimes Often or sometimes2 Number of women Wealth quintile Lowest 55.7 31.5 16.7 48.2 4,345 Second 54.7 32.8 14.5 47.3 4,480 Middle 58.4 39.8 13.0 52.9 4,351 Fourth 53.0 29.7 17.2 46.9 4,234 Highest 41.6 20.5 14.9 35.3 3,914 Total 52.9 31.1 15.3 46.4 21,324 1 Includes violence in the past 12 months. For women who were married before age 15 and who reported physical violence by a spouse, the violence could have occurred before age 15. 2 Includes women who report physical violence in the past 12 months but for whom frequency is not known. 3 Total includes 17 women with missing information on employment status. 4 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 284 • Domestic Violence Table 16.2 Experience of violence during pregnancy Among ever-married women age 15-49 who have ever been pregnant, percentage who have ever experienced physical violence during pregnancy, by background characteristics, Afghanistan 2015 Background characteristic Percentage who experienced violence during pregnancy Number of women who have ever been pregnant Age 15-19 8.2 883 20-24 11.7 4,056 25-29 15.3 4,381 30-39 17.5 6,205 40-49 18.6 4,594 Marital status Married 15.8 19,618 Divorced/separated/ widowed 13.4 501 Number of living children 0 6.6 927 1-2 12.8 5,248 3-4 15.5 5,583 5+ 18.7 8,361 Residence Urban 7.7 4,473 Rural 18.0 15,646 Province1 Kabul 8.2 2,228 Kapisa 2.8 145 Parwan 13.1 441 Wardak 51.0 248 Logar 32.5 344 Nangarhar 26.4 531 Laghman 23.7 420 Panjsher 1.6 39 Baghlan 32.1 569 Bamyan 8.4 202 Ghazni 37.4 861 Paktika 26.1 528 Paktya 16.0 380 Khost 6.0 595 Kunarha 7.5 390 Nooristan 14.7 160 Badakhshan 2.2 662 Takhar 16.1 750 Kunduz 19.7 848 Samangan 0.6 233 Balkh 8.8 1,258 Sar-E-Pul 22.0 460 Ghor 65.7 509 Daykundi 8.6 225 Urozgan 10.2 165 Kandahar 12.8 1,588 Jawzjan 3.7 432 Faryab 10.6 1,455 Helmand 0.9 575 Badghis 13.2 427 Herat 9.6 1,688 Farah 24.5 564 Nimroz 2.8 185 Education No education 17.1 16,975 Primary 8.0 1,489 Secondary 9.9 1,294 More than secondary 2.4 360 Wealth quintile Lowest 20.3 4,088 Second 20.0 4,185 Middle 18.8 4,131 Fourth 12.6 4,026 Highest 5.7 3,690 Total 15.7 20,119 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Domestic Violence • 285 Table 16.3 Persons committing physical violence Among ever-married women age 15-49 who have experienced physical violence since age 15, percentage who report specific persons who committed the violence, Afghanistan 2015 Person Percentage of ever-married women Current husband 93.9 Former husband 3.2 Father/ step-father 7.5 Mother/ step-mother 8.7 Sister/brother 3.7 Daughter/ son 0.2 Other relative 1.1 Mother-in-law 6.9 Father-in-law 7.2 Other in-law 4.6 Teacher 0.1 Police/ soldier 0.0 Other 0.9 Number women who have experienced physical violence since age 15 11,284 Note: Women can report more than one person who committed the violence. 286 • Domestic Violence Table 16.4 Marital control exercised by husbands Percentage of ever-married women age 15-49 whose husbands have ever demonstrated specific types of controlling behaviors, by background characteristics, Afghanistan 2015 Percentage of women whose husband: Background characteristic Is jealous or angry if she talks to other men Frequently accuses her of being unfaithful Does not permit her to meet her female friends Tries to limit her contact with her family Insists on knowing where she is at all times Displays 3 or more of the specific behaviors Displays none of the specific behaviors Number of ever- married women Age 15-19 48.0 19.5 16.6 10.8 29.9 17.9 42.9 1,280 20-24 58.6 21.2 19.0 10.3 33.7 21.2 32.4 4,434 25-29 62.3 25.7 20.5 10.6 37.0 23.7 28.5 4,525 30-39 62.2 27.0 19.2 11.6 36.2 24.3 29.9 6,388 40-49 59.9 26.2 20.8 11.8 34.7 23.7 31.2 4,696 Marital status Married 60.1 24.7 19.4 11.0 35.2 22.8 31.1 20,793 Divorced/separated/ widowed 58.8 33.0 29.6 16.4 33.5 31.6 34.1 531 Number of living children 0 49.0 18.7 14.5 8.0 29.1 17.1 43.2 2,132 1-2 61.3 23.9 19.4 10.6 33.8 22.0 30.9 5,248 3-4 62.9 27.4 21.9 11.8 37.2 25.5 28.0 5,583 5+ 60.3 25.5 19.6 11.8 36.2 23.5 30.3 8,361 Employment1 Employed for cash 64.8 25.7 16.5 14.5 31.3 22.2 27.9 1,852 Employed not for cash 75.0 35.2 44.8 16.1 38.3 39.0 14.2 951 Not employed 58.9 24.3 18.7 10.5 35.4 22.3 32.3 18,504 Residence Urban 63.3 22.6 24.2 12.9 37.6 26.1 29.5 4,735 Rural 59.2 25.6 18.3 10.6 34.5 22.1 31.6 16,589 Province2 Kabul 64.9 25.8 25.6 17.5 41.7 28.5 25.9 2,410 Kapisa 43.7 16.9 7.5 4.3 15.1 8.5 46.7 152 Parwan 62.4 37.2 17.8 7.2 24.9 20.4 29.7 467 Wardak 84.5 58.1 31.8 25.0 62.7 49.2 9.4 277 Logar 77.6 19.8 10.9 9.0 17.7 13.6 17.2 354 Nangarhar 92.9 24.0 12.5 9.6 72.4 22.3 2.8 569 Laghman 67.6 28.4 17.6 16.3 42.2 23.9 24.7 437 Panjsher 45.9 4.3 3.8 2.3 21.1 3.9 36.3 40 Baghlan 52.2 39.4 25.1 4.9 25.3 24.0 38.9 608 Bamyan 29.1 9.6 4.0 3.3 43.2 5.8 40.1 210 Ghazni 75.8 39.1 21.2 12.5 41.1 30.2 15.8 916 Paktika 57.7 12.3 5.6 2.5 13.9 7.1 39.8 564 Paktya 90.2 50.9 30.7 25.7 65.6 34.9 5.2 399 Khost 13.3 16.4 10.2 7.0 10.4 7.8 72.1 634 Kunarha 77.3 10.2 7.5 5.3 31.5 10.1 21.5 403 Nooristan 72.7 9.7 35.6 1.5 14.0 6.9 14.1 166 Badakhshan 28.3 7.1 5.0 3.9 6.4 5.2 70.5 748 Takhar 31.9 7.9 4.5 3.6 16.7 6.8 63.9 805 Kunduz 28.5 12.3 14.2 14.6 37.9 15.8 45.6 900 Samangan 36.7 3.7 4.1 2.2 54.5 5.8 36.6 244 Balkh 80.2 5.2 1.5 3.5 5.5 3.3 19.4 1,320 Sar-E-Pul 56.6 16.7 12.3 2.1 24.1 11.7 37.5 483 Ghor 76.6 74.0 46.2 33.3 91.3 69.0 1.9 528 Daykundi 50.1 32.2 20.7 20.6 23.2 22.8 45.4 240 Urozgan 47.7 7.8 1.7 0.9 28.2 6.3 46.4 168 Kandahar 81.3 20.9 47.0 17.1 64.0 48.8 12.4 1,630 Jawzjan 56.9 25.9 21.4 20.8 30.4 24.9 42.4 444 Faryab 56.8 24.0 2.2 0.7 16.4 4.9 36.8 1,577 Helmand 8.0 6.8 8.6 2.4 33.9 5.9 62.0 625 Badghis 59.0 11.2 10.2 6.2 45.2 10.4 35.0 470 Herat 79.0 59.6 48.7 19.6 44.3 58.6 15.4 1,748 Farah 41.5 18.4 13.7 15.7 34.4 15.6 41.7 577 Nimroz 44.1 1.6 8.4 1.0 33.4 6.7 49.1 197 Education No education 61.0 26.2 20.3 11.4 36.8 24.3 30.1 17,817 Primary 56.7 15.9 15.9 9.6 26.7 16.0 36.4 1,664 Secondary 55.3 18.9 18.7 9.6 27.1 17.4 35.3 1,443 More than secondary 53.5 26.3 7.8 8.8 24.9 16.4 41.8 399 (Continued…) Domestic Violence • 287 Table 16.4—Continued Percentage of women whose husband: Background characteristic Is jealous or angry if she talks to other men Frequently accuses her of being unfaithful Does not permit her to meet her female friends Tries to limit her contact with her family Insists on knowing where she is at all times Displays 3 or more of the specific behaviors Displays none of the specific behaviors Number of ever- married women Wealth quintile Lowest 54.1 26.1 17.5 10.9 34.3 22.8 35.1 4,345 Second 56.8 24.1 18.8 10.7 34.3 21.5 32.3 4,480 Middle 62.0 25.4 17.6 10.0 35.4 22.0 30.4 4,351 Fourth 65.7 26.5 20.9 11.8 35.0 23.6 26.7 4,234 Highest 62.4 22.3 23.9 12.3 37.0 25.6 31.1 3,914 Woman afraid of husband3 Most of the time afraid 75.1 36.6 27.3 16.7 44.1 34.2 17.3 7,872 Sometimes afraid 54.0 19.5 15.8 8.0 32.5 17.8 36.4 10,981 Never afraid 38.9 12.1 11.9 7.2 17.9 10.5 52.5 2,390 Total 60.1 24.9 19.6 11.1 35.2 23.0 31.2 21,324 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. 1 Total includes 17 women with missing information on employment status. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 3 Total includes 80 women with missing information on whether they are afraid of their husband. Table 16.5 Forms of spousal violence Percentage of ever-married women age 15-49 who have experienced various forms of violence ever or in the 12 months preceding the survey, committed by their husbands, Afghanistan 2015 In the past 12 months Type of violence Ever Often Sometimes Often or sometimes Physical violence Any physical violence 50.5 30.7 15.0 45.8 Pushed her, shook her, or threw something at her 41.1 19.0 16.3 35.3 Slapped her 45.9 18.4 21.4 39.8 Twisted her arm or pulled her hair 28.4 9.7 12.0 21.7 Punched her with his fist or with something that could hurt her 22.2 8.0 9.3 17.3 Kicked her, dragged her, or beat her up 17.3 5.7 7.6 13.4 Tried to choke her or burn her on purpose 3.2 1.0 1.3 2.4 Threatened her or attacked her with a knife, gun, or other weapon 2.9 1.0 1.1 2.1 Sexual violence Any sexual violence 7.4 3.3 2.7 6.1 Physically forced her to have sexual intercourse with him when she did not want to 5.5 2.1 2.3 4.4 Physically forced her to perform any other sexual acts she did not want to 4.7 1.5 2.1 3.6 Forced her with threats or in any other way to perform sexual acts she did not want to 3.9 1.5 1.3 2.7 Emotional violence Any emotional violence 37.3 21.4 13.0 34.4 Said or did something to humiliate her in front of others 33.6 15.5 15.0 30.6 Threatened to hurt or harm her or someone she cared about 15.0 4.8 8.9 13.7 Insulted her or made her feel bad about herself 25.4 9.1 10.8 19.9 Any form of physical and/or sexual violence 50.8 31.2 14.8 46.0 Any form of emotional and/or physical and/or sexual violence 55.5 35.8 16.0 51.8 Spousal violence committed by any husband Physical violence 50.5 na na 45.8 Sexual violence 7.5 na na 6.1 Physical and/or sexual violence 50.8 na na 46.1 Number of ever- married women 21,324 21,324 21,324 21,324 na = Not applicable. 288 • Domestic Violence Table 16.6 Spousal violence by background characteristics Percentage of ever-married women age 15-49 who have ever experienced emotional, physical, or sexual violence committed by their husband, by background characteristics, Afghanistan 2015 Background characteristic Emotional violence Physical violence Sexual violence Physical and sexual Physical and sexual and emotional Physical or sexual Physical or sexual or emotional Number of ever-married women Age 15-19 23.0 30.6 6.3 6.1 4.4 30.8 36.7 1,280 20-24 32.1 43.7 6.7 6.6 4.7 43.8 49.9 4,434 25-29 39.9 51.8 8.9 8.6 6.9 52.0 58.2 4,525 30-39 38.6 53.6 7.4 7.0 5.7 53.9 57.2 6,388 40-49 42.0 56.8 7.0 6.5 5.2 57.2 60.8 4,696 Marital status Married 37.2 50.4 7.5 7.2 5.6 50.7 55.4 20,793 Divorced/separated/ widowed 43.3 53.9 4.5 4.5 3.4 53.9 56.9 531 Number of living children 0 21.8 27.7 5.3 4.9 3.2 28.1 33.3 2,132 1-2 35.7 48.6 7.8 7.7 5.8 48.6 54.9 5,248 3-4 40.5 53.1 7.7 7.4 6.4 53.4 58.0 5,583 5+ 40.2 55.7 7.5 7.1 5.5 56.1 59.7 8,361 Employment1 Employed for cash 32.3 51.7 8.5 8.1 7.2 52.2 56.0 1,852 Employed not for cash 61.4 61.0 16.3 16.1 15.2 61.2 73.3 951 Not employed 36.6 49.8 6.8 6.6 4.9 50.1 54.5 18,504 Residence Urban 35.8 40.1 6.6 5.9 3.9 40.7 49.3 4,735 Rural 37.8 53.4 7.6 7.5 6.0 53.6 57.2 16,589 Province2 Kabul 34.0 37.9 10.7 9.5 6.5 39.2 49.3 2,410 Kapisa 6.0 25.0 4.4 4.3 1.2 25.1 25.7 152 Parwan 50.7 53.6 4.8 4.4 4.2 53.9 58.4 467 Wardak 75.6 85.5 53.3 52.2 47.3 86.6 87.8 277 Logar 44.2 80.5 3.2 2.7 1.1 80.9 82.5 354 Nangarhar 54.5 56.0 4.5 4.5 4.4 56.0 64.6 569 Laghman 27.8 59.6 2.1 1.8 1.3 59.8 62.4 437 Panjsher 12.7 24.3 0.0 0.0 0.0 24.3 25.4 40 Baghlan 45.3 72.1 17.0 16.7 9.1 72.4 73.1 608 Bamyan 9.7 16.9 5.3 5.2 3.0 16.9 19.0 210 Ghazni 53.9 74.0 18.2 18.1 16.9 74.1 76.8 916 Paktika 23.9 42.1 6.2 6.2 3.5 42.1 46.5 564 Paktya 64.2 79.9 2.1 2.1 1.8 79.9 84.1 399 Khost 9.1 21.4 0.9 0.9 0.6 21.4 21.6 634 Kunarha 26.0 45.6 3.1 3.1 3.0 45.6 46.1 403 Nooristan 24.6 50.0 14.1 11.3 7.7 52.8 53.8 166 Badakhshan 5.9 5.7 1.9 1.9 1.6 5.7 6.9 748 Takhar 52.0 41.1 0.8 0.8 0.7 41.1 61.1 805 Kunduz 21.2 39.6 12.6 12.5 11.3 39.7 40.7 900 Samangan 1.0 20.6 0.2 0.2 0.0 20.6 20.8 244 Balkh 14.1 24.6 1.1 1.1 1.1 24.6 26.7 1,320 Sar-E-Pul 18.8 58.2 11.4 11.4 9.4 58.2 58.4 483 Ghor 82.3 91.6 50.1 50.0 48.9 91.6 91.8 528 Daykundi 5.8 13.4 1.2 1.2 1.2 13.4 14.3 240 Urozgan 34.8 40.3 0.7 0.7 0.7 40.3 50.1 168 Kandahar 59.8 70.5 2.5 2.4 2.3 70.7 84.7 1,630 Jawzjan 9.6 29.9 8.7 8.7 5.2 29.9 30.3 444 Faryab 30.3 57.0 0.7 0.7 0.4 57.0 62.4 1,577 Helmand 3.7 5.6 0.0 0.0 0.0 5.6 6.4 625 Badghis 16.8 47.8 11.3 11.3 5.3 47.8 48.8 470 Herat 84.9 91.0 0.2 0.1 0.0 91.1 92.2 1,748 Farah 26.6 52.0 19.0 17.0 6.2 54.0 55.7 577 Nimroz 15.6 18.4 0.8 0.2 0.2 19.0 21.8 197 Education No education 39.0 53.3 8.0 7.7 6.0 53.6 57.7 17,817 Primary 28.7 41.8 4.9 4.7 3.4 42.0 48.2 1,664 Secondary 29.9 32.4 4.3 4.1 3.2 32.6 42.1 1,443 More than secondary 24.7 26.2 4.7 3.5 2.0 27.4 33.3 399 (Continued…) Domestic Violence • 289 Table 16.6—Continued Background characteristic Emotional violence Physical violence Sexual violence Physical and sexual Physical and sexual and emotional Physical or sexual Physical or sexual or emotional Number of ever-married women Wealth quintile Lowest 36.5 53.5 10.6 10.5 8.7 53.6 55.5 4,345 Second 37.9 52.3 8.2 7.9 5.9 52.6 56.6 4,480 Middle 39.7 56.3 5.6 5.5 4.3 56.5 59.9 4,351 Fourth 37.0 50.2 6.1 5.7 4.9 50.6 55.8 4,234 Highest 35.3 38.7 6.3 5.7 3.7 39.3 48.9 3,914 Total 37.3 50.5 7.4 7.1 5.6 50.8 55.5 21,324 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. 1 Total includes 17 women with missing information on employment status. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 290 • Domestic Violence Table 16.7 Spousal violence by husband's characteristics and empowerment indicators Percentage of ever-married women age15-49 who have ever experienced emotional, physical, or sexual violence committed by their husband, by husband's characteristics, and empowerment indicators, Afghanistan 2015 Background characteristic Emotional violence Physical violence Sexual violence Physical and sexual Physical and sexual and emotional Physical or sexual Physical or sexual or emotional Number of ever- married women Husband's education No education 40.2 54.8 7.7 7.5 6.1 55.0 59.2 12,468 Primary 33.5 45.9 5.4 5.2 3.4 46.1 51.3 3,012 Secondary 33.4 45.2 7.3 6.9 5.7 45.7 51.5 4,312 More than secondary 32.2 37.8 8.9 8.2 4.8 38.5 44.1 1,344 Don’t know 37.9 45.2 8.5 8.5 5.4 45.2 51.0 187 Husband's alcohol consumption1 Does not drink 37.2 50.3 7.2 6.9 5.4 50.6 55.3 21,124 Drinks/never gets drunk * * * * * * * 12 Gets drunk sometimes 58.9 96.6 45.6 45.6 36.2 96.6 96.6 74 Gets drunk very often (72.6) (95.8) (35.3) (35.3) (29.1) (95.8) (95.8) 46 Spousal education difference Husband better educated 33.6 46.0 7.1 6.7 5.0 46.4 51.1 7,404 Wife better educated 30.2 38.2 4.0 3.8 2.9 38.3 45.1 1,493 Both equally educated 30.4 32.0 5.2 4.4 4.1 32.8 43.4 608 Neither educated 41.2 55.9 8.0 7.7 6.3 56.1 60.3 11,542 Don’t know 28.6 48.7 14.8 14.8 4.0 48.7 53.0 277 Spousal age difference2 Wife older 37.4 52.6 7.5 6.6 5.2 53.5 58.9 885 Wife is same age 38.7 54.7 4.9 4.8 4.2 54.8 56.9 941 Wife's 1-4 years younger 36.5 51.2 8.2 8.0 6.3 51.4 55.8 8,973 Wife's 5-9 years younger 36.6 49.7 7.8 7.4 5.5 50.0 54.9 6,182 Wife's 10+ years younger 39.4 47.9 5.8 5.5 4.7 48.2 54.5 3,720 Number of marital control behaviors displayed by husband3 0 14.3 24.9 2.3 2.2 0.8 25.0 29.3 6,643 1-2 35.3 53.6 5.9 5.5 3.7 54.1 58.6 9,773 3-4 73.1 80.0 14.8 14.5 12.9 80.3 86.1 3,931 5 70.2 74.2 27.3 27.2 26.1 74.2 79.3 978 Number of decisions in which women participate4 0 37.5 51.8 7.6 7.4 5.5 52.1 57.1 7,338 1-2 44.1 58.9 10.1 9.7 8.0 59.4 64.6 6,585 3 30.2 40.6 4.8 4.6 3.5 40.8 45.0 6,870 Number of reasons for which wife-beating is justified5 0 26.9 33.2 4.4 4.3 3.2 33.4 40.4 4,192 1-2 40.9 53.6 8.0 7.6 5.9 54.0 59.2 7,333 3-4 39.6 56.4 7.1 6.7 5.0 56.7 60.1 7,222 5 37.7 53.0 11.6 11.3 10.2 53.3 56.4 2,577 Woman's father beat her mother Yes 50.9 70.1 10.5 10.3 8.8 70.3 74.8 8,180 No 27.2 34.9 5.6 5.1 3.4 35.4 40.1 8,545 Don’t know 32.0 44.5 5.3 5.1 3.7 44.6 49.6 4,599 Woman afraid of husband6 Most of the time afraid 52.5 74.5 13.6 13.2 11.0 74.9 77.4 7,872 Sometimes afraid 32.1 40.6 3.9 3.7 2.4 40.8 47.3 10,981 Never afraid 11.5 16.9 3.3 2.6 1.9 17.6 21.2 2,390 Total 37.3 50.5 7.4 7.1 5.6 50.8 55.5 21,324 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Total includes 68 women with missing information on husband’s alcohol consumption. 2 Includes only currently married women who have been married only once. Total includes 92 currently married women with missing information on spousal age difference. 3 According to the wife's report. See Table 16.7 for list of behaviors. 4 According to the wife's report. Includes only currently married women. See Table 15.6.1 for list of decisions. 5 According to the wife's report. See Table 15.7.1 for list of reasons. 6 Total includes 80 women with missing information on whether they are afraid of their husband. Domestic Violence • 291 Table 16.8 Physical or sexual violence in the past 12 months by any husband Percentage of ever-married women who have experienced physical or sexual violence by any husband in the past 12 months, by background characteristics, Afghanistan 2015 Background characteristic Percentage of women who have experienced physical or sexual violence in the past 12 months from any husband Number of ever- married women Age 15-19 28.7 1,280 20-24 41.1 4,434 25-29 48.6 4,525 30-39 49.2 6,388 40-49 48.8 4,696 Marital status Married 46.2 20,793 Divorced/separated/widowed 41.0 531 Employment1 Employed for cash 48.2 1,852 Employed not for cash 55.3 951 Not employed 45.4 18,504 Number of living children 0 26.6 2,132 1-2 45.1 5,248 3-4 48.9 5,583 5+ 49.7 8,361 Residence Urban 37.4 4,735 Rural 48.5 16,589 Province2 Kabul 36.4 2,410 Kapisa 15.8 152 Parwan 50.7 467 Wardak 84.1 277 Logar 75.9 354 Nangarhar 50.5 569 Laghman 53.1 437 Panjsher 23.2 40 Baghlan 72.0 608 Bamyan 14.9 210 Ghazni 64.9 916 Paktika 41.9 564 Paktya 67.2 399 Khost 21.4 634 Kunarha 45.0 403 Nooristan 40.2 166 Badakhshan 5.5 748 Takhar 22.0 805 Kunduz 37.3 900 Samangan 20.0 244 Balkh 18.0 1,320 Sar-E-Pul 51.7 483 Ghor 90.3 528 Daykundi 12.9 240 Urozgan 26.5 168 Kandahar 70.4 1,630 Jawzjan 29.9 444 Faryab 43.4 1,577 Helmand 4.5 625 Badghis 44.0 470 Herat 89.9 1,748 Farah 46.4 577 Nimroz 9.2 197 Education No education 48.6 17,817 Primary 38.2 1,664 Secondary 29.6 1,443 More than secondary 26.8 399 Wealth quintile Lowest 48.1 4,345 Second 46.7 4,480 Middle 52.4 4,351 Fourth 46.4 4,234 Highest 35.7 3,914 (Continued…) 292 • Domestic Violence Table 16.8—Continued Background characteristic Percentage of women who have experienced physical or sexual violence in the past 12 months from any husband Number of ever- married women Woman afraid of husband3 Most of the time afraid 69.7 7,872 Sometimes afraid 36.1 10,981 Never afraid 14.3 2,390 Total 46.1 21,324 Note: Any husband includes all current, most recent and former husbands. 1 Total includes 17 women with missing information on employment status. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 3 Total includes 80 women with missing information on whether they are afraid of their husband. Table 16.9 Experience of spousal violence by duration of marriage Among currently married women age 15-49 who have been married only once, the percentage who first experienced physical or sexual violence committed by their current husband by specific exact years since marriage according to marital duration, Afghanistan 2015 Percentage who first experienced spousal physical or sexual violence by exact marital duration: Percentage who have not experience d spousal sexual or physical violence Number of currently married women who have been married only once Duration of marriage Before marriage 2 years 5 years 10 years Years since marriage <2 0.6 na na na 75.7 1,739 2-4 0.7 37.6 na na 53.0 2,792 5-9 0.8 30.9 47.2 na 49.2 4,171 10+ 0.7 26.7 45.4 51.5 44.7 11,546 Total 0.7 28.5 43.9 48.0 49.4 20,248 na = Not applicable. Domestic Violence • 293 Table 16.10 Injuries to women due to spousal violence Percentage of ever-married women age 15-49 who have experienced specific types of spousal violence by types of injuries resulting from the violence, according to the type of violence and whether they experienced the violence ever and in the 12 months preceding the survey, Afghanistan 2015 Type of violence Cuts, bruises, or aches Eye injuries, sprains, dislocations, or burns Deep wounds, broken bones, broken teeth, or any other serious injury Any of these injuries Number of ever- married women who have ever experienced any physical or sexual violence Experienced physical violence1 Ever2 22.9 12.9 7.5 26.1 10,762 In the past 12 months 23.4 13.3 7.9 26.4 9,757 Experienced sexual violence Ever2 53.7 41.9 30.4 59.5 1,580 In the past 12 months 54.2 42.9 33.9 59.8 1,294 Experienced physical or sexual violence1 Ever2 22.9 12.8 7.5 26.0 10,825 In the past 12 months 23.4 13.3 7.9 26.4 9,817 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. 1 Excludes women who reported violence only in response to a direct question on violence during pregnancy. 2 Includes in the past 12 months. 294 • Domestic Violence Table 16.11 Women's violence against their spouse by background characteristics Percentage of ever-married women age 15-49 who have committed physical violence against their current or most recent husband when he was not already beating or physically hurting her, ever and in the past 12 months, according to women's own experience of spousal violence and background characteristics, Afghanistan 2015 Percentage who have committed physical violence against their husband Number of ever- married women Background Characteristic Ever1 In the past 12 months Woman's experience of spousal physical violence Ever1 1.7 1.4 10,762 In the past 12 months 1.8 1.4 9,757 Never 0.2 0.1 10,562 Age 15-19 0.6 0.5 1,280 20-24 0.7 0.6 4,434 25-29 0.9 0.6 4,525 30-39 1.1 0.9 6,388 40-49 1.1 0.9 4,696 Marital status Married 0.9 0.7 20,793 Divorced/separated/ widowed 1.6 0.8 531 Employment2 Employed for cash 1.2 1.0 1,852 Employed not for cash 1.1 0.7 951 Not employed 0.9 0.7 18,504 Number of living children 0 1.0 0.8 2,132 1-2 0.6 0.4 5,248 3-4 1.1 0.9 5,583 5+ 1.1 0.8 8,361 Residence Urban 1.3 1.0 4,735 Rural 0.9 0.7 16,589 Wealth quintile Lowest 0.6 0.4 4,345 Second 1.2 1.0 4,480 Middle 0.8 0.7 4,351 Fourth 0.8 0.6 4,234 Highest 1.4 1.0 3,914 Total 1.0 0.7 21,324 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated or widowed women. 1 Includes in the past 12 months. 2 Total includes 17 women with missing information on employment status. Domestic Violence • 295 Table 16.12 Women's violence against their spouse by husband’s characteristics and empowerment indicators Percentage of ever-married women age 15-49 who have committed physical violence against their current or most recent husband when he was not already beating or physically hurting her, ever and in the past 12 months, according their husband's characteristics, Afghanistan 2015 Percentage who have committed physical violence against their husband Number of ever- married women Background Characteristic Ever1 In the past 12 months Husband's education No education 0.9 0.7 12,468 Primary 1.1 0.7 3,012 Secondary 1.1 0.7 4,312 More than secondary 1.1 1.0 1,344 Don’t know 1.0 0.7 187 Husband's alcohol consumption2 Does not drink 0.9 0.7 21,124 Drinks/never gets drunk * * 12 Gets drunk sometimes 15.1 9.6 74 Gets drunk very often (19.8) (19.8) 46 Spousal age difference3 Wife older 3.3 3.0 885 Wife is same age 1.0 0.6 941 Wife's 1-4 years younger 0.9 0.7 8,973 Wife's 5-9 years younger 0.9 0.6 6,182 Wife's 10+ years younger 0.6 0.5 3,720 Number of marital control behaviors displayed by husband4 0 0.5 0.4 6,643 1-2 0.9 0.7 9,773 3-4 1.5 1.3 3,931 5 1.9 1.8 978 Number of decisions in which women participate5 0 1.0 0.9 7,338 1-2 0.9 0.6 6,585 3 0.9 0.7 6,870 Number of reasons for which wife-beating is justified6 0 1.3 1.1 4,192 1-2 1.0 0.8 7,333 3-4 0.7 0.5 7,222 5 0.8 0.7 2,577 Woman's father beat her mother Yes 1.1 0.8 8,180 No 0.8 0.6 8,545 Don’t know 1.0 0.9 4,599 Woman afraid of husband7 Most of the time afraid 1.2 0.9 7,872 Sometimes afraid 0.7 0.6 10,981 Never afraid 1.3 0.9 2,390 Total 1.0 0.7 21,324 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes in the past 12 months. 2Total includes 68 women with missing information on husband’s alcohol consumption. 3 Includes only currently married women who have been married only once. Total includes 92 currently married women with missing information on spousal age difference. 4 According to the wife's report. See 16.7 for list of behaviors. 5 According to the wife's report. Includes only currently married women. See Table 15.6.1 for list of decisions. 6 According to the wife's report. See Table 15.7.1 for list of reasons. 7 Total includes 80 women with missing information on whether they are afraid of their husband. 296 • Domestic Violence Table 16.13 Help seeking to stop violence Percent distribution of ever-married women age 15-49 who have ever experienced physical or sexual violence by their help-seeking behavior by type of violence and background characteristics, Afghanistan 2015 Background Characteristic Sought help to stop violence Never sought help but told someone Never sought help, never told anyone Missing/ don't know Total Number of women who have ever experienced any physical or sexual violence Type of violence experienced Physical only 18.2 16.3 61.9 3.6 100.0 9,733 Sexual only 9.2 11.2 75.2 4.5 100.0 52 Physical and sexual 32.8 8.0 57.0 2.1 100.0 1,551 Age 15-19 18.0 10.1 63.8 8.0 100.0 422 20-24 17.2 13.8 66.2 2.9 100.0 2,052 25-29 19.9 13.3 63.9 3.0 100.0 2,436 30-39 22.1 15.5 59.2 3.2 100.0 3,589 40-49 20.3 18.1 58.0 3.6 100.0 2,838 Marital status Married 19.9 15.3 61.5 3.3 100.0 11,024 Divorced/separated/ widowed 30.2 9.6 53.4 6.9 100.0 312 Number of living children 0 16.0 8.1 70.5 5.4 100.0 662 1-2 19.2 12.1 65.3 3.4 100.0 2,670 3-4 22.1 13.9 60.8 3.3 100.0 3,091 5+ 20.0 18.7 58.3 3.1 100.0 4,913 Employment1 Employed for cash 17.8 12.3 67.6 2.2 100.0 999 Employed not for cash 10.3 8.5 79.6 1.6 100.0 597 Not employed 21.0 15.9 59.5 3.6 100.0 9,731 Residence Urban 15.5 14.4 67.4 2.7 100.0 2,069 Rural 21.2 15.4 60.0 3.5 100.0 9,267 Province2 Kabul 11.5 10.8 74.9 2.8 100.0 1,035 Kapisa 5.5 4.0 86.8 3.7 100.0 41 Parwan 14.7 6.8 70.9 7.6 100.0 279 Wardak 17.5 6.1 76.0 0.4 100.0 244 Logar 12.3 21.7 64.0 1.9 100.0 297 Nangarhar 18.9 11.5 64.9 4.6 100.0 365 Laghman 13.5 11.6 67.5 7.4 100.0 267 Panjsher 4.1 1.6 88.7 5.6 100.0 10 Baghlan 12.8 9.9 54.6 22.7 100.0 449 Bamyan 22.9 3.9 71.6 1.5 100.0 52 Ghazni 11.0 2.7 81.9 4.3 100.0 704 Paktika 9.9 13.7 66.6 9.8 100.0 291 Paktya 4.1 3.0 89.9 3.0 100.0 332 Khost 1.7 2.4 88.8 7.1 100.0 141 Kunarha 13.6 3.4 82.6 0.4 100.0 185 Nooristan 19.4 8.1 67.3 5.2 100.0 93 Badakhshan 22.1 2.7 67.4 7.9 100.0 54 Takhar 1.9 53.9 40.3 3.9 100.0 359 Kunduz 10.5 5.1 79.4 5.0 100.0 374 Samangan 5.5 9.0 82.9 2.5 100.0 81 Balkh 9.4 47.3 41.7 1.6 100.0 345 Sar-E-Pul 23.9 19.3 54.9 1.9 100.0 289 Ghor 58.6 1.6 39.2 0.5 100.0 492 Daykundi 9.0 17.1 70.4 3.5 100.0 43 Urozgan 19.7 19.2 58.9 2.2 100.0 78 Kandahar 4.0 38.7 56.3 1.1 100.0 1,166 Jawzjan 15.4 2.4 77.6 4.6 100.0 133 Faryab 11.7 11.4 76.4 0.6 100.0 920 Helmand 0.0 0.7 75.5 23.8 100.0 36 Badghis 25.5 14.3 58.3 1.9 100.0 231 Herat 53.0 13.1 33.7 0.2 100.0 1,598 Farah 44.2 9.7 46.1 0.0 100.0 313 Nimroz 30.8 1.8 64.8 2.6 100.0 38 (Continued…) Domestic Violence • 297 Table 16.13—Continued Background Characteristic Sought help to stop violence Never sought help but told someone Never sought help, never told anyone Missing/ don't know Total Number of women who have ever experienced any physical or sexual violence Education No education 20.2 15.5 61.0 3.4 100.0 9,973 Primary 19.7 14.3 63.5 2.6 100.0 739 Secondary 18.5 10.8 65.7 5.0 100.0 509 More than secondary 25.9 17.1 55.5 1.5 100.0 116 Wealth quintile Lowest 28.9 13.9 53.5 3.7 100.0 2,424 Second 21.9 15.4 58.8 3.9 100.0 2,460 Middle 17.3 18.1 61.8 2.7 100.0 2,545 Fourth 16.3 14.2 65.8 3.7 100.0 2,260 Highest 14.3 13.5 69.6 2.6 100.0 1,647 Total 20.1 15.2 61.3 3.4 100.0 11,336 1 Total includes 10 women with missing information on employment status. 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Table 16.14 Sources for help to stop the violence Percentage of ever-married women age 15-49 who have experienced physical or sexual violence and sought help by sources from which they sought help, according to the type of violence that women reported, Afghanistan 2015 Type of violence experienced Person Physical only Physical and sexual Total Own family 81.4 76.2 80.3 Husband's family 28.7 52.4 33.9 Husband 1.1 0.8 1.0 Friend 3.0 8.6 4.3 Neighbor 8.9 48.5 17.7 Religious leader 1.1 5.4 2.0 Doctor/medical personnel 0.1 1.0 0.3 Police 0.0 0.9 0.2 Lawyer 0.0 0.6 0.2 Social work organization 0.0 0.3 0.1 Other 0.1 0.0 0.1 Number of women who have experienced violence and sought help 1,769 509 2,283 Note: Women can report more than one source from which they sought help. Total includes 5 women who experienced only sexual violence not shown separately. Fistula • 299 FISTULA 17 Key Findings  Fistula prevalence: Three percent of women reported having ever experienced symptoms of fistula.  Fistula prevalence by residence: Both urban and rural women reported having experienced symptoms of fistula (4% and 3%).  Treatment for fistula: More than half of women (56%) who reported ever suffering from symptoms of fistula did not seek treatment. bstetric fistula is a complication that arises from obstructed or prolonged labor that creates a hole or opening in the birth canal. Prolonged obstructed labor that does not receive prompt medical care stops the blood supply to the tissues of the vagina, bladder, and/or rectum. Unrelieved obstructed labor can compress a woman’s bladder, urethra, rectum, and vaginal wall between the fetal head and maternal pubis. This compression and the resultant loss of blood supply produces necrosis of the compressed tissues. Necrosis then causes uncontrolled leakage of urine from the bladder through the vagina (vesico-vaginal fistula) and leakage of stool from the vagina (recto-vaginal fistula) (HERA and ICRH 2010). The 2015 AfDHS included a series of questions on fistula that measured awareness levels, estimated the prevalence of fistula among Afghanistan women, and examined events that can precipitate fistula symptoms and access to treatment. This chapter explores women’s knowledge and experience of fistula symptoms and presents findings on women’s experiences among ever-married women of reproductive age 15-49. 17.1 WOMENS’ KNOWLEDGE OF FISTULA All ever-married women age 15-49 interviewed in the 2015 AfDHS were asked if they have heard of fistula. Those who reported having knowledge of fistula were asked further questions. Twenty-three percent of ever-married women are aware of the symptoms of fistula (Table 17.1). Patterns by background characteristics  There is substantial variation in knowledge of fistula among women by age: 17% of women age 15-19 have heard of fistula compared with 31% of women age 40-49 (Figure 17.1 and Table 17.1).  Knowledge of fistula is higher among urban women (29%) than rural women (22%). O Figure 17.1 Knowledge of fistula by age 17 19 22 24 31 15-19 20-24 25-29 30-39 40-49 Percentage of ever-married women who have ever heard of fistula 300 • Fistula  Women with more than secondary education are the most likely to have heard about symptoms of fistula (34%).  Women in the highest wealth quintile are more likely to be aware of fistula (31%) than women in the other wealth quintiles (18-23%). 17.2 SELF-REPORTED SYMPTOMS AND TREATMENT 17.2.1 Self-reported Fistula Symptoms All women who reported hearing about fistula were asked if they had ever experienced the condition. Three percent of women age 15-49 reported experiencing symptoms of fistula during their lifetime (Table 17.1). Those who reported suffering from fistula were asked how the problem began. Two-thirds of women (66%) believed that it began after delivery, 6% after having a stillbirth, and 7% after sexual assault; 17% were unable to cite a reason for developing such symptoms (Figure 17.2). Among women who reported that the problem began after delivery or stillbirth, 37% reported that they had a very difficult labor and delivery. However, 58% of women who reported their symptoms began after delivery of a baby or a stillbirth reported having had a normal delivery. Twenty-nine percent of women reported that the symptoms started within 2 to 4 days after delivery, while 37% reported that the symptoms started 8 or more days after delivery (Table 17.2). Patterns by background characteristics  Younger women age 15-19 and women age 30-39 more often reported having experienced symptoms of fistula than other women (Table 17.1).  Both urban and rural women reported having experienced fistula (4% and 3%).  Reports of fistula are high in Ghor (26%) and Baghlan (13%).  Women of all educational levels and wealth status report having experienced fistula. 17.2.2 Treatment Seeking for Fistula Women who experienced the symptoms of fistula were asked if they sought treatment for this condition, from whom they sought treatment, and whether the treatment stopped the leakage.  A total of 4 in 10 women with symptoms of fistula sought treatment, 3 in 10 from a doctor (30%), and 1 in 10 from a nurse or midwife (13%) (Table 17.3).  More than 5 in 10 women with fistula (56%) did not seek any treatment.  Fifteen percent of women with fistula had an operation to attempt to fix the problem (Table 17.4). Figure 17.2 Reported cause of fistula After delivery 66% After stillbirth 6% Sexual assault 7% Do not know 17% Other cause 4% Percent distribution among ever-married women reporting fistula symptoms Fistula • 301  Among all women who sought treatment, 47% reported the leakage stopped completely (Figure 17.3).  One in 3 women who sought treatment had their leakage reduced but not stopped.  Twelve percent of women who sought treatment had no reduction in leakage.  Eight percent of women who sought treatment did not receive any medical support. Patterns by background characteristics  An overwhelming majority of rural women (63%) did not seek treatment for fistula compared with urban women (37%) (Table 17.3).  Women in the lowest wealth quintile are more than three times less likely to seek treatment for fistula than those in the highest wealth quintile (76% versus 24%).  Women age 20-34 who experienced the symptoms of fistula more often reported that the leakage stopped after treatment than women age 35-49 (54% versus 46%) (Table 17.4).  Older women (age 35-49) who experienced the symptoms of fistula were more likely than younger women (age 20-34) to have had an operation to attempt to fix the problem (24% versus 8%).  Rural women (24%) were more likely than urban women (4%) to have had an operation.  Rural women (54%) were also more likely than urban women (38%) to report that their leakage was completely stopped after having sought treatment. Women who did not seek treatment were asked for the reason for not getting treatment. The most common reason for not seeking treatment among women who reported fistula symptoms was their lack of awareness about the possibility of fixing the problem (46%), followed by embarrassment (12%) and their lack of knowledge about where to go for treatment (11%) (Table 17.5 and Figure 17.4). LIST OF TABLES For more information on fistula, see the following tables:  Table 17.1 Fistula  Table 17.2 Characteristics of labor reported as cause of fistula symptoms  Table 17.3 Type of provider for treatment of fistula  Table 17.4 Outcome of treatment of fistula  Table 17.5 Reasons for not seeking treatment for fistula symptoms Figure 17.3 Outcome of fistula treatment Figure 17.4 Reason for not seeking treatment Leakage stopped completely 47% Not stopped but reduced 33% Not stopped at all 12% Did not receive medical support 8% Percent distribution among ever-married women reporting fistula symptoms 46 12 11 8 5 3 2 Did not know it can be fixed Embarrassment Did not know where to go Too expensive Too far Could not get permission Problem disappeared Percentage among ever-married women age 15-49 with fistula symptoms 302 • Fistula Table 17.1 Fistula Percentage of ever-married women who have ever heard of fistula and percentage who have experienced fistula, according to background characteristics, Afghanistan 2015 Percentage of women who: Background characteristic have ever heard of fistula have ever had fistula Number of women Age 15-19 16.9 3.6 1,825 20-24 18.5 1.9 6,089 25-29 21.8 2.6 6,299 30-39 23.9 3.7 8,765 40-49 30.6 3.2 6,482 Residence Urban 29.4 3.8 6,870 Rural 21.6 2.7 22,591 Province1 Kabul 19.7 6.1 3,658 Kapisa 4.0 0.6 205 Parwan 18.2 1.6 625 Wardak 23.5 7.7 382 Logar 33.5 4.6 472 Nangarhar 20.9 2.3 794 Laghman 26.5 0.9 583 Panjsher 1.8 0.4 54 Baghlan 56.5 13.2 839 Bamyan 9.4 0.2 303 Ghazni 19.3 4.6 1,328 Paktika 7.1 0.8 792 Paktya 10.5 0.1 542 Khost 25.7 2.4 851 Kunarha 1.9 0.1 559 Nooristan 6.1 0.3 222 Badakhshan 7.3 0.3 1,004 Takhar 50.6 0.0 1,105 Kunduz 1.3 1.2 1,232 Samangan 1.9 0.2 330 Balkh 15.4 0.4 1,781 Sar-E-Pul 49.5 4.2 654 Ghor 35.4 26.0 715 Daykundi 2.2 2.4 329 Urozgan 3.2 0.9 230 Kandahar 62.0 2.6 2,227 Jawzjan 1.8 0.2 614 Faryab 11.2 0.2 2,114 Helmand 29.1 0.3 875 Badghis 28.2 0.6 650 Herat 21.0 1.6 2,316 Farah 17.0 1.7 777 Nimroz 56.3 0.1 278 Education No education 23.4 3.1 24,604 Primary 21.6 1.9 2,330 Secondary 22.5 3.5 1,971 More than secondary 33.8 1.8 556 Wealth quintile Lowest 22.8 4.1 5,904 Second 18.2 2.6 6,001 Middle 23.3 2.0 5,888 Fourth 22.2 2.9 6,010 Highest 30.9 3.2 5,657 Total 23.4 3.0 29,461 1 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. Fistula • 303 Table 17.2 Characteristics of labor reported as cause of fistula symptoms Among ever-married women who reported labor as the cause of their fistula symptoms, the percent distribution by characteristics of labor and delivery and survival status of infant, and by the number of days after the delivery that symptoms began, Afghanistan 2015 Characteristic Percentage of women Characteristics of labor and delivery Normal labor and delivery, baby born alive 57.9 Normal labor and delivery, baby stillborn 0.9 Very difficult labor and delivery, baby born alive 30.6 Very difficult labor and delivery, baby stillborn 6.0 Missing 4.6 Number of days after the delivery that symptoms began 0-1 22.6 2-4 29.2 5-7 6.6 8 or more days 36.9 Missing 4.7 Total 100.0 Number 635 304 • Fistula Table 17.3 Type of provider for treatment of fistula Among ever-married women age 15-49 who experienced symptoms of fistula, the percent distribution by type of provider of the treatment, according to background characteristics, Afghanistan 2015 Type of health provider Background characteristic Doctor Nurse/ midwife Community health worker Other Missing No treatment Total Number of women Women's age at first birth <20 (48.0) (2.1) (0.0) (0.0) (0.0) (49.9) 100.0 65 20-34 25.6 10.6 0.3 0.1 0.2 63.2 100.0 446 35-49 33.0 17.5 0.2 1.7 0.0 47.6 100.0 367 Residence Urban 44.1 18.5 0.0 0.0 0.0 37.4 100.0 259 Rural 24.6 10.5 0.4 1.1 0.2 63.3 100.0 619 Education No education 26.3 11.2 0.3 0.9 0.1 61.2 100.0 756 Primary (54.7) (16.4) (0.0) (0.0) (0.0) (29.0) 100.0 43 Secondary 58.1 21.6 0.0 0.0 0.0 20.3 100.0 69 More than secondary * * * * * * 100.0 10 Wealth quintile Lowest 14.1 6.8 0.6 2.4 0.0 76.1 100.0 242 Second 28.4 17.3 0.5 0.6 0.0 53.1 100.0 156 Middle 29.5 7.3 0.0 0.0 0.9 62.3 100.0 120 Fourth 29.3 12.5 0.0 0.0 0.0 58.2 100.0 175 Highest 54.9 20.8 0.0 0.0 0.0 24.2 100.0 184 Total 30.3 12.8 0.3 0.8 0.1 55.7 100.0 878 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Table 17.4 Outcome of treatment of fistula Among ever-married women age 15-49 who experienced symptoms of fistula and sought treatment, the percent distribution by outcome of treatment, and the percentage who had an operation, according to background characteristics, Afghanistan 2015 Among those who sought treatment: Percentage of women who had an operation Background characteristic Leakage stopped completely Not stopped but reduced Not stopped at all Did not receive any treatment Missing Total Number of women Women's age at first birth <20 * * * * * 100.0 * 33 20-34 53.6 29.9 6.7 9.2 0.7 100.0 7.6 164 35-49 46.1 39.8 7.0 7.2 0.0 100.0 23.7 192 Residence Urban 37.6 36.2 17.6 8.6 0.0 100.0 3.9 162 Rural 53.9 29.8 7.9 8.0 0.5 100.0 23.7 227 Education No education 49.0 37.7 6.8 6.1 0.4 100.0 17.9 293 Primary 48.9 3.0 29.0 19.1 0.0 100.0 14.9 31 Secondary 29.4 27.1 30.3 13.3 0.0 100.0 4.2 55 More than secondary 82.3 0.0 9.0 8.6 0.0 100.0 7.1 10 Wealth quintile Lowest 35.2 39.7 12.6 12.6 0.0 100.0 31.0 58 Second 66.9 24.9 8.2 0.0 0.0 100.0 26.5 73 Middle 59.3 27.8 9.4 1.1 2.4 100.0 12.5 45 Fourth 42.3 36.0 4.0 17.6 0.0 100.0 18.1 73 Highest 40.1 33.2 18.6 8.2 0.0 100.0 2.7 139 Total 47.1 32.5 11.9 8.2 0.3 100.0 15.4 389 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Fistula • 305 Table 17.5 Reasons for not seeking treatment for fistula symptoms Among ever-married women who reported experiencing fistula but not seeking treatment, percentage by reasons for not seeking treatment, Afghanistan 2015 Reasons Percentage of women Did not know the problem can be fixed 46.3 Did not know where to go 11.4 Too expensive 7.9 Embarrassment 12.2 Too far 4.7 Problem disappeared 2.4 Could not get permission 2.9 Other 2.7 Number 489 References • 307 REFERENCES Afghanistan National Development Strategy Secretariat. 2010. Afghanistan National Development Strategy 2008-2013: An Interim Strategy for Security, Governance, Economic Growth, and Poverty Reduction, Volume 1. Kabul, Afghanistan: Islamic Republic of Afghanistan. Bradley, S. E. K., T. N. Croft, J. D. Fishel, and C. F. Westoff. 2012. Revising Unmet Need for Family Planning. DHS Analytical Studies No. 25. Calverton, Maryland, USA: ICF International. Graham, W., W. Brass, and R. W. Snow. 1989. “Indirect Estimation of Maternal Mortality: The Sisterhood Method,” Studies in Family Planning 20(3): 125-135. doi:10.2307/1966567. Health Research for Action (HERA) and International Center for Reproductive Health (ICRH). 2010. Thematic Evaluation of National Programs and UNFPA Experience in the Campaign to End Fistula: Assessment of Global/Regional Activities. “Volume I: Global/Regional Report, Final Report – March 2010.” Reet, Belgium: HERA and ICRH. Ministry of Justice (MoJ) [Afghanistan]. 2009. Law on Elimination of Violence against Women (EVAW). Afghanistan: Ministry of Justice. Ministry of Public Health (MoPH) [Afghanistan]. 2009. Afghanistan Annual Malaria Journal - Issue 1 April 2009. Kabul, Afghanistan: MoPH. Ministry of Public Health (MoPH) [Afghanistan]. 2010a. A Basic Package of Health Services for Afghanistan – 2010/1389. Kabul, Afghanistan: MoPH. Ministry of Public Health (MoPH) [Afghanistan]. 2010b. 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Sullivan. 1991. “Direct and Indirect Estimates of Maternal Mortality from the Sisterhood Method,” Proceedings of the Demographic and Health Surveys World Conference 3: 1669- 1696. Columbia, Maryland, USA: IRD/Macro International Inc. Saleem, Sarah, et al. 2014. “A Prospective Study of Maternal, Fetal and Neonatal Deaths in Low- and Middle-Income Countries.” Bulletin World Health Organization 92:605-612. 308 • References Stanton, C. N. Abderrahim, and K. Hill. 1997. DHS Maternal Mortality Indicators: An Assessment of Data Quality and Implications for Data Use. DHS Analytical Reports No. 4. Calverton, Maryland, USA: Macro International Inc. United Nations. 1993. Declaration on the Elimination of Violence against Women. A/RES/48/104. General Assembly 85th plenary meeting. New York: United Nations. United Nations. 2006. Secretary-General’s In-depth Study on All Forms of Violence against Women. New York: United Nations. United Nations Program on HIV and AIDS. 2015. HIV and AIDS Estimates (2015), UNAIDS Spectrum Estimates – 2015. http://www.unaids.org/en/regionscountries/countries/afghanistan. World Health Organization (WHO). 1998. Complementary Feeding of Young Children in Developing Countries: A Review of Current Scientific Knowledge. Geneva, Switzerland: World Health Organization. World Health Organization (WHO). 2001. Putting Women First: Ethical and Safety Recommendations for Research on Domestic Violence against Women. Geneva, Switzerland: WHO. World Health Organization (WHO). 2008. Indicators for Assessing Infant and Young Child Feeding Practices. Part I: Definitions. Conclusions of a Consensus Meeting held 6-8 November 2007 in Washington, DC, USA. http://whqlibdoc.who.int/publications/2008/9789241596664_eng.pdf. World Health Organization (WHO). 2011. International Statistical Classification of Diseases and Related Health Problems – 10th Revision, 2010 Edition. Geneva, Switzerland: WHO. http://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf?ua=1. World Health Organization (WHO). 2015a. WHO Statement on Caesarean Section Rates. Geneva: WHO. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/ (WHO/RHR/15.02). World Health Organization (WHO).2015b. Postnatal Care for Mothers and Newborns, Highlights from the World Health Organization 2013 Guideline. Geneva: WHO http://www.who.int/maternal_child_adolescent/publications/WHO-MCA-PNC-2014-Briefer_A4.pdf (accessed August 21, 2016). Appendix A • 309 SAMPLE DESIGN APPENDIX A A.1 INTRODUCTION he 2015 Afghanistan Demographic and Health Survey (2015 AfDHS) is the first DHS survey conducted in Afghanistan. The main objective of the 2015 AfDHS is to provide up-to-date information on fertility and childhood mortality levels; fertility preferences; awareness, approval, and use of family planning methods; maternal and child health; and knowledge and attitudes toward HIV/AIDS and other sexually transmitted infections (STIs). The 2015 AfDHS calls for a nationally representative sample of 25,650 residential households; in all the sample households, all ever-married women age 15-49 who are usual members of the selected households and those who spent the night before the survey in the selected households were eligible to be interviewed in the survey. In half of the sample households, all ever-married men age 15-49 who are usual members of the selected households and those who spent the night before the survey in the selected households were eligible to be interviewed in the survey. In each household, one woman age 15-49 was randomly selected to be eligible for the Domestic Violence module. The 2015 AfDHS was designed to provide most of the key indicators for the country as a whole, for urban and rural areas separately, and for each of the 34 provinces in Afghanistan. These provinces are located in eight regions as follows:  The Northern region: Balkh, Faryab, Jawzjan, Samangan, and Sar-E-Pul  The North Eastern region: Badakhshan, Baghlan, Kunduz, and Takhar  The Western region: Badghis, Farah, Ghor, and Herat  The Central Highland region: Bamyan and Daykundi  The Capital region: Kabul, Kapisa, Logar, Panjsher, Parwan, and Wardak  The Southern region: Ghazni, Helmand, Kandahar, Nimroz, Urozgan, and Zabul  The South Eastern region: Khost, Paktika, and Paktya  The Eastern region: Kunarha, Laghman, Nangarhar, and Nooristan A.2 SAMPLE FRAME The sampling frame for the 2015 AfDHS is the updated version of the Household Listing Frame, prepared in 2003-2004 and updated in 2009, provided by the Central Statistical Organization (CSO). The CSO disposes an electronic file consisting of 25,974 enumeration areas (EAs) that cover the entire country. An EA is a geographic area consisting of a convenient number of dwelling units that serve as counting units for the census. In urban areas, an EA is a city block; in rural areas, an EA is either a village, a group of small, adjacent villages, or a part of a large village. The frame file contains information about the location (province, district, and control area), the type of residence (urban or rural), and the estimated number of residential households for each of the 25,974 EAs. Also available for each EA are satellite maps, which delimit the geographic boundaries of the EA. The EA sizes are rough estimates and quite homogenous, with an average of 164.4 households per EA, as indicated in Table A.2. Administratively, Afghanistan is divided into 34 provinces; each province is subdivided into districts, with a total number of 458 districts, and each district is subdivided into Nahia’s in urban areas and villages in rural areas. The 34 provinces are regrouped to form eight geographical regions. Table A.1 below shows the household distribution by province and by type of residence. In Afghanistan, 23% of the households reside T 310 • Appendix A in urban areas, and 78% reside in rural areas. Among the 34 provinces, most of them have a very small area that is urban, and two of them, Nooristan and Panjsher, have no urban areas at all. The provinces are very different in size; with the largest province, Kabul, representing 13% of the total households of the country, and the smallest province, Panjsher, representing only 0.6%. The percentage of urban areas is low in most of the 34 provinces, less than 10% in 22 provinces, between 10% and 20% in 4 provinces, and more than 20% in 8 provinces, where the highest percentage of urban areas is 80% in Kabul. Table A.1 Distribution of residential households by province and type of residence Households Households Distribution Province Urban Rural Total Province Urban Kabul 448,333 110,665 558,998 13.1% 80.2% Kapisa 164 56,848 57,012 1.3% 0.3% Parwan 8,569 85,408 93,977 2.2% 9.1% Wardak 494 91,695 92,189 2.2% 0.5% Logar 535 62,172 62,707 1.5% 0.9% Nangarhar 26,163 207,439 233,602 5.5% 11.2% Laghman 1,727 67,631 69,358 1.6% 2.5% Panjsher 26,079 26,079 0.6% 0.0% Baghlan 32,051 101,845 133,896 3.1% 23.9% Bamyan 4,489 56,524 61,013 1.4% 7.4% Ghazni 5,664 175,112 180,776 4.2% 3.1% Paktika 295 109,220 109,515 2.6% 0.3% Paktya 3,410 101,639 105,049 2.5% 3.2% Khost 8,062 86,333 94,395 2.2% 8.5% Kunarha 7,800 99,237 107,037 2.5% 7.3% Nooristan 29,858 29,858 0.7% 0.0% Badakhshan 9,270 136,065 145,335 3.4% 6.4% Takhar 22,616 126,929 149,545 3.5% 15.1% Kunduz 32,144 91,708 123,852 2.9% 26.0% Samangan 5,037 55,706 60,743 1.4% 8.3% Balkh 70,267 124,400 194,667 4.6% 36.1% Sar-E-Pul 6,824 82,754 89,578 2.1% 7.6% Ghor 3,467 127,929 131,396 3.1% 2.6% Daykundi 1,609 86,305 87,914 2.1% 1.8% Urozgan 5,092 58,855 63,947 1.5% 8.0% Zabul 3,569 56,217 59,786 1.4% 6.0% Kandahar 59,958 95,337 155,295 3.6% 38.6% Jawzjan 19,644 53,613 73,257 1.7% 26.8% Faryab 20,960 121,369 142,329 3.3% 14.7% Helmand 35,246 193,332 228,578 5.4% 15.4% Badghis 3,905 87,522 91,427 2.1% 4.3% Herat 101,467 232,530 333,997 7.8% 30.4% Farah 4,684 89,129 93,813 2.2% 5.0% Nimroz 6,900 21,595 28,495 0.7% 24.2% Afghanistan 960,415 3,309,000 4,269,415 100.0% 22.5% Source: The updated version of the Household Listing Frame prepared in 2003-2004 and updated in 2009, provided by the Central Statistical Organization (CSO). Table A.2 below indicates the distribution of EAs and their average size in number of households by province and by type of residence. There are a total 25,974 EAs; 4,340 EAs are in urban areas and 21,634 EAs are in rural areas. The average EA size is 164.4 households; the urban EAs have a larger size, with an average of 221.3 households per EA, and the rural EAs have a smaller size with an average of 153 households per EA. Appendix A • 311 Table A.2 Numbers of EAs and average size of EAs by province and type of residence Number of EAs Average number of households per EA Province Urban Rural Total Urban Rural Total Kabul 1,870 575 2,445 239.8 192.5 228.6 Kapisa 1 365 366 164.0 155.7 155.8 Parwan 46 464 510 186.3 184.1 184.3 Wardak 2 689 691 247.0 133.1 133.4 Logar 5 349 354 107.0 178.1 177.1 Nangarhar 139 1,459 1,598 188.2 142.2 146.2 Laghman 13 451 464 132.8 150.0 149.5 Panjsher 0 154 154 NA 169.3 169.3 Baghlan 173 684 857 185.3 148.9 156.2 Bamyan 19 410 429 236.3 137.9 142.2 Ghazni 24 1,327 1,351 236.0 132.0 133.8 Paktika 1 545 546 295.0 200.4 200.6 Paktya 15 662 677 227.3 153.5 155.2 Khost 28 599 627 287.9 144.1 150.6 Kunarha 31 657 688 251.6 151.0 155.6 Nooristan 0 181 181 NA 165.0 165.0 Badakhshan 46 950 996 201.5 143.2 145.9 Takhar 112 807 919 201.9 157.3 162.7 Kunduz 155 669 824 207.4 137.1 150.3 Samangan 21 344 365 239.9 161.9 166.4 Balkh 332 905 1,237 211.6 137.5 157.4 Sar-E-Pul 33 529 562 206.8 156.4 159.4 Ghor 10 754 764 346.7 169.7 172.0 Daykundi 5 581 586 321.8 148.5 150.0 Urozgan 22 324 346 231.5 181.7 184.8 Zabul 15 423 438 237.9 132.9 136.5 Kandahar 279 640 919 214.9 149.0 169.0 Jawzjan 95 403 498 206.8 133.0 147.1 Faryab 98 820 918 213.9 148.0 155.0 Helmand 185 1,233 1,418 190.5 156.8 161.2 Badghis 21 534 555 186.0 163.9 164.7 Herat 492 1,461 1,953 206.2 159.2 171.0 Farah 24 567 591 195.2 157.2 158.7 Nimroz 28 119 147 246.4 181.5 193.8 Afghanistan 4,340 21,634 25,974 221.3 153.0 164.4 Source: The updated version of the Household Listing Frame prepared in 2003-2004 and updated in 2009, provided by the Central Statistical Organization (CSO). A.3 SAMPLE DESIGN AND IMPLEMENTATION The sample for the 2015 AfDHS is a stratified sample selected in two stages from the sampling frame. Stratification was achieved by separating each province into urban and rural areas. In total, 66 sampling strata have been created because there are no urban areas in Nooristan and Panjsher. Samples were selected independently in each sampling stratum, by a two-stage selection. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels within a sampling stratum. This was done by sorting the sampling frame according to administrative units at different levels within each stratum and by using a probability proportional to size selection at the first stage of sampling. In the first stage, 950 EAs were selected, 260 EAs in urban areas and 690 EAs in rural areas, with probability proportional to the EA size and with independent selection in each sampling stratum, with the sample allocation given in Table A.3. It was recognized that some areas in the country might be difficult to reach because of ongoing security issues. Therefore, to mitigate the situation, replacement clusters were selected in rural areas for 101 clusters. Within each province, the number of the preselected replacement clusters did not exceed 10 percent of the selected clusters in the province. A household listing operation was carried out in all the selected EAs, and the resulting lists of households served as a sampling frame for the selection of households in the second stage. During the household listing activities, some of the selected EAs, 127 EAs, were found to be very large. To minimize the task of household listing in these EAs, each large EA was segmented into 2-3 segments. Only one segment was selected for the survey with probability proportional to the segment size. Household listing was conducted only in the selected segment. This means that a 2015 AfDHS cluster is either an EA or a segment of an EA. 312 • Appendix A During the household listing operation, more than 70 selected clusters were identified as insecure. Therefore, a decision was made to carry out the household listing operation in all of the 101 preselected replacement clusters. Overall, the survey was successfully carried out in 956 clusters. Because of extreme security issues in rural areas of Zabul, all selected clusters in rural areas were dropped; only seven clusters that were selected from urban areas could be covered. Consequently, it was not possible to provide provincial level estimates for Zabul; however, the information collected from this province is included in the national level estimates. In the second stage of selection, a fixed number of 27 households per cluster was selected with an equal probability systematic selection from the newly created household listing. The survey interviewer interviewed only the pre-selected households. No replacements and no changes of the pre-selected households were allowed in the implementing stages in order to prevent bias. All ever-married women age 15-49 who are usual members of the selected households or who spent the night before the survey in the selected households were eligible for the female survey. In about half of the selected households, all men age 15-49 who are usual members of the households or who spent the night before the survey in the households were eligible for the male survey. Table A.3 shows the allocation of EAs and households according to provinces and urban-rural areas, and Table A.4 shows the expected number of completed women’s interviews according to provinces and urban-rural areas. To ensure that the survey precision is comparable across provinces, the sample allocation figures a power allocation between provinces and between different types of residences within each province. The survey was expected to be conducted in 25,650 residential households, 7,020 in urban areas and 18,630 in rural areas. The sample was expected to result in about 29,541 completed interviews with ever-married women age 15-49: 7,878 interviews in urban areas and 21,663 interviews in rural areas. Also, the sample was expected to result in about 11,859 completed interviews with men age 15-49: 3,163 interviews in urban areas and 8,696 interviews in rural areas. Table A.3 Sample allocation of clusters and households by province and type of residence Number of clusters allocated Number of households allocated Province Urban Rural Total Urban Rural Total Kabul 21 12 33 567 324 891 Kapisa 1 27 28 27 729 756 Parwan 8 19 27 216 513 729 Wardak 2 27 29 54 729 783 Logar 3 23 26 81 621 702 Nangarhar 9 21 30 243 567 810 Laghman 5 21 26 135 567 702 Panjsher 0 26 26 0 702 702 Baghlan 11 17 28 297 459 756 Bamyan 7 19 26 189 513 702 Ghazni 6 23 29 162 621 783 Paktika 1 29 30 27 783 810 Paktya 6 22 28 162 594 756 Khost 8 20 28 216 540 756 Kunarha 8 20 28 216 540 756 Nooristan 0 26 26 0 702 702 Badakhshan 7 21 28 189 567 756 Takhar 10 19 29 270 513 783 Kunduz 12 16 28 324 432 756 Samangan 8 18 26 216 486 702 Balkh 13 16 29 351 432 783 Sar-E-Pul 8 20 28 216 540 756 Ghor 6 22 28 162 594 756 Daykundi 5 22 27 135 594 729 Urozgan 7 19 26 189 513 702 Zabul 7 19 26 189 513 702 Kandahar 13 16 29 351 432 783 Jawzjan 11 16 27 297 432 729 Faryab 10 19 29 270 513 783 Helmand 10 20 30 270 540 810 Badghis 6 21 27 162 567 729 Herat 13 18 31 351 486 837 Farah 7 21 28 189 567 756 Nimroz 11 15 26 297 405 702 Afghanistan 260 690 950 7,020 18,630 25,650 Appendix A • 313 Table A.4 Sample allocation of expected completed women’s and men’s interviews by province and type of residence Expected number of interviews with women age 15-49 Expected number of interviews with men age 15-49 Province Urban Rural Total Urban Rural Total Kabul 637 377 1,014 255 152 407 Kapisa 30 847 877 12 340 352 Parwan 242 597 839 98 239 337 Wardak 60 847 907 24 340 364 Logar 92 722 814 36 290 326 Nangarhar 273 660 933 109 265 374 Laghman 152 660 812 60 265 325 Panjsher 0 817 817 0 328 328 Baghlan 333 534 867 134 214 348 Bamyan 212 597 809 85 239 324 Ghazni 182 722 904 73 290 363 Paktika 30 910 940 12 365 377 Paktya 182 690 872 73 277 350 Khost 242 627 869 98 252 350 Kunarha 242 627 869 98 252 350 Nooristan 0 817 817 0 328 328 Badakhshan 212 660 872 85 265 350 Takhar 303 597 900 122 239 361 Kunduz 364 502 866 146 202 348 Samangan 242 565 807 98 227 325 Balkh 394 502 896 158 202 360 Sar-E-Pul 242 627 869 98 252 350 Ghor 182 690 872 73 277 350 Daykundi 152 690 842 60 277 337 Urozgan 212 597 809 85 239 324 Zabul 212 597 809 85 239 324 Kandahar 394 502 896 158 202 360 Jawzjan 333 502 835 134 202 336 Faryab 303 597 900 122 239 361 Helmand 303 627 930 122 252 374 Badghis 182 660 842 73 265 338 Herat 394 565 959 158 227 385 Farah 212 660 872 85 265 350 Nimroz 333 472 805 134 189 323 Afghanistan 7,878 21,663 29,541 3,163 8,696 11,859 The sample allocations were derived using information obtained from the 2010 Afghanistan Mortality Survey (AMS); the average number of women age 15-49 per household is 1.2; the average number of men age 15-49 per household is 1; the household completion rate is 96% in urban areas and 98% in rural areas; the women individual completion rate is 97.5% in urban areas and 98.5% in rural areas. The same completion rates were used to calculate the expected number of completed interviews with men. A.4 SAMPLE PROBABILITIES AND SAMPLING WEIGHTS Due to the nonproportional allocation of the sample across provinces and to their urban and rural areas, and the differential response rates, sampling weights must be used in all analyses of the 2015 AfDHS results to ensure that survey results are representative at both the national and domain level. Because the 2015 AfDHS sample is a two-stage stratified cluster sample, sampling weights are based on sampling probabilities calculated separately for each sampling stage and for each cluster where: P1hi: first-stage sampling probability of the ith cluster in stratum h P2hi: second-stage sampling probability within the ith cluster (households) The following describes the calculation of these probabilities: Let ah be the number of clusters selected in stratum h, Mhi the number of households according to the sampling frame in the ith cluster, and M hi the total number of households in the stratum. The probability of selecting the ith cluster in stratum h in the 2015 AfDHS sample is calculated as follows: 314 • Appendix A M M a hi hih  Let hib be the proportion of households in the selected segment compared with the total number of households in cluster i in stratum h if the cluster is segmented, otherwise 1hib . Then the probability of selecting cluster i in the sample is: hi hi hih 1hi b M M a = P   Let hiL be the number of households listed in the household listing operation in cluster i in stratum h, and let hig be the number of households selected in the cluster. The second stage’s selection probability for each household in the cluster is calculated as follows: hi hi hi L g P 2 The overall selection probability of each household in cluster i of stratum h in the 2015 AfDHS is therefore the product of the two stages’ selection probabilities: hihihi PPP 21  The design weight for each household in cluster i of stratum h is the inverse of its overall selection probability: hihi PW /1 A spreadsheet containing all sampling parameters and selection probabilities was prepared to facilitate the calculation of the design weights. Design weights were adjusted for household nonresponse and individual nonresponse to obtain the sampling weights for households and for women and men, respectively. Nonresponse is adjusted at the sampling stratum level. For the household sampling weight, the household design weight is multiplied by the inverse of the household response rate, by stratum. For the women’s individual sampling weight, the household sampling weight is multiplied by the inverse of the women’s individual response rate, by stratum. For the men’s individual sampling weight, the household sampling weight for the male subsample is multiplied by the inverse of the men’s individual response rate, by stratum. After adjusting for nonresponse, the sampling weights are normalized to get the final standard weights that appear in the data files. The normalization process is aimed at obtaining a total number of unweighted cases equal to the total number of weighted cases using normalized weights at the national level, for the total number of households, women, and men. Normalization is done by multiplying the sampling weight by the estimated total sampling fraction obtained from the survey for the household weight, the individual woman’s weight, and the individual man’s weight. The normalized weights are relative weights that are valid for estimating means, proportions, ratios, and rates, but they are not valid for estimating population totals or for pooled data. Special weights for domestic violence were calculated that account for the selection of one woman per household. Appendix A • 315 Ta bl e A .5 S am pl e im pl em en ta ti o n: W om en P er ce nt d is tri bu tio n of h ou se ho ld s an d el ig ib le w om en b y re su lts o f t he h ou se ho ld a nd in di vi du al in te rv ie w s, a nd h ou se ho ld , e lig ib le w om en , an d ov er al l w om en ’s r es po ns e ra te s, a cc or di ng to u rb an -r ur al r es id en ce a nd re gi on ( un w ei gh te d) , A fg ha ni st an 2 01 5 R es id en ce P ro vi nc e R es ul t U rb an R ur al K ab ul K ap is a P ar w an W ar da k Lo ga r N an ga rh ar La gh m an P an js he r B ag hl an B am ya n G ha zn i P ak tik a P ak ty a K ho st K un ar ha N oo ris ta n S el ec te d ho u se ho ld s C om pl et ed ( C ) 91 .6 95 .9 86 .5 96 .7 95 .6 93 .7 98 .2 91 .9 95 .2 88 .4 96 .3 93 .2 94 .5 99 .5 98 .8 97 .7 92 .3 99 .4 H ou se ho ld p re se nt b ut n o co m pe te nt re sp on de nt a t ho m e (H P ) 0. 9 0. 5 1. 6 0. 3 0. 7 0. 2 0. 0 0. 3 0. 3 0. 4 0. 3 0. 8 0. 5 0. 0 0. 3 0. 3 3. 9 0. 0 P os tp on ed ( P ) 0. 0 0. 1 0. 1 0. 0 0. 0 0. 1 0. 1 0. 1 0. 2 0. 0 0. 0 0. 0 1. 0 0. 0 0. 0 0. 0 0. 0 0. 1 R ef us ed ( R ) 2. 6 0. 7 6. 9 1. 0 0. 4 0. 0 0. 5 0. 2 0. 8 1. 8 1. 3 0. 1 2. 1 0. 4 0. 3 0. 8 0. 1 0. 1 D w el lin g no t f ou nd ( D N F) 0. 3 0. 2 0. 7 0. 1 0. 0 1. 1 0. 1 0. 1 0. 2 2. 3 0. 1 0. 3 0. 1 0. 0 0. 0 0. 4 0. 0 0. 0 H ou se ho ld a bs en t ( H A ) 1. 9 1. 0 2. 1 0. 8 1. 6 3. 0 0. 6 1. 6 2. 2 2. 3 0. 4 0. 7 1. 2 0. 1 0. 4 0. 1 2. 8 0. 2 D w el lin g va ca nt /a dd re ss no t a d w el lin g (D V ) 1. 5 0. 9 1. 0 0. 6 1. 1 0. 6 0. 1 1. 6 0. 6 1. 8 1. 0 3. 7 0. 2 0. 0 0. 1 0. 5 0. 1 0. 0 D w el lin g de st ro ye d (D D ) 0. 2 0. 2 0. 3 0. 1 0. 0 0. 2 0. 0 0. 3 0. 0 0. 8 0. 4 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 O th er ( O ) 0. 8 0. 6 0. 8 0. 4 0. 7 1. 0 0. 3 3. 7 0. 6 2. 2 0. 1 1. 2 0. 3 0. 0 0. 0 0. 1 0. 8 0. 1 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of s am pl ed ho us eh ol ds 6, 97 7 18 ,7 64 87 4 77 9 75 5 80 6 78 3 86 4 64 8 77 5 70 2 75 0 88 8 75 5 78 0 75 5 72 7 80 1 H ou se ho ld r es po ns e ra te (H R R )1 95 .9 98 .5 90 .3 98 .6 98 .9 98 .4 99 .2 99 .1 98 .6 95 .1 98 .3 98 .7 96 .2 99 .6 99 .5 98 .5 95 .9 99 .7 E lig ib le w om en C om pl et ed ( E W C ) 95 .0 97 .4 88 .5 98 .9 97 .9 97 .9 99 .7 97 .2 98 .8 97 .3 97 .2 93 .5 90 .0 94 .4 97 .1 98 .2 95 .8 98 .7 N ot a t h om e (E W N H ) 2. 0 1. 2 3. 6 0. 3 1. 4 1. 0 0. 1 0. 9 0. 6 1. 0 1. 7 5. 5 2. 0 0. 5 1. 9 0. 5 3. 7 0. 5 P os tp on ed ( E W P ) 0. 2 0. 0 0. 6 0. 0 0. 3 0. 0 0. 0 0. 1 0. 0 0. 0 0. 3 0. 0 0. 4 0. 1 0. 0 0. 0 0. 0 0. 0 R ef us ed ( E W R ) 1. 2 0. 8 3. 9 0. 3 0. 1 0. 4 0. 2 0. 2 0. 2 0. 3 0. 5 0. 3 6. 4 4. 2 0. 2 0. 1 0. 0 0. 3 P ar tly c om pl et ed (E W P C ) 0. 4 0. 1 1. 5 0. 0 0. 1 0. 3 0. 0 0. 2 0. 1 0. 0 0. 0 0. 0 0. 2 0. 3 0. 2 0. 0 0. 0 0. 2 In ca pa ci ta te d (E W I) 0. 2 0. 1 0. 2 0. 0 0. 1 0. 2 0. 0 0. 1 0. 0 0. 0 0. 0 0. 3 0. 6 0. 4 0. 2 0. 0 0. 0 0. 0 O th er ( E W O ) 1. 0 0. 4 1. 6 0. 5 0. 0 0. 1 0. 0 1. 3 0. 2 1. 4 0. 3 0. 4 0. 4 0. 1 0. 5 1. 2 0. 5 0. 3 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of w om en 7, 39 6 23 ,0 38 85 3 88 4 76 0 88 9 91 8 1, 05 3 81 0 70 0 76 1 69 7 1, 27 3 1, 17 6 1, 20 9 1, 36 3 76 6 1, 41 6 E lig ib le w om en re sp on se ra te (E W R R )2 95 .0 97 .4 88 .5 98 .9 97 .9 97 .9 99 .7 97 .2 98 .8 97 .3 97 .2 93 .5 90 .0 94 .4 97 .1 98 .2 95 .8 98 .7 O ve ra ll w om en r es po ns e ra te ( O R R )3 91 .1 95 .9 79 .9 97 .4 96 .8 96 .3 98 .9 96 .3 97 .3 92 .6 95 .5 92 .4 86 .6 94 .0 96 .6 96 .7 91 .9 98 .5 1 U si ng th e nu m be r o f h ou se ho ld s fa lli ng in to s pe ci fic r es po ns e ca te go rie s, th e ho us eh ol d re sp on se r at e (H R R ) i s ca lc ul at ed a s: 10 0 * C C + H P + P + R + D N F 2 T he e lig ib le w om en r es po ns e ra te (E W R R ) i s eq ui va le nt to th e pe rc en ta ge o f i nt er vi ew s co m pl et ed ( E W C ) 3 T he o ve ra ll w om en r es po ns e ra te ( O W R R ) i s ca lc ul at ed a s: O W R R = H R R * E W R R /1 00 316 • Appendix A Ta bl e A .5 S am pl e im pl em en ta ti o n: W om en (C o nt in ue d) P er ce nt d is tri bu tio n of h ou se ho ld s an d el ig ib le w om en b y re su lts o f t he h ou se ho ld a nd in di vi du al in te rv ie w s, a nd h ou se ho ld , e lig ib le w om en , a nd o ve ra ll w om en ’s r es po ns e ra te s, a cc or di ng to u rb an -r ur al r es id en ce a nd re gi on ( un w ei gh te d) , A fg ha ni st an 2 01 5 P ro vi nc e R es ul t B ad ak hs ha n T ak ha r K un du z S am an ga n B al kh S ar -E -P ul G ho r D ay ku nd i U ro zg an K an da ha r Ja w zj an Fa ry ab H el m an d B ad gh is H er at Fa ra h N im ro z T ot al S el ec te d ho u se ho ld s C om pl et ed ( C ) 93 .1 94 .7 92 .3 96 .4 96 .7 97 .5 95 .6 95 .1 90 .6 98 .4 96 .9 97 .5 93 .9 96 .4 95 .4 94 .9 85 .6 94 .8 H ou se ho ld p re se nt b ut n o co m pe te nt re sp on de nt at h om e (H P ) 2. 1 0. 2 0. 2 0. 3 0. 1 0. 2 1. 1 0. 0 2. 1 0. 3 0. 0 0. 2 0. 5 0. 5 0. 7 0. 6 1. 0 0. 6 P os tp on ed ( P ) 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 R ef us ed ( R ) 1. 6 0. 4 1. 9 0. 9 1. 0 0. 2 0. 4 0. 7 5. 5 0. 5 1. 9 0. 0 1. 6 0. 7 1. 0 2. 0 2. 5 1. 2 D w el lin g no t f ou nd ( D N F) 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 1. 0 0. 3 0. 0 0. 0 0. 0 0. 5 0. 1 0. 0 0. 0 0. 0 0. 0 0. 2 H ou se ho ld a bs en t ( H A ) 2. 4 1. 0 1. 9 1. 2 0. 4 0. 6 1. 4 0. 7 1. 3 0. 3 0. 7 0. 9 0. 4 0. 5 1. 9 1. 5 2. 7 1. 2 D w el lin g va ca nt /a dd re ss no t a d w el lin g (D V ) 0. 3 3. 5 2. 0 1. 2 1. 4 1. 4 0. 6 0. 0 0. 3 0. 4 0. 2 0. 5 2. 2 0. 7 1. 0 0. 6 5. 9 1. 1 D w el lin g de st ro ye d (D D ) 0. 1 0. 0 1. 5 0. 0 0. 0 0. 0 0. 0 0. 7 0. 0 0. 0 0. 0 0. 3 0. 3 0. 1 0. 1 0. 0 0. 0 0. 2 O th er ( O ) 0. 4 0. 2 0. 0 0. 0 0. 4 0. 0 0. 0 2. 6 0. 1 0. 1 0. 2 0. 2 0. 8 1. 1 0. 0 0. 4 2. 3 0. 6 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of s am pl ed ho us eh ol ds 75 6 81 0 80 8 67 5 80 9 83 6 83 8 75 6 66 9 72 9 80 8 64 8 75 9 75 6 91 7 81 0 73 0 25 ,7 41 H ou se ho ld r es po ns e ra te (H R R )1 96 .2 99 .4 97 .5 98 .8 98 .7 99 .5 97 .6 99 .0 92 .2 99 .2 98 .1 99 .4 97 .5 98 .8 98 .3 97 .3 96 .2 97 .8 E lig ib le w om en C om pl et ed ( E W C ) 98 .8 97 .6 95 .8 98 .6 98 .2 98 .3 96 .9 97 .1 94 .9 97 .7 95 .6 97 .9 96 .5 97 .5 99 .3 98 .2 96 .3 96 .8 N ot a t h om e (E W N H ) 0. 6 1. 1 2. 2 1. 2 1. 1 0. 4 2. 7 2. 0 0. 9 0. 7 1. 9 0. 8 1. 9 2. 2 0. 4 0. 6 1. 4 1. 4 P os tp on ed ( E W P ) 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 1 0. 1 0. 0 0. 0 0. 1 R ef us ed ( E W R ) 0. 4 0. 1 0. 6 0. 0 0. 3 0. 6 0. 0 0. 1 1. 5 1. 0 1. 0 0. 0 0. 9 0. 0 0. 1 0. 7 0. 7 0. 9 P ar tly c om pl et ed (E W P C ) 0. 0 0. 2 0. 2 0. 0 0. 0 0. 0 0. 1 0. 0 0. 2 0. 2 0. 6 0. 7 0. 1 0. 0 0. 0 0. 0 0. 3 0. 2 In ca pa ci ta te d (E W I) 0. 1 0. 2 0. 0 0. 0 0. 0 0. 0 0. 1 0. 1 0. 1 0. 0 0. 8 0. 3 0. 0 0. 0 0. 0 0. 3 0. 0 0. 1 O th er ( E W O ) 0. 1 0. 5 1. 3 0. 3 0. 4 0. 7 0. 1 0. 6 2. 2 0. 3 0. 2 0. 4 0. 5 0. 1 0. 1 0. 3 1. 3 0. 6 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of w om en 84 5 83 9 87 6 69 2 92 6 82 6 91 4 68 9 84 8 97 4 90 5 75 8 87 4 89 7 99 6 1, 15 4 70 6 30 ,4 34 E lig ib le w om en re sp on se ra te (E W R R )2 98 .8 97 .6 95 .8 98 .6 98 .2 98 .3 96 .9 97 .1 94 .9 97 .7 95 .6 97 .9 96 .5 97 .5 99 .3 98 .2 96 .3 96 .8 O ve ra ll w om en r es po ns e ra te ( O R R )3 95 .0 97 .0 93 .4 97 .4 96 .9 97 .8 94 .6 96 .2 87 .6 96 .9 93 .8 97 .3 94 .1 96 .4 97 .6 95 .6 92 .6 94 .7 1 U si ng th e nu m be r o f h ou se ho ld s fa lli ng in to s pe ci fic r es po ns e ca te go rie s, th e ho us eh ol d re sp on se r at e (H R R ) i s ca lc ul at ed a s: 10 0 * C C + H P + P + R + D N F 2 T he e lig ib le w om en r es po ns e ra te (E W R R ) i s eq ui va le nt to th e pe rc en ta ge o f i nt er vi ew s co m pl et ed ( E W C ) 3 T he o ve ra ll w om en r es po ns e ra te ( O W R R ) i s ca lc ul at ed a s: O W R R = H R R * E W R R /1 00 Appendix A • 317 Ta bl e A .6 S am pl e im pl em en ta ti o n: M en P er ce nt d is tri bu tio n of h ou se ho ld s an d el ig ib le m en b y re su lts o f t he h ou se ho ld a nd in di vi du al in te rv ie w s, a nd h ou se ho ld , e lig ib le m en , a nd o ve ra ll m en ’s re sp on se r at es , a cc or di ng to u rb an -r ur al r es id en ce a nd re gi on ( un w ei gh te d) , A fg ha ni st an 2 01 5 R es id en ce P ro vi nc e R es ul t U rb an R ur al K ab ul K ap is a P ar w an W ar da k Lo ga r N an ga rh ar La gh m an P an js he r B ag hl an B am ya n G ha zn i P ak tik a P ak ty a K ho st K un ar ha N oo ris ta n S el ec te d ho u se ho ld s C om pl et ed ( C ) 91 .0 95 .9 87 .0 96 .3 95 .6 94 .3 97 .6 91 .8 96 .5 86 .3 95 .6 95 .6 95 .3 99 .5 98 .2 97 .8 91 .2 99 .2 H ou se ho ld p re se nt b ut n o co m pe te nt re sp on de nt a t ho m e (H P ) 1. 1 0. 5 1. 4 0. 3 0. 3 0. 0 0. 0 0. 5 0. 0 0. 8 0. 3 0. 3 0. 2 0. 0 0. 3 0. 3 5. 4 0. 0 P os tp on ed ( P ) 0. 0 0. 1 0. 2 0. 0 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 9 0. 0 0. 0 0. 0 0. 0 0. 0 R ef us ed ( R ) 2. 6 0. 8 6. 0 1. 3 0. 5 0. 0 0. 0 0. 2 0. 6 2. 4 1. 5 0. 3 2. 1 0. 5 0. 5 0. 6 0. 3 0. 3 D w el lin g no t f ou nd ( D N F) 0. 3 0. 3 0. 7 0. 3 0. 0 1. 3 0. 3 0. 2 0. 0 2. 7 0. 0 0. 0 0. 0 0. 0 0. 0 0. 6 0. 0 0. 0 H ou se ho ld a bs en t ( H A ) 2. 2 0. 8 1. 9 0. 3 1. 4 1. 6 1. 3 1. 9 1. 6 2. 2 0. 9 0. 3 1. 4 0. 0 0. 5 0. 3 2. 5 0. 3 D w el lin g va ca nt /a dd re ss no t a d w el lin g (D V ) 1. 6 0. 9 1. 2 0. 5 1. 4 0. 8 0. 3 1. 4 0. 6 2. 2 1. 2 2. 8 0. 0 0. 0 0. 3 0. 3 0. 3 0. 0 D w el lin g de st ro ye d (D D ) 0. 2 0. 2 0. 2 0. 3 0. 0 0. 5 0. 0 0. 0 0. 0 0. 8 0. 6 0. 0 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 O th er ( O ) 1. 0 0. 6 1. 4 0. 8 0. 8 1. 6 0. 3 3. 9 0. 6 2. 7 0. 0 0. 8 0. 0 0. 0 0. 0 0. 3 0. 3 0. 3 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of s am pl ed ho us eh ol ds 3, 38 7 9, 03 7 43 0 37 5 36 5 38 7 38 0 41 5 31 1 37 1 33 8 36 0 42 9 36 5 38 0 36 3 35 3 38 5 H ou se ho ld r es po ns e ra te (H R R )1 95 .7 98 .4 91 .2 98 .1 99 .1 98 .6 99 .5 99 .0 99 .3 93 .6 98 .2 99 .4 96 .7 99 .5 99 .2 98 .6 94 .2 99 .7 E lig ib le m en C om pl et ed ( E M C ) 84 .2 93 .6 61 .8 94 .3 91 .2 97 .9 97 .6 90 .1 95 .7 83 .5 90 .8 80 .1 91 .4 87 .9 93 .5 98 .4 83 .0 93 .5 N ot a t h om e (E M N H ) 9. 8 3. 4 18 .8 3. 4 5. 6 1. 6 0. 5 3. 3 1. 7 9. 9 6. 6 17 .4 3. 8 2. 3 3. 8 1. 6 12 .9 1. 6 P os tp on ed ( E M P ) 0. 5 0. 1 1. 8 0. 0 1. 4 0. 0 0. 0 0. 3 0. 0 0. 0 0. 4 1. 2 0. 2 0. 0 0. 0 0. 0 0. 4 0. 0 R ef us ed ( E M R ) 2. 2 1. 0 8. 7 0. 3 0. 0 0. 0 0. 7 0. 0 1. 4 0. 0 0. 4 0. 0 3. 2 8. 4 0. 4 0. 0 0. 4 0. 2 P ar tly c om pl et ed (E M P C ) 0. 4 0. 2 2. 1 0. 0 0. 0 0. 2 0. 2 0. 0 0. 6 0. 4 0. 0 0. 0 0. 3 0. 4 0. 2 0. 0 0. 0 0. 9 In ca pa ci ta te d (E M I) 0. 5 0. 2 0. 9 0. 0 0. 0 0. 0 0. 7 0. 3 0. 0 0. 4 0. 0 0. 0 0. 8 0. 2 0. 0 0. 0 0. 0 0. 2 O th er ( E M O ) 2. 5 1. 5 6. 0 2. 0 1. 8 0. 2 0. 2 6. 1 0. 6 5. 8 1. 8 1. 2 0. 3 0. 8 2. 2 0. 0 3. 1 3. 6 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of m en 2, 77 1 9, 00 7 33 5 29 7 28 4 42 7 41 4 39 2 34 9 24 2 27 1 24 1 63 0 51 3 50 5 56 9 22 4 44 8 E lig ib le m en r es po ns e ra te (E M R R )2 84 .2 93 .6 61 .8 94 .3 91 .2 97 .9 97 .6 90 .1 95 .7 83 .5 90 .8 80 .1 91 .4 87 .9 93 .5 98 .4 83 .0 93 .5 O ve ra ll m en r es po ns e ra te (O R R )3 80 .6 92 .1 56 .4 92 .5 90 .4 96 .6 97 .1 89 .1 95 .1 78 .1 89 .1 79 .6 88 .4 87 .4 92 .7 97 .1 78 .2 93 .3 1 U si ng th e nu m be r o f h ou se ho ld s fa lli ng in to s pe ci fic r es po ns e ca te go rie s, th e ho us eh ol d re sp on se r at e (H R R ) i s ca lc ul at ed a s: 10 0 * C C + H P + P + R + D N F 2 T he e lig ib le m en r es po ns e ra te ( E M R R ) i s eq ui va le nt to th e pe rc en ta ge o f i nt er vi ew s co m pl et ed ( E M C ) 3 T he o ve ra ll m en re sp on se r at e (O M R R ) i s ca lc ul at ed a s: O M R R = H R R * E M R R /1 00 318 • Appendix A Ta bl e A .6 S am pl e im pl em en ta ti o n: M en (C o nt in ue d) P er ce nt d is tri bu tio n of h ou se ho ld s an d el ig ib le m en b y re su lts o f t he h ou se ho ld a nd in di vi du al in te rv ie w s, a nd h ou se ho ld , e lig ib le m en , a nd o ve ra ll m en ’s re sp on se ra te s, a cc or di ng to u rb an -r ur al r es id en ce a nd r eg io n (u nw ei gh te d) , A fg ha ni st an 2 01 5 P ro vi nc e R es ul t B ad ak hs ha n T ak ha r K un du z S am an ga n B al kh S ar -E -P ul G ho r D ay ku nd i U ro zg an K an da ha r Ja w zj an Fa ry ab H el m an d B ad gh is H er at Fa ra h N im ro z T ot al S el ec te d ho u se ho ld s C om pl et ed ( C ) 93 .2 93 .9 90 .3 98 .8 97 .4 96 .8 95 .0 94 .8 88 .9 98 .0 97 .2 96 .8 94 .3 95 .7 94 .4 95 .7 84 .7 94 .6 H ou se ho ld p re se nt b ut n o co m pe te nt re sp on de nt at h om e (H P ) 1. 9 0. 5 0. 3 0. 0 0. 3 0. 2 1. 0 0. 0 2. 5 0. 3 0. 0 0. 0 0. 5 0. 5 1. 4 0. 5 1. 1 0. 6 P os tp on ed ( P ) 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 R ef us ed ( R ) 2. 2 0. 8 2. 3 0. 6 1. 0 0. 5 0. 5 1. 1 5. 9 0. 6 1. 5 0. 0 1. 6 0. 5 1. 1 1. 5 2. 0 1. 3 D w el lin g no t f ou nd ( D N F) 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 1. 7 0. 3 0. 0 0. 0 0. 0 0. 6 0. 0 0. 0 0. 0 0. 0 0. 0 0. 3 H ou se ho ld a bs en t ( H A ) 2. 4 1. 1 1. 5 0. 0 0. 3 1. 0 1. 7 0. 8 2. 2 0. 6 0. 8 1. 0 0. 5 0. 8 2. 3 1. 3 2. 5 1. 2 D w el lin g va ca nt /a dd re ss no t a d w el lin g (D V ) 0. 0 3. 2 3. 1 0. 6 1. 0 1. 5 0. 0 0. 0 0. 3 0. 3 0. 3 1. 0 1. 9 1. 1 0. 7 0. 8 7. 1 1. 1 D w el lin g de st ro ye d (D D ) 0. 0 0. 0 2. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 3 0. 3 0. 3 0. 2 0. 0 0. 0 0. 2 O th er ( O ) 0. 3 0. 5 0. 0 0. 0 0. 0 0. 0 0. 0 3. 0 0. 3 0. 3 0. 3 0. 3 0. 8 1. 1 0. 0 0. 3 2. 5 0. 7 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of s am pl ed ho us eh ol ds 36 8 37 9 39 2 32 5 38 9 40 3 40 1 36 5 32 3 35 2 39 0 31 2 36 9 37 0 44 3 39 1 35 3 12 ,4 24 H ou se ho ld r es po ns e ra te (H R R )1 95 .8 98 .6 97 .0 99 .4 98 .7 99 .2 96 .7 98 .6 91 .4 99 .1 98 .4 99 .3 97 .8 98 .9 97 .4 97 .9 96 .5 97 .7 E lig ib le m en C om pl et ed ( E M C ) 88 .2 88 .2 85 .6 96 .4 91 .5 95 .2 94 .1 86 .2 94 .1 96 .7 95 .9 93 .1 90 .1 93 .8 95 .6 96 .2 77 .4 91 .4 N ot a t h om e (E M N H ) 9. 7 6. 9 8. 4 2. 9 5. 8 2. 6 5. 7 8. 0 1. 1 0. 7 2. 6 5. 7 6. 5 3. 7 2. 9 2. 7 15 .2 4. 9 P os tp on ed ( E M P ) 0. 0 0. 0 1. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 3 0. 0 0. 3 0. 0 0. 5 0. 2 0. 0 0. 2 R ef us ed ( E M R ) 1. 4 0. 4 0. 3 0. 4 1. 7 0. 4 0. 2 0. 6 2. 0 1. 4 0. 6 0. 0 1. 0 0. 3 0. 3 0. 6 1. 6 1. 3 P ar tly c om pl et ed (E M P C ) 0. 0 0. 0 0. 6 0. 0 0. 3 0. 0 0. 0 0. 0 1. 4 0. 2 0. 0 0. 0 0. 0 0. 0 0. 3 0. 0 0. 0 0. 3 In ca pa ci ta te d (E M I) 0. 0 0. 0 0. 0 0. 0 0. 0 0. 4 0. 0 1. 1 0. 0 0. 7 0. 3 0. 0 0. 8 0. 0 0. 0 0. 0 0. 8 0. 2 O th er ( E M O ) 0. 7 4. 5 4. 0 0. 4 0. 6 1. 5 0. 0 4. 0 1. 4 0. 2 0. 3 1. 2 1. 3 2. 2 0. 5 0. 2 5. 1 1. 7 T ot al 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r of m en 27 9 24 6 34 7 27 9 34 3 27 3 42 3 17 4 35 8 42 5 34 5 24 7 38 2 32 4 38 4 47 5 25 7 11 ,7 78 E lig ib le m en r es po ns e ra te (E M R R )2 88 .2 88 .2 85 .6 96 .4 91 .5 95 .2 94 .1 86 .2 94 .1 96 .7 95 .9 93 .1 90 .1 93 .8 95 .6 96 .2 77 .4 91 .4 O ve ra ll m en r es po ns e ra te (O R R )3 84 .5 87 .0 83 .0 95 .8 90 .4 94 .5 91 .0 85 .0 86 .0 95 .9 94 .4 92 .5 88 .0 92 .8 93 .1 94 .2 74 .7 89 .3 1 U si ng th e nu m be r o f h ou se ho ld s fa lli ng in to s pe ci fic r es po ns e ca te go rie s, th e ho us eh ol d re sp on se r at e (H R R ) i s ca lc ul at ed a s: 10 0 * C C + H P + P + R + D N F 2 T he e lig ib le m en r es po ns e ra te ( E M R R ) i s eq ui va le nt to th e pe rc en ta ge o f i nt er vi ew s co m pl et ed ( E M C ) 3 T he o ve ra ll m en re sp on se r at e (O M R R ) i s ca lc ul at ed a s: O M R R = H R R * E M R R /1 00 Appendix B • 319 ESTIMATES OF SAMPLING ERRORS Appendix B he estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions by either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2015 Afghanistan Demographic and Health Survey (2015 AfDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 2015 AfDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability among all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. Sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95% of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2015 AfDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed by SAS programs developed by ICF. These programs use the Taylor linearization method to estimate variances for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance:                     H h h h m i hi h h m z z m m x f rvarrSE h 1 2 1 2 2 2 1 1 )()( in which hihihi rxyz  , and hhh rxyz  where h represents the stratum, which varies from 1 to H, mh is the total number of clusters selected in the hth stratum, yhi is the sum of the weighted values of variable y in the ith cluster in the hth stratum, xhi is the sum of the weighted number of cases in the ith cluster in the hth stratum, and f is the overall sampling fraction, which is so small that it is ignored. T 320 • Appendix B The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulas. Each replication considers all but one cluster in the calculation of the estimates. Pseudo-independent replications are thus created. In the 2015 AfDHS there were 956 non-empty clusters. Hence, 956 replications were created. The variance of a rate r is calculated as follows: SE r var r k k r r i k i 2 1 21 1 ( ) ( ) ( ) ( )      in which )()1( ii rkkrr  where r is the estimate computed from the full sample of 956 clusters, r(i) is the estimate computed from the reduced sample of 955 clusters (ith cluster excluded), and k is the total number of clusters. In addition to the standard error, the design effect (DEFT) for each estimate is also calculated. The design effect is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. Relative standard errors and confidence limits for the estimates are also calculated. Sampling errors for the 2015 AfDHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for Afghanistan as a whole, for urban and rural areas, and for 33 provinces1. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Tables B.2 through B.37 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95% confidence limits (R±2SE), for each variable. The sampling errors for mortality rates are presented for the 5-year period preceding the survey for the national sample and for the 10-year period preceding the survey at domain levels. The DEFT is considered undefined when the standard error considering a simple random sample is zero (when the estimate is close to 0 or 1). The confidence interval (e.g., as calculated for children ever born to women age 15-49) can be interpreted as follows: the overall average number of children ever born to women age 15-49 from the national sample is 2.948, and the standard error is 0.065. Therefore, to obtain the 95% confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 2.948±2×0.065. There is a high probability (95%) that the true average number of children ever born to all women age 15 to 49 is between 2.818 and 3.078. For the total sample, the value of the DEFT, averaged over all variables, is 2.737. This means that, due to multi-stage clustering of the sample, the average standard error is increased by a factor of 2.737 over that in an equivalent simple random sample. 1 Provincial-level estimates for Zabul have not been presented separately because there are few cases. However, national estimates include the results for Zabul. Appendix B • 321 Table B.1 List of selected variables for sampling errors, Afghanistan, 2015 Variable Estimate Base population WOMEN Urban residence Proportion Ever-married women 15-49 Literacy Proportion Ever-married women 15-49 No education Proportion Ever-married women 15-49 Secondary education or higher Proportion Ever-married women 15-49 Never married/in union Proportion All women 15-49 Currently married/in union Proportion All women 15-49 Married before age 20 Proportion All women 20-49 Had sexual intercourse before age 18 Proportion All women 20-49 Currently pregnant Proportion All women 15-49 Children ever born Mean All women 15-49 Children surviving Mean All women 15-49 Children ever born to women age 40-49 Mean All women 40-49 Know any contraceptive method Proportion Currently married women 15-49 Know a modern method Proportion Currently married women 15-49 Currently using any method Proportion Currently married women 15-49 Currently using a modern method Proportion Currently married women 15-49 Currently using pill Proportion Currently married women 15-49 Currently using IUD Proportion Currently married women 15-49 Currently using condoms Proportion Currently married women 15-49 Currently using injectables Proportion Currently married women 15-49 Currently using implants Proportion Currently married women 15-49 Currently using female sterilization Proportion Currently married women 15-49 Used public sector source Proportion Current users of modern method Want no more children Proportion Currently married women 15-49 Want to delay next birth at least 2 years Proportion Currently married women 15-49 Ideal number of children Mean All women 15-49 Mothers received antenatal care for last birth Proportion Women with a live birth in last five years Mothers protected against tetanus for last birth Proportion Women with a live birth in last five years Births with skilled attendant at delivery Proportion Births occurring 1-59 months before survey Had diarrhea in the past 2 weeks Proportion Children under 5 Treated with ORS Proportion Children under 5 with diarrhea in past 2 weeks Sought medical treatment for diarrhea Proportion Children under 5 with diarrhea in past 2 weeks Vaccination card seen Proportion Children 12-23 months Received BCG vaccination Proportion Children 12-23 months Received Penvavalent vaccination (3 doses) Proportion Children 12-23 months Received polio vaccination (3 doses) Proportion Children 12-23 months Received measles vaccination Proportion Children 12-23 months Received all vaccinations Proportion Children 12-23 months Had an HIV test and received results in past 12 months Proportion Ever-married women 15-49 Accepting attitudes towards people with HIV Proportion All women who have heard of HIV/AIDS Ever experienced any physical violence since age 15 Proportion Ever-married women 15-49 Ever experienced any physical/sexual violence by husband Proportion Ever-married women 15-49 Ever experienced any physical/sexual violence in the last 12 months Proportion Ever-married women 15-49 Total fertility rate (3 years) Rate Women-years of exposure to childbearing Neonatal mortality rate¹ Rate Children exposed to the risk of mortality Post-neonatal mortality rate¹ Rate Children exposed to the risk of mortality Infant mortality rate¹ Rate Children exposed to the risk of mortality Child mortality rate¹ Rate Children exposed to the risk of mortality Under-five mortality rate¹ Rate Children exposed to the risk of mortality MEN Urban residence Proportion Ever-married men 15-49 Literacy Proportion Ever-married men 15-49 No education Proportion Ever-married men 15-49 Secondary education or higher Proportion Ever-married men 15-49 Never married/in union Proportion All men 15-49 Currently married/in union Proportion All men 15-49 Had sexual intercourse before age 18 Proportion All men 20-49 Know any contraceptive method Proportion Currently married men 15-49 Know a modern method Proportion Currently married men 15-49 Want no more children Proportion Currently married men 15-49 Want to delay next birth at least 2 years Proportion Currently married men 15-49 Ideal number of children Mean All men 15-49 Had an HIV test and received results in past 12 months Proportion Ever-married men 15-49 Accepting attitudes towards people with HIV Proportion All men who have heard of HIV/AIDS 1 The mortality rates are calculated for 5 years and 10 years before the survey for the national sample and regional samples, respectively 322 • Appendix B Table B.2 Sampling errors: Total sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.233 0.013 29461 29461 5.312 0.056 0.207 0.260 Literacy 0.148 0.006 29461 29461 3.137 0.044 0.135 0.161 No education 0.835 0.009 29461 29461 3.941 0.010 0.818 0.852 Secondary or higher education 0.086 0.006 29461 29461 3.391 0.065 0.075 0.097 Never married (never in union) 0.302 0.012 41936 42221 1.95 0.038 0.279 0.325 Currently married (in union) 0.679 0.011 41936 42221 1.915 0.016 0.657 0.701 Married before age 20 0.620 0.004 31505 31473 1.825 0.007 0.611 0.629 Had sexual intercourse before age 18 0.391 0.006 31505 31473 2.133 0.015 0.380 0.402 Currently pregnant 0.152 0.004 41936 42221 2.000 0.027 0.144 0.160 Children ever born 2.948 0.065 41936 42221 2.158 0.022 2.818 3.078 Children surviving 2.703 0.058 41936 42221 2.102 0.021 2.587 2.818 Children ever born to women age 40-49 6.953 0.060 6324 6489 1.741 0.009 6.832 7.073 Know any contraceptive method 0.945 0.004 28661 28671 3.269 0.005 0.937 0.954 Know a mordern method 0.942 0.004 28661 28671 3.229 0.005 0.933 0.951 Currently using any method 0.225 0.008 28661 28671 3.066 0.034 0.210 0.240 Currently using a modern method 0.198 0.007 28661 28671 2.891 0.034 0.184 0.211 Currently using pill 0.068 0.004 28661 28671 2.534 0.055 0.061 0.076 Currently using IUD 0.014 0.001 28661 28671 1.697 0.083 0.012 0.017 Currently using condoms 0.033 0.003 28661 28671 2.432 0.078 0.028 0.038 Currently using injectables 0.049 0.002 28661 28671 1.917 0.050 0.044 0.054 Currently using implants 0.002 0.001 28661 28671 3.210 0.471 0.000 0.003 Currently using female sterilization 0.018 0.001 28661 28671 1.747 0.075 0.016 0.021 Using public sector source 0.472 0.019 4727 5313 2.631 0.041 0.434 0.510 Want no more children 0.236 0.006 28661 28671 2.267 0.024 0.224 0.247 Want to delay next birth at least 2 years 0.244 0.005 28661 28671 1.784 0.019 0.235 0.253 Ideal number of children 5.614 0.079 23956 24538 5.192 0.014 5.455 5.772 Mothers received antenatal care for last birth 0.586 0.016 19801 19632 4.529 0.027 0.554 0.618 Mothers protected against tetanus for last birth 0.530 0.015 19801 19632 4.239 0.029 0.500 0.560 Births with skilled attendant at delivery 0.505 0.017 32712 31802 4.659 0.033 0.471 0.538 Had diarrhea in the last 2 weeks 0.287 0.006 31064 30311 2.047 0.020 0.275 0.298 Treated with ORS 0.462 0.020 7990 8687 3.282 0.042 0.423 0.501 Sought medical treatment for diarrhea 0.541 0.021 7990 8687 3.542 0.039 0.498 0.584 Vaccination card seen 0.564 0.018 5820 5708 2.707 0.032 0.528 0.599 Received BCG vaccination 0.737 0.017 5820 5708 2.926 0.023 0.703 0.772 Received Pentavalent vaccination (3 doses) 0.577 0.020 5820 5708 3.076 0.035 0.536 0.617 Received polio vaccination (3 doses) 0.648 0.016 5820 5708 2.488 0.024 0.616 0.680 Received measles vaccination 0.604 0.015 5820 5708 2.313 0.025 0.574 0.634 Received all vaccinations 0.457 0.017 5820 5708 2.586 0.038 0.422 0.491 Had an HIV test and received results in past 12 months 0.004 0.001 29461 29461 2.267 0.222 0.002 0.005 Accepting attitudes towards people with HIV 0.059 0.008 5960 6970 2.647 0.137 0.043 0.075 Ever experienced any physical violence since age 15 0.529 0.010 21324 21324 2.999 0.019 0.509 0.550 Ever experienced any physical/sexual violence by any husband 0.508 0.010 21324 21324 3.010 0.020 0.488 0.529 Physical/sexual violence in the last 12 months by any husband 0.461 0.011 21324 21324 3.151 0.023 0.439 0.482 Total fertility rate (last 3 years) 5.285 0.089 116330 116463 2.582 0.017 5.107 5.463 Neonatal mortality (last 0-4 years) 22 1.745 32870 31933 1.914 0.079 18.696 25.677 Post-neonatal mortality (last 0-4 years) 23 2.259 32979 32121 2.574 0.100 18.068 27.104 Infant mortality (last 0-4 years) 45 3.096 32921 32005 2.410 0.069 38.581 50.964 Child mortality (last 0-4 years) 11 0.930 32478 31403 1.510 0.086 9.004 12.726 Under-five mortality (last 0-4 years) 55 3.287 33066 32147 2.331 0.060 48.577 61.725 MEN Urban residence 0.230 0.018 10760 10760 4.401 0.078 0.195 0.266 Literacy 0.493 0.014 10760 10760 2.866 0.028 0.465 0.520 No education 0.506 0.017 10760 10760 3.487 0.033 0.473 0.540 Secondary or higher education 0.309 0.012 10760 10760 2.657 0.038 0.285 0.333 Never married (in union) 0.423 0.036 19015 18656 1.476 0.085 0.351 0.495 Currently married (in union) 0.572 0.036 19015 18656 1.482 0.063 0.501 0.644 Had first sexual intercourse before age 18 0.079 0.004 14391 14038 1.573 0.051 0.071 0.087 Knows any contraceptive method 0.921 0.008 10687 10679 2.943 0.008 0.906 0.937 Knows any modern contraceptive method 0.910 0.008 10687 10679 2.912 0.009 0.894 0.926 Want no more children 0.197 0.007 10687 10679 1.941 0.038 0.182 0.212 Want to delay birth at least 2 years 0.297 0.010 10687 10679 2.201 0.033 0.278 0.317 Ideal number of children 6.193 0.060 8574 8539 2.158 0.010 6.074 6.313 Had HIV test and received results in past 12 months 0.017 0.003 10760 10760 2.409 0.177 0.011 0.023 Accepting attitudes towards people with HIV 0.055 0.005 5970 6287 1.755 0.094 0.045 0.066 Appendix B • 323 Table B.3 Sampling errors: Urban sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 1.000 0.000 7026 6874 na na na na Literacy 0.320 0.016 7026 6874 2.962 0.051 0.287 0.353 No education 0.669 0.016 7026 6874 2.784 0.023 0.638 0.700 Secondary or higher education 0.197 0.014 7026 6874 2.931 0.071 0.169 0.225 Never married (never in union) 0.235 0.031 11556 10916 3.021 0.132 0.173 0.297 Currently married (in union) 0.612 0.027 11556 10916 1.998 0.045 0.557 0.667 Married before age 20 0.587 0.007 8081 7829 1.485 0.012 0.573 0.601 Had sexual intercourse before age 18 0.393 0.011 8081 7829 1.997 0.027 0.372 0.414 Currently pregnant 0.090 0.006 11556 10916 1.954 0.070 0.078 0.103 Children ever born 2.643 0.163 11556 10916 2.418 0.062 2.318 2.969 Children surviving 2.469 0.151 11556 10916 2.413 0.061 2.166 2.771 Children ever born to women age 40-49 6.733 0.154 1457 1503 2.129 0.023 6.426 7.040 Know any contraceptive method 0.956 0.014 6816 6677 5.577 0.015 0.928 0.983 Know a mordern method 0.953 0.014 6816 6677 5.384 0.015 0.925 0.981 Currently using any method 0.349 0.022 6816 6677 3.813 0.063 0.305 0.393 Currently using a modern method 0.290 0.020 6816 6677 3.624 0.069 0.250 0.329 Currently using pill 0.093 0.009 6816 6677 2.501 0.095 0.075 0.110 Currently using IUD 0.027 0.004 6816 6677 1.958 0.142 0.020 0.035 Currently using condoms 0.072 0.010 6816 6677 3.161 0.138 0.052 0.092 Currently using injectables 0.050 0.007 6816 6677 2.505 0.133 0.037 0.063 Currently using implants 0.002 0.001 6816 6677 1.729 0.479 0.000 0.004 Currently using female sterilization 0.034 0.004 6816 6677 1.699 0.109 0.027 0.042 Using public sector source 0.402 0.034 1621 1861 2.751 0.084 0.335 0.469 Want no more children 0.356 0.017 6816 6677 2.973 0.048 0.321 0.390 Want to delay next birth at least 2 years 0.228 0.011 6816 6677 2.253 0.050 0.205 0.251 Ideal number of children 4.789 0.086 6033 6160 3.015 0.018 4.617 4.961 Mothers received antenatal care for last birth 0.717 0.018 4747 4563 2.743 0.025 0.681 0.753 Mothers protected against tetanus for last birth 0.547 0.017 4747 4563 2.326 0.031 0.513 0.581 Births with skilled attendant at delivery 0.789 0.019 7755 7250 3.130 0.024 0.751 0.827 Had diarrhea in the last 2 weeks 0.320 0.013 7492 7050 2.170 0.040 0.294 0.346 Treated with ORS 0.437 0.036 2031 2254 3.031 0.082 0.366 0.508 Sought medical treatment for diarrhea 0.551 0.031 2031 2254 2.690 0.057 0.489 0.614 Vaccination card seen 0.641 0.024 1422 1377 1.877 0.038 0.592 0.689 Received BCG vaccination 0.824 0.019 1422 1377 1.900 0.024 0.785 0.863 Received Pentavalent vaccination (3 doses) 0.675 0.027 1422 1377 2.129 0.040 0.622 0.729 Received polio vaccination (3 doses) 0.693 0.025 1422 1377 2.037 0.037 0.642 0.744 Received measles vaccination 0.681 0.024 1422 1377 1.884 0.035 0.633 0.728 Received all vaccinations 0.528 0.027 1422 1377 2.014 0.052 0.473 0.582 Had an HIV test and received results in past 12 months 0.011 0.003 7026 6874 2.458 0.283 0.005 0.017 Accepting attitudes towards people with HIV 0.035 0.009 2183 2695 2.261 0.254 0.017 0.053 Ever experienced any physical violence since age 15 0.431 0.022 5307 4738 3.294 0.052 0.386 0.476 Ever experienced any physical/sexual violence by any husband 0.407 0.022 5307 4738 3.232 0.054 0.364 0.451 Physical/sexual violence in the last 12 months by any husband 0.374 0.021 5307 4738 3.226 0.057 0.331 0.417 Total fertility rate (last 3 years) 4.834 0.128 31716 29783 1.982 0.026 4.578 5.090 Neonatal mortality (last 0-9 years) 17 2.182 15627 14211 1.807 0.126 13.016 21.744 Post-neonatal mortality (last 0-9 years) 17 2.413 15738 14310 1.968 0.140 12.360 22.012 Infant mortality (last 0-9 years) 35 2.810 15637 14216 1.646 0.081 28.945 40.187 Child mortality (last 0-9 years) 9 1.787 15570 14127 2.046 0.204 5.189 12.336 Under-five mortality (last 0-9 years) 43 3.512 15667 14257 1.744 0.082 36.002 50.049 MEN Urban residence 1.000 0.000 2333 2479 na na na na Literacy 0.649 0.030 2333 2479 3.028 0.046 0.589 0.709 No education 0.313 0.021 2333 2479 2.134 0.066 0.272 0.354 Secondary or higher education 0.457 0.030 2333 2479 2.859 0.065 0.398 0.517 Never married (in union) 0.262 0.028 3363 3358 1.225 0.108 0.205 0.319 Currently married (in union) 0.730 0.029 3363 3358 1.243 0.039 0.673 0.787 Had first sexual intercourse before age 18 0.086 0.012 2952 3029 2.207 0.134 0.063 0.110 Knows any contraceptive method 0.897 0.027 2324 2452 4.327 0.031 0.842 0.952 Knows any modern contraceptive method 0.896 0.027 2324 2452 4.309 0.031 0.841 0.951 Want no more children 0.259 0.022 2324 2452 2.394 0.084 0.216 0.303 Want to delay birth at least 2 years 0.293 0.024 2324 2452 2.502 0.081 0.245 0.340 Ideal number of children 5.427 0.159 1952 2144 2.634 0.029 5.109 5.745 Had HIV test and received results in past 12 months 0.048 0.010 2333 2479 2.310 0.213 0.027 0.068 Accepting attitudes towards people with HIV 0.086 0.014 1647 1799 1.999 0.161 0.058 0.114 na = Not applicable 324 • Appendix B Table B.4 Sampling errors: Rural sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.000 0.000 22435 22587 na na na na Literacy 0.095 0.007 22435 22587 3.645 0.075 0.081 0.109 No education 0.886 0.011 22435 22587 5.072 0.012 0.864 0.907 Secondary or higher education 0.052 0.007 22435 22587 4.453 0.127 0.039 0.065 Never married (never in union) 0.326 0.012 30859 31321 1.713 0.038 0.301 0.35 Currently married (in union) 0.702 0.011 30859 31321 1.687 0.016 0.680 0.724 Married before age 20 0.631 0.006 23480 23637 1.933 0.009 0.620 0.642 Had sexual intercourse before age 18 0.390 0.007 23480 23637 2.188 0.017 0.377 0.404 Currently pregnant 0.173 0.005 30859 31321 1.861 0.027 0.164 0.183 Children ever born 3.053 0.064 30859 31321 1.884 0.021 2.924 3.182 Children surviving 2.783 0.056 30859 31321 1.816 0.020 2.670 2.895 Children ever born to women age 40-49 7.013 0.064 4872 4991 1.622 0.009 6.885 7.141 Know any contraceptive method 0.942 0.004 21845 21994 2.535 0.004 0.934 0.950 Know a mordern method 0.938 0.004 21845 21994 2.581 0.004 0.930 0.947 Currently using any method 0.187 0.007 21845 21994 2.783 0.039 0.172 0.202 Currently using a modern method 0.170 0.007 21845 21994 2.612 0.039 0.157 0.183 Currently using pill 0.061 0.004 21845 21994 2.489 0.066 0.053 0.069 Currently using IUD 0.010 0.001 21845 21994 1.590 0.106 0.008 0.012 Currently using condoms 0.021 0.002 21845 21994 1.783 0.082 0.018 0.025 Currently using injectables 0.049 0.002 21845 21994 1.703 0.051 0.044 0.054 Currently using implants 0.002 0.001 21845 21994 3.618 0.626 0.000 0.003 Currently using female sterilization 0.014 0.001 21845 21994 1.592 0.092 0.011 0.016 Using public sector source 0.510 0.023 3106 3451 2.510 0.044 0.465 0.555 Want no more children 0.199 0.005 21845 21994 1.963 0.027 0.189 0.210 Want to delay next birth at least 2 years 0.248 0.005 21845 21994 1.635 0.019 0.239 0.258 Ideal number of children 5.890 0.094 17923 18377 5.394 0.016 5.701 6.079 Mothers received antenatal care for last birth 0.546 0.020 15054 15070 4.938 0.037 0.506 0.586 Mothers protected against tetanus for last birth 0.525 0.019 15054 15070 4.669 0.036 0.487 0.563 Births with skilled attendant at delivery 0.421 0.020 24957 24552 5.079 0.048 0.380 0.461 Had diarrhea in the last 2 weeks 0.277 0.006 23572 23260 2.000 0.023 0.264 0.289 Treated with ORS 0.471 0.023 5959 6433 3.378 0.050 0.424 0.518 Sought medical treatment for diarrhea 0.537 0.027 5959 6433 3.789 0.049 0.484 0.590 Vaccination card seen 0.539 0.022 4398 4331 2.937 0.042 0.494 0.584 Received BCG vaccination 0.710 0.022 4398 4331 3.136 0.031 0.666 0.754 Received Pentavalent vaccination (3 doses) 0.545 0.026 4398 4331 3.368 0.047 0.494 0.597 Received polio vaccination (3 doses) 0.634 0.020 4398 4331 2.657 0.031 0.595 0.673 Received measles vaccination 0.579 0.018 4398 4331 2.420 0.032 0.543 0.616 Received all vaccinations 0.434 0.021 4398 4331 2.818 0.049 0.391 0.477 Had an HIV test and received results in past 12 months 0.001 0.000 22435 22587 1.563 0.282 0.001 0.002 Accepting attitudes towards people with HIV 0.073 0.012 3777 4275 2.708 0.157 0.050 0.096 Ever experienced any physical violence since age 15 0.557 0.012 16017 16586 2.964 0.021 0.534 0.580 Ever experienced any physical/sexual violence by any husband 0.537 0.012 16017 16586 2.960 0.022 0.514 0.561 Physical/sexual violence in the last 12 months by any husband 0.485 0.012 16017 16586 3.140 0.026 0.461 0.510 Total fertility rate (last 3 years) 5.433 0.112 85578 86774 2.731 0.021 5.210 5.657 Neonatal mortality (last 0-9 years) 27 1.398 50586 49987 1.633 0.052 24.216 29.806 Post-neonatal mortality (last 0-9 years) 27 1.714 50743 50204 2.164 0.064 23.404 30.260 Infant mortality (last 0-9 years) 54 2.641 50655 50053 2.227 0.049 48.561 59.125 Child mortality (last 0-9 years) 14 1.133 51216 50589 1.890 0.079 12.107 16.638 Under-five mortality (last 0-9 years) 67 3.333 50794 50210 2.486 0.049 60.776 74.106 MEN Urban residence 0.000 0.000 8427 8281 na na na na Literacy 0.446 0.017 8427 8281 3.094 0.038 0.412 0.479 No education 0.564 0.021 8427 8281 3.958 0.038 0.521 0.607 Secondary or higher education 0.265 0.013 8427 8281 2.805 0.051 0.238 0.292 Never married (in union) 0.459 0.041 15652 15298 1.493 0.089 0.377 0.540 Currently married (in union) 0.538 0.041 15652 15298 1.499 0.076 0.456 0.619 Had first sexual intercourse before age 18 0.077 0.004 11439 11009 1.409 0.053 0.069 0.085 Knows any contraceptive method 0.929 0.005 8363 8227 1.948 0.006 0.918 0.939 Knows any modern contraceptive method 0.914 0.006 8363 8227 2.120 0.007 0.901 0.927 Want no more children 0.178 0.008 8363 8227 1.870 0.044 0.162 0.194 Want to delay birth at least 2 years 0.299 0.011 8363 8227 2.107 0.035 0.278 0.320 Ideal number of children 6.451 0.068 6622 6394 2.237 0.011 6.314 6.587 Had HIV test and received results in past 12 months 0.008 0.001 8427 8281 1.477 0.183 0.005 0.011 Accepting attitudes towards people with HIV 0.043 0.005 4323 4488 1.628 0.117 0.033 0.053 na = Not applicable Appendix B • 325 Table B.5 Sampling errors: Kabul sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.766 0.036 755 3658 2.318 0.047 0.694 0.838 Literacy 0.332 0.029 755 3658 1.675 0.087 0.274 0.389 No education 0.657 0.026 755 3658 1.523 0.040 0.604 0.709 Secondary or higher education 0.201 0.023 755 3658 1.585 0.115 0.155 0.248 Never married (never in union) 0.239 0.055 1185 5966 1.512 0.231 0.129 0.35 Currently married (in union) 0.599 0.041 1185 5966 1.035 0.069 0.516 0.681 Married before age 20 0.533 0.011 878 4225 0.727 0.020 0.512 0.555 Had sexual intercourse before age 18 0.360 0.019 878 4225 1.197 0.052 0.322 0.398 Currently pregnant 0.077 0.011 1185 5966 1.219 0.141 0.056 0.099 Children ever born 2.480 0.241 1185 5966 1.270 0.097 1.998 2.962 Children surviving 2.343 0.226 1185 5966 1.265 0.097 1.890 2.795 Children ever born to women age 40-49 6.655 0.271 180 820 1.411 0.041 6.113 7.196 Know any contraceptive method 0.923 0.025 737 3571 2.568 0.027 0.873 0.974 Know a mordern method 0.918 0.025 737 3571 2.461 0.027 0.868 0.968 Currently using any method 0.321 0.037 737 3571 2.154 0.116 0.247 0.396 Currently using a modern method 0.265 0.033 737 3571 2.009 0.124 0.199 0.330 Currently using pill 0.055 0.012 737 3571 1.372 0.210 0.032 0.078 Currently using IUD 0.035 0.007 737 3571 1.029 0.200 0.021 0.049 Currently using condoms 0.081 0.018 737 3571 1.815 0.226 0.044 0.117 Currently using injectables 0.035 0.009 737 3571 1.383 0.267 0.016 0.054 Currently using implants 0.003 0.002 737 3571 0.983 0.721 0.000 0.006 Currently using female sterilization 0.044 0.006 737 3571 0.799 0.137 0.032 0.056 Using public sector source 0.566 0.061 191 899 1.695 0.108 0.444 0.689 Want no more children 0.388 0.033 737 3571 1.824 0.084 0.323 0.454 Want to delay next birth at least 2 years 0.221 0.020 737 3571 1.299 0.090 0.181 0.260 Ideal number of children 4.624 0.141 702 3444 1.672 0.031 4.342 4.907 Mothers received antenatal care for last birth 0.661 0.029 485 2385 1.374 0.044 0.602 0.720 Mothers protected against tetanus for last birth 0.517 0.029 485 2385 1.267 0.055 0.460 0.575 Births with skilled attendant at delivery 0.845 0.032 769 3769 1.950 0.038 0.781 0.910 Had diarrhea in the last 2 weeks 0.308 0.025 750 3684 1.375 0.080 0.258 0.357 Treated with ORS 0.427 0.063 229 1133 1.776 0.148 0.301 0.553 Sought medical treatment for diarrhea 0.467 0.053 229 1133 1.464 0.113 0.361 0.573 Vaccination card seen 0.630 0.044 147 718 1.090 0.069 0.543 0.718 Received BCG vaccination 0.825 0.036 147 718 1.143 0.043 0.753 0.896 Received Pentavalent vaccination (3 doses) 0.717 0.047 147 718 1.250 0.065 0.624 0.810 Received polio vaccination (3 doses) 0.703 0.046 147 718 1.210 0.065 0.611 0.795 Received measles vaccination 0.728 0.046 147 718 1.238 0.063 0.637 0.820 Received all vaccinations 0.556 0.056 147 718 1.341 0.100 0.445 0.667 Had an HIV test and received results in past 12 months 0.016 0.005 755 3658 1.173 0.333 0.005 0.027 Accepting attitudes towards people with HIV 0.054 0.019 265 1445 1.332 0.342 0.017 0.092 Ever experienced any physical violence since age 15 0.420 0.035 573 2410 1.675 0.082 0.351 0.489 Ever experienced any physical/sexual violence by any husband 0.392 0.034 573 2410 1.680 0.088 0.323 0.461 Physical/sexual violence in the last 12 months by any husband 0.364 0.034 573 2410 1.665 0.092 0.297 0.431 Total fertility rate (last 3 years) 4.614 0.215 3290 15936 1.254 0.047 4.183 5.044 Neonatal mortality (last 0-9 years) 18 3.997 1536 7219 1.061 0.227 9.580 25.568 Post-neonatal mortality (last 0-9 years) 18 4.843 1554 7295 1.129 0.268 8.385 27.756 Infant mortality (last 0-9 years) 36 5.030 1536 7219 0.911 0.141 25.585 45.704 Child mortality (last 0-9 years) 7 2.882 1535 7138 1.108 0.389 1.644 13.171 Under-five mortality (last 0-9 years) 43 6.077 1541 7245 0.931 0.142 30.634 54.943 MEN Urban residence 0.777 0.043 207 1350 1.470 0.055 0.692 0.863 Literacy 0.657 0.053 207 1350 1.590 0.080 0.551 0.762 No education 0.284 0.032 207 1350 1.011 0.112 0.220 0.347 Secondary or higher education 0.483 0.054 207 1350 1.539 0.111 0.375 0.590 Never married (in union) 0.237 0.054 316 1769 0.853 0.226 0.130 0.344 Currently married (in union) 0.753 0.053 316 1769 0.854 0.070 0.647 0.859 Had first sexual intercourse before age 18 0.105 0.023 253 1589 1.181 0.218 0.059 0.151 Knows any contraceptive method 0.837 0.051 204 1332 1.950 0.061 0.736 0.939 Knows any modern contraceptive method 0.830 0.051 204 1332 1.929 0.062 0.727 0.932 Want no more children 0.278 0.039 204 1332 1.247 0.141 0.199 0.356 Want to delay birth at least 2 years 0.300 0.040 204 1332 1.254 0.135 0.219 0.380 Ideal number of children 5.373 0.283 185 1230 1.285 0.053 4.808 5.938 Had HIV test and received results in past 12 months 0.051 0.017 207 1350 1.130 0.338 0.017 0.086 Accepting attitudes towards people with HIV 0.043 0.017 142 919 0.996 0.396 0.009 0.077 326 • Appendix B Table B.6 Sampling errors: Kapisa sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.006 0.006 874 205 2.316 1.033 0.000 0.018 Literacy 0.201 0.021 874 205 1.573 0.106 0.158 0.244 No education 0.772 0.023 874 205 1.597 0.029 0.727 0.818 Secondary or higher education 0.120 0.022 874 205 1.997 0.183 0.076 0.164 Never married (never in union) 0.163 0.013 1415 327 1.3 0.083 0.136 0.19 Currently married (in union) 0.602 0.056 1415 327 1.120 0.094 0.490 0.715 Married before age 20 0.613 0.013 1019 238 0.912 0.021 0.588 0.638 Had sexual intercourse before age 18 0.393 0.014 1019 238 0.924 0.035 0.365 0.421 Currently pregnant 0.092 0.011 1415 327 1.051 0.122 0.069 0.114 Children ever born 3.088 0.324 1415 327 1.169 0.105 2.440 3.737 Children surviving 2.796 0.295 1415 327 1.178 0.106 2.206 3.386 Children ever born to women age 40-49 7.522 0.221 246 62 1.399 0.029 7.080 7.964 Know any contraceptive method 0.929 0.019 842 197 2.097 0.020 0.892 0.967 Know a mordern method 0.929 0.019 842 197 2.097 0.020 0.892 0.967 Currently using any method 0.201 0.022 842 197 1.570 0.108 0.158 0.245 Currently using a modern method 0.191 0.019 842 197 1.420 0.101 0.152 0.229 Currently using pill 0.022 0.006 842 197 1.240 0.286 0.009 0.034 Currently using IUD 0.029 0.007 842 197 1.245 0.250 0.014 0.043 Currently using condoms 0.022 0.005 842 197 0.958 0.218 0.013 0.032 Currently using injectables 0.084 0.010 842 197 1.001 0.114 0.065 0.103 Currently using implants 0.002 0.002 842 197 1.304 0.987 0.000 0.006 Currently using female sterilization 0.031 0.007 842 197 1.142 0.220 0.017 0.045 Using public sector source 0.789 0.034 148 37 1.019 0.044 0.720 0.857 Want no more children 0.411 0.026 842 197 1.534 0.063 0.359 0.463 Want to delay next birth at least 2 years 0.292 0.021 842 197 1.311 0.070 0.251 0.334 Ideal number of children 4.938 0.080 570 139 1.386 0.016 4.777 5.098 Mothers received antenatal care for last birth 0.759 0.040 562 129 2.185 0.053 0.679 0.839 Mothers protected against tetanus for last birth 0.704 0.033 562 129 1.713 0.047 0.638 0.771 Births with skilled attendant at delivery 0.498 0.048 954 219 2.306 0.096 0.402 0.594 Had diarrhea in the last 2 weeks 0.265 0.032 922 211 1.867 0.122 0.200 0.330 Treated with ORS 0.449 0.045 233 56 1.217 0.101 0.359 0.539 Sought medical treatment for diarrhea 0.411 0.047 233 56 1.252 0.114 0.317 0.504 Vaccination card seen 0.477 0.048 178 41 1.248 0.100 0.382 0.573 Received BCG vaccination 0.843 0.040 178 41 1.456 0.048 0.762 0.923 Received Pentavalent vaccination (3 doses) 0.716 0.051 178 41 1.486 0.072 0.614 0.819 Received polio vaccination (3 doses) 0.809 0.038 178 41 1.270 0.047 0.733 0.886 Received measles vaccination 0.703 0.044 178 41 1.277 0.063 0.615 0.792 Received all vaccinations 0.579 0.059 178 41 1.555 0.101 0.461 0.696 Had an HIV test and received results in past 12 months 0.002 0.002 874 205 1.181 1.003 0.000 0.005 Accepting attitudes towards people with HIV 0.014 0.013 185 46 1.530 0.950 0.000 0.041 Ever experienced any physical violence since age 15 0.266 0.025 654 152 1.461 0.095 0.216 0.317 Ever experienced any physical/sexual violence by any husband 0.255 0.024 654 152 1.412 0.095 0.207 0.303 Physical/sexual violence in the last 12 months by any husband 0.158 0.026 654 152 1.852 0.168 0.105 0.211 Total fertility rate (last 3 years) 4.812 0.237 3939 915 1.128 0.049 4.338 5.286 Neonatal mortality (last 0-9 years) 23 3.605 1897 442 0.929 0.154 16.189 30.608 Post-neonatal mortality (last 0-9 years) 17 3.365 1918 447 1.054 0.192 10.763 24.223 Infant mortality (last 0-9 years) 41 3.657 1901 443 0.667 0.089 33.578 48.205 Child mortality (last 0-9 years) 9 2.384 1900 447 0.981 0.269 4.086 13.623 Under-five mortality (last 0-9 years) 49 4.103 1904 443 0.662 0.083 41.178 57.590 MEN Urban residence 0.008 0.008 280 63 1.515 1.031 0.000 0.024 Literacy 0.628 0.039 280 63 1.333 0.062 0.551 0.705 No education 0.267 0.047 280 63 1.769 0.176 0.173 0.362 Secondary or higher education 0.466 0.046 280 63 1.535 0.099 0.374 0.558 Never married (in union) 0.240 0.072 376 83 1.207 0.298 0.097 0.384 Currently married (in union) 0.760 0.072 376 83 1.207 0.094 0.616 0.903 Had first sexual intercourse before age 18 0.088 0.014 339 76 0.906 0.155 0.061 0.115 Knows any contraceptive method 0.994 0.006 280 63 1.311 0.006 0.982 1.006 Knows any modern contraceptive method 0.994 0.006 280 63 1.311 0.006 0.982 1.006 Want no more children 0.319 0.033 280 63 1.197 0.105 0.252 0.386 Want to delay birth at least 2 years 0.255 0.030 280 63 1.150 0.118 0.195 0.315 Ideal number of children 5.293 0.143 194 44 1.095 0.027 5.007 5.579 Had HIV test and received results in past 12 months 0.010 0.007 280 63 1.208 0.724 0.000 0.024 Accepting attitudes towards people with HIV 0.000 0.000 215 48 na na na na na = Not applicable Appendix B • 327 Table B.7 Sampling errors: Parwan sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.090 0.015 744 625 1.381 0.161 0.061 0.119 Literacy 0.122 0.018 744 625 1.520 0.150 0.085 0.158 No education 0.860 0.023 744 625 1.777 0.026 0.814 0.905 Secondary or higher education 0.078 0.021 744 625 2.080 0.263 0.037 0.119 Never married (never in union) 0.189 0.017 1143 1025 1.211 0.089 0.155 0.222 Currently married (in union) 0.577 0.070 1143 1025 1.417 0.121 0.437 0.717 Married before age 20 0.519 0.019 915 767 1.193 0.036 0.482 0.557 Had sexual intercourse before age 18 0.347 0.019 915 767 1.176 0.054 0.310 0.384 Currently pregnant 0.104 0.017 1143 1025 1.363 0.162 0.070 0.137 Children ever born 2.755 0.369 1143 1025 1.431 0.134 2.018 3.492 Children surviving 2.469 0.333 1143 1025 1.446 0.135 1.803 3.136 Children ever born to women age 40-49 7.706 0.167 188 159 0.937 0.022 7.373 8.039 Know any contraceptive method 0.995 0.003 701 592 0.989 0.003 0.989 1.000 Know a mordern method 0.994 0.003 701 592 0.970 0.003 0.988 1.000 Currently using any method 0.273 0.024 701 592 1.424 0.088 0.225 0.321 Currently using a modern method 0.238 0.023 701 592 1.421 0.096 0.192 0.283 Currently using pill 0.039 0.010 701 592 1.383 0.261 0.019 0.059 Currently using IUD 0.018 0.005 701 592 0.989 0.275 0.008 0.028 Currently using condoms 0.038 0.009 701 592 1.201 0.228 0.021 0.056 Currently using injectables 0.100 0.010 701 592 0.927 0.105 0.079 0.121 Currently using implants 0.004 0.003 701 592 1.480 0.932 0.000 0.010 Currently using female sterilization 0.020 0.007 701 592 1.246 0.331 0.007 0.033 Using public sector source 0.763 0.045 164 129 1.332 0.058 0.674 0.852 Want no more children 0.312 0.028 701 592 1.584 0.089 0.257 0.368 Want to delay next birth at least 2 years 0.268 0.026 701 592 1.574 0.098 0.215 0.321 Ideal number of children 5.255 0.075 639 537 1.162 0.014 5.104 5.405 Mothers received antenatal care for last birth 0.875 0.025 517 437 1.715 0.028 0.825 0.925 Mothers protected against tetanus for last birth 0.617 0.041 517 437 1.895 0.066 0.536 0.698 Births with skilled attendant at delivery 0.525 0.044 868 728 2.061 0.084 0.437 0.614 Had diarrhea in the last 2 weeks 0.234 0.025 822 688 1.526 0.106 0.185 0.284 Treated with ORS 0.705 0.064 213 161 1.751 0.091 0.577 0.834 Sought medical treatment for diarrhea 0.574 0.057 213 161 1.450 0.100 0.459 0.689 Vaccination card seen 0.687 0.033 168 144 0.915 0.047 0.621 0.752 Received BCG vaccination 0.888 0.032 168 144 1.307 0.036 0.825 0.951 Received Pentavalent vaccination (3 doses) 0.754 0.031 168 144 0.934 0.041 0.692 0.815 Received polio vaccination (3 doses) 0.824 0.027 168 144 0.933 0.033 0.769 0.879 Received measles vaccination 0.731 0.033 168 144 0.969 0.045 0.666 0.797 Received all vaccinations 0.578 0.032 168 144 0.844 0.055 0.514 0.642 Had an HIV test and received results in past 12 months 0.000 0.000 744 625 na na na na Accepting attitudes towards people with HIV 0.439 0.047 191 125 1.293 0.106 0.346 0.533 Ever experienced any physical violence since age 15 0.594 0.033 590 467 1.644 0.056 0.527 0.661 Ever experienced any physical/sexual violence by any husband 0.548 0.029 590 467 1.404 0.053 0.490 0.605 Physical/sexual violence in the last 12 months by any husband 0.507 0.027 590 467 1.314 0.053 0.453 0.561 Total fertility rate (last 3 years) 5.731 0.232 3277 2802 0.821 0.041 5.266 6.196 Neonatal mortality (last 0-9 years) 42 6.598 1688 1427 1.030 0.157 28.735 55.126 Post-neonatal mortality (last 0-9 years) 21 4.191 1690 1422 1.162 0.202 12.366 29.128 Infant mortality (last 0-9 years) 63 7.474 1691 1429 1.016 0.119 47.729 77.625 Child mortality (last 0-9 years) 14 4.293 1663 1394 1.322 0.298 5.830 23.001 Under-five mortality (last 0-9 years) 76 7.892 1698 1434 1.097 0.104 60.405 91.974 MEN Urban residence 0.099 0.019 259 220 0.996 0.187 0.062 0.136 Literacy 0.567 0.050 259 220 1.619 0.088 0.467 0.667 No education 0.383 0.050 259 220 1.636 0.130 0.284 0.482 Secondary or higher education 0.445 0.047 259 220 1.528 0.106 0.351 0.540 Never married (in union) 0.338 0.104 354 333 1.398 0.309 0.129 0.546 Currently married (in union) 0.657 0.104 354 333 1.399 0.158 0.450 0.864 Had first sexual intercourse before age 18 0.111 0.018 325 271 1.034 0.161 0.075 0.147 Knows any contraceptive method 1.000 0.000 258 218 na na na na Knows any modern contraceptive method 0.996 0.003 258 218 0.843 0.003 0.989 1.003 Want no more children 0.246 0.044 258 218 1.634 0.179 0.158 0.334 Want to delay birth at least 2 years 0.443 0.040 258 218 1.276 0.089 0.364 0.522 Ideal number of children 6.670 0.326 176 151 1.452 0.049 6.019 7.321 Had HIV test and received results in past 12 months 0.000 0.000 259 220 na na na na Accepting attitudes towards people with HIV 0.066 0.024 183 157 1.277 0.356 0.019 0.114 na = Not applicable 328 • Appendix B Table B.8 Sampling errors: Wardak sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.022 0.005 870 382 1.077 0.244 0.011 0.033 Literacy 0.070 0.012 870 382 1.392 0.172 0.046 0.094 No education 0.945 0.011 870 382 1.360 0.011 0.924 0.966 Secondary or higher education 0.015 0.006 870 382 1.359 0.368 0.004 0.027 Never married (never in union) 0.183 0.018 1306 542 1.339 0.097 0.148 0.218 Currently married (in union) 0.697 0.065 1306 542 1.123 0.094 0.566 0.828 Married before age 20 0.510 0.033 945 416 2.161 0.064 0.444 0.575 Had sexual intercourse before age 18 0.238 0.028 945 416 2.018 0.118 0.182 0.295 Currently pregnant 0.104 0.017 1306 542 1.377 0.163 0.070 0.137 Children ever born 2.471 0.291 1306 542 1.293 0.118 1.890 3.053 Children surviving 2.220 0.261 1306 542 1.293 0.118 1.698 2.742 Children ever born to women age 40-49 6.157 0.230 192 83 1.263 0.037 5.696 6.618 Know any contraceptive method 0.918 0.016 860 378 1.747 0.018 0.886 0.951 Know a mordern method 0.918 0.016 860 378 1.747 0.018 0.886 0.951 Currently using any method 0.319 0.018 860 378 1.148 0.057 0.282 0.355 Currently using a modern method 0.301 0.017 860 378 1.085 0.056 0.267 0.335 Currently using pill 0.086 0.011 860 378 1.134 0.126 0.064 0.107 Currently using IUD 0.009 0.003 860 378 1.074 0.391 0.002 0.016 Currently using condoms 0.059 0.011 860 378 1.414 0.192 0.037 0.082 Currently using injectables 0.108 0.010 860 378 0.956 0.094 0.088 0.128 Currently using implants 0.000 0.000 860 378 na na na na Currently using female sterilization 0.036 0.008 860 378 1.198 0.210 0.021 0.052 Using public sector source 0.705 0.042 252 113 1.445 0.059 0.621 0.788 Want no more children 0.156 0.029 860 378 2.328 0.185 0.098 0.214 Want to delay next birth at least 2 years 0.283 0.021 860 378 1.335 0.072 0.242 0.324 Ideal number of children 6.158 0.086 716 303 1.214 0.014 5.986 6.330 Mothers received antenatal care for last birth 0.669 0.030 549 249 1.498 0.045 0.609 0.729 Mothers protected against tetanus for last birth 0.570 0.040 549 249 1.913 0.071 0.489 0.651 Births with skilled attendant at delivery 0.607 0.077 756 345 3.550 0.127 0.453 0.762 Had diarrhea in the last 2 weeks 0.253 0.019 718 329 1.116 0.075 0.215 0.291 Treated with ORS 0.646 0.068 200 83 1.787 0.105 0.510 0.782 Sought medical treatment for diarrhea 0.571 0.068 200 83 1.734 0.120 0.434 0.708 Vaccination card seen 0.910 0.045 137 67 1.916 0.050 0.819 1.000 Received BCG vaccination 0.905 0.037 137 67 1.522 0.041 0.831 0.978 Received Pentavalent vaccination (3 doses) 0.776 0.065 137 67 1.891 0.084 0.646 0.906 Received polio vaccination (3 doses) 0.796 0.066 137 67 1.994 0.083 0.664 0.929 Received measles vaccination 0.824 0.057 137 67 1.816 0.069 0.710 0.938 Received all vaccinations 0.714 0.060 137 67 1.611 0.084 0.594 0.834 Had an HIV test and received results in past 12 months 0.000 0.000 870 382 na na na na Accepting attitudes towards people with HIV 0.116 0.025 318 125 1.382 0.215 0.066 0.165 Ever experienced any physical violence since age 15 0.871 0.024 652 277 1.791 0.027 0.824 0.918 Ever experienced any physical/sexual violence by any husband 0.866 0.022 652 277 1.611 0.025 0.823 0.909 Physical/sexual violence in the last 12 months by any husband 0.841 0.021 652 277 1.452 0.025 0.799 0.883 Total fertility rate (last 3 years) 4.169 0.352 3637 1526 1.224 0.085 3.464 4.874 Neonatal mortality (last 0-9 years) 34 8.663 1552 716 1.688 0.254 16.789 51.440 Post-neonatal mortality (last 0-9 years) 20 5.180 1571 729 1.451 0.256 9.862 30.582 Infant mortality (last 0-9 years) 54 10.466 1553 717 1.712 0.193 33.404 75.270 Child mortality (last 0-9 years) 14 5.198 1591 731 1.697 0.369 3.678 24.470 Under-five mortality (last 0-9 years) 68 13.619 1562 721 1.954 0.201 40.407 94.884 MEN Urban residence 0.016 0.002 418 171 0.265 0.101 0.013 0.019 Literacy 0.584 0.036 418 171 1.510 0.062 0.511 0.657 No education 0.494 0.042 418 171 1.718 0.085 0.409 0.578 Secondary or higher education 0.389 0.045 418 171 1.865 0.115 0.300 0.479 Never married (in union) 0.445 0.060 742 309 0.936 0.134 0.325 0.565 Currently married (in union) 0.549 0.060 742 309 0.947 0.109 0.429 0.669 Had first sexual intercourse before age 18 0.050 0.013 549 227 1.407 0.262 0.024 0.077 Knows any contraceptive method 0.655 0.028 413 170 1.211 0.043 0.598 0.712 Knows any modern contraceptive method 0.655 0.028 413 170 1.211 0.043 0.598 0.712 Want no more children 0.190 0.036 413 170 1.861 0.190 0.118 0.262 Want to delay birth at least 2 years 0.319 0.022 413 170 0.977 0.070 0.274 0.364 Ideal number of children 6.432 0.212 310 128 1.700 0.033 6.009 6.855 Had HIV test and received results in past 12 months 0.008 0.008 418 171 1.699 0.916 0.000 0.023 Accepting attitudes towards people with HIV 0.055 0.020 177 68 1.167 0.367 0.015 0.095 na = Not applicable Appendix B • 329 Table B.9 Sampling errors: Logar sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.013 0.001 915 472 0.220 0.062 0.012 0.015 Literacy 0.250 0.029 915 472 2.054 0.118 0.191 0.309 No education 0.724 0.031 915 472 2.087 0.043 0.662 0.786 Secondary or higher education 0.154 0.023 915 472 1.932 0.150 0.107 0.200 Never married (never in union) 0.072 0.005 1454 731 1.477 0.063 0.063 0.081 Currently married (in union) 0.636 0.058 1454 731 1.352 0.091 0.520 0.753 Married before age 20 0.362 0.021 1103 557 1.477 0.058 0.320 0.404 Had sexual intercourse before age 18 0.125 0.012 1103 557 1.237 0.098 0.100 0.149 Currently pregnant 0.165 0.019 1454 731 1.295 0.115 0.127 0.202 Children ever born 3.159 0.331 1454 731 1.409 0.105 2.498 3.821 Children surviving 3.064 0.327 1454 731 1.437 0.107 2.409 3.718 Children ever born to women age 40-49 7.091 0.169 280 144 1.242 0.024 6.753 7.429 Know any contraceptive method 0.976 0.013 901 465 2.517 0.013 0.951 1.002 Know a mordern method 0.968 0.013 901 465 2.177 0.013 0.942 0.993 Currently using any method 0.328 0.020 901 465 1.287 0.061 0.287 0.368 Currently using a modern method 0.247 0.017 901 465 1.159 0.067 0.214 0.281 Currently using pill 0.058 0.008 901 465 1.084 0.146 0.041 0.075 Currently using IUD 0.061 0.009 901 465 1.119 0.147 0.043 0.079 Currently using condoms 0.044 0.007 901 465 0.956 0.148 0.031 0.057 Currently using injectables 0.077 0.008 901 465 0.859 0.099 0.062 0.092 Currently using implants 0.000 0.000 901 465 0.333 1.001 0.000 0.000 Currently using female sterilization 0.005 0.003 901 465 1.127 0.546 0.000 0.010 Using public sector source 0.717 0.029 230 114 0.977 0.041 0.659 0.775 Want no more children 0.362 0.018 901 465 1.144 0.051 0.325 0.398 Want to delay next birth at least 2 years 0.285 0.024 901 465 1.607 0.085 0.236 0.333 Ideal number of children 5.940 0.098 915 472 1.583 0.016 5.744 6.135 Mothers received antenatal care for last birth 0.744 0.026 533 276 1.359 0.034 0.693 0.796 Mothers protected against tetanus for last birth 0.686 0.043 533 276 2.158 0.063 0.599 0.773 Births with skilled attendant at delivery 0.696 0.037 846 439 1.871 0.054 0.622 0.771 Had diarrhea in the last 2 weeks 0.230 0.019 804 417 1.203 0.081 0.193 0.267 Treated with ORS 0.839 0.038 178 96 1.340 0.045 0.763 0.915 Sought medical treatment for diarrhea 0.415 0.052 178 96 1.380 0.124 0.312 0.518 Vaccination card seen 0.426 0.061 98 46 1.157 0.143 0.304 0.548 Received BCG vaccination 0.791 0.056 98 46 1.300 0.071 0.679 0.903 Received Pentavalent vaccination (3 doses) 0.415 0.060 98 46 1.129 0.145 0.295 0.535 Received polio vaccination (3 doses) 0.654 0.055 98 46 1.065 0.084 0.544 0.764 Received measles vaccination 0.465 0.061 98 46 1.135 0.131 0.343 0.587 Received all vaccinations 0.344 0.055 98 46 1.098 0.161 0.233 0.455 Had an HIV test and received results in past 12 months 0.000 0.000 915 472 na na na na Accepting attitudes towards people with HIV 0.039 0.011 582 312 1.396 0.287 0.017 0.062 Ever experienced any physical violence since age 15 0.835 0.022 734 354 1.630 0.027 0.790 0.880 Ever experienced any physical/sexual violence by any husband 0.809 0.022 734 354 1.520 0.027 0.765 0.854 Physical/sexual violence in the last 12 months by any husband 0.759 0.022 734 354 1.364 0.028 0.716 0.802 Total fertility rate (last 3 years) 4.150 0.238 4363 2192 1.414 0.057 3.675 4.626 Neonatal mortality (last 0-9 years) 7 1.584 2108 1092 0.894 0.235 3.576 9.911 Post-neonatal mortality (last 0-9 years) 21 3.447 2112 1092 1.052 0.165 13.979 27.768 Infant mortality (last 0-9 years) 28 3.571 2109 1092 0.945 0.129 20.475 34.758 Child mortality (last 0-9 years) 7 1.978 2219 1151 0.864 0.264 3.526 11.437 Under-five mortality (last 0-9 years) 35 3.428 2112 1094 0.778 0.098 28.036 41.746 MEN Urban residence 0.010 0.001 404 204 0.295 0.148 0.007 0.013 Literacy 0.607 0.032 404 204 1.327 0.053 0.542 0.671 No education 0.356 0.035 404 204 1.471 0.099 0.286 0.427 Secondary or higher education 0.498 0.037 404 204 1.500 0.075 0.423 0.572 Never married (in union) 0.219 0.059 514 261 1.237 0.269 0.101 0.338 Currently married (in union) 0.776 0.059 514 261 1.234 0.076 0.659 0.894 Had first sexual intercourse before age 18 0.045 0.011 478 241 1.204 0.248 0.023 0.067 Knows any contraceptive method 0.946 0.013 402 203 1.193 0.014 0.919 0.973 Knows any modern contraceptive method 0.919 0.016 402 203 1.177 0.017 0.887 0.951 Want no more children 0.271 0.022 402 203 0.991 0.081 0.227 0.315 Want to delay birth at least 2 years 0.404 0.028 402 203 1.125 0.068 0.348 0.459 Ideal number of children 6.690 0.174 397 201 1.288 0.026 6.341 7.038 Had HIV test and received results in past 12 months 0.099 0.022 404 204 1.457 0.219 0.056 0.143 Accepting attitudes towards people with HIV 0.011 0.006 261 132 0.958 0.565 0.000 0.023 na = Not applicable 330 • Appendix B Table B.10 Sampling errors: Nangarhar sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.288 0.029 1023 794 2.037 0.100 0.230 0.346 Literacy 0.112 0.014 1023 794 1.438 0.127 0.084 0.140 No education 0.846 0.018 1023 794 1.591 0.021 0.810 0.882 Secondary or higher education 0.066 0.010 1023 794 1.262 0.148 0.046 0.086 Never married (never in union) 0.297 0.027 1643 1246 1.134 0.091 0.243 0.352 Currently married (in union) 0.617 0.037 1643 1246 1.047 0.060 0.543 0.691 Married before age 20 0.602 0.014 1149 891 1.105 0.023 0.575 0.630 Had sexual intercourse before age 18 0.405 0.022 1149 891 1.602 0.055 0.361 0.450 Currently pregnant 0.112 0.012 1643 1246 1.258 0.111 0.087 0.137 Children ever born 2.911 0.190 1643 1246 0.996 0.065 2.530 3.292 Children surviving 2.700 0.177 1643 1246 0.994 0.065 2.347 3.053 Children ever born to women age 40-49 8.155 0.249 189 143 1.319 0.031 7.657 8.653 Know any contraceptive method 0.992 0.006 995 769 2.022 0.006 0.981 1.003 Know a mordern method 0.972 0.023 995 769 4.257 0.023 0.927 1.017 Currently using any method 0.214 0.022 995 769 1.696 0.103 0.169 0.258 Currently using a modern method 0.133 0.018 995 769 1.671 0.135 0.097 0.169 Currently using pill 0.034 0.006 995 769 0.972 0.163 0.023 0.046 Currently using IUD 0.011 0.003 995 769 0.834 0.250 0.006 0.017 Currently using condoms 0.017 0.005 995 769 1.101 0.263 0.008 0.026 Currently using injectables 0.041 0.008 995 769 1.306 0.200 0.025 0.057 Currently using implants 0.001 0.001 995 769 1.199 0.986 0.000 0.004 Currently using female sterilization 0.011 0.004 995 769 1.185 0.350 0.003 0.019 Using public sector source 0.337 0.061 116 90 1.372 0.180 0.216 0.459 Want no more children 0.244 0.022 995 769 1.649 0.092 0.199 0.289 Want to delay next birth at least 2 years 0.234 0.024 995 769 1.767 0.101 0.187 0.282 Ideal number of children 5.789 0.185 415 325 1.467 0.032 5.418 6.160 Mothers received antenatal care for last birth 0.772 0.031 750 576 2.008 0.040 0.709 0.834 Mothers protected against tetanus for last birth 0.609 0.033 750 576 1.824 0.054 0.543 0.675 Births with skilled attendant at delivery 0.663 0.044 1361 1028 2.624 0.066 0.575 0.751 Had diarrhea in the last 2 weeks 0.423 0.022 1293 972 1.510 0.052 0.379 0.468 Treated with ORS 0.632 0.033 559 411 1.399 0.051 0.567 0.697 Sought medical treatment for diarrhea 0.632 0.033 559 411 1.359 0.052 0.567 0.698 Vaccination card seen 0.726 0.043 258 193 1.487 0.059 0.640 0.811 Received BCG vaccination 0.883 0.027 258 193 1.303 0.031 0.828 0.938 Received Pentavalent vaccination (3 doses) 0.779 0.030 258 193 1.121 0.039 0.719 0.839 Received polio vaccination (3 doses) 0.886 0.022 258 193 1.063 0.025 0.842 0.931 Received measles vaccination 0.698 0.044 258 193 1.479 0.063 0.611 0.786 Received all vaccinations 0.650 0.043 258 193 1.390 0.066 0.565 0.736 Had an HIV test and received results in past 12 months 0.000 0.000 1023 794 na na na na Accepting attitudes towards people with HIV 0.037 0.009 236 186 0.767 0.256 0.018 0.056 Ever experienced any physical violence since age 15 0.641 0.024 699 569 1.299 0.037 0.594 0.689 Ever experienced any physical/sexual violence by any husband 0.562 0.029 699 569 1.525 0.051 0.505 0.620 Physical/sexual violence in the last 12 months by any husband 0.505 0.027 699 569 1.449 0.054 0.450 0.560 Total fertility rate (last 3 years) 6.355 0.396 4414 3372 1.456 0.062 5.563 7.147 Neonatal mortality (last 0-9 years) 29 4.421 2627 1982 1.098 0.152 20.258 37.942 Post-neonatal mortality (last 0-9 years) 22 4.225 2641 1995 1.408 0.196 13.139 30.039 Infant mortality (last 0-9 years) 51 7.193 2629 1984 1.394 0.142 36.302 65.076 Child mortality (last 0-9 years) 14 3.789 2568 1942 1.379 0.277 6.094 21.25 Under-five mortality (last 0-9 years) 64 8.652 2634 1988 1.447 0.136 46.363 80.973 MEN Urban residence 0.271 0.038 353 273 1.619 0.142 0.194 0.348 Literacy 0.606 0.032 353 273 1.240 0.053 0.541 0.670 No education 0.385 0.030 353 273 1.169 0.079 0.324 0.445 Secondary or higher education 0.440 0.037 353 273 1.384 0.083 0.366 0.513 Never married (in union) 0.321 0.058 515 402 1.177 0.182 0.204 0.437 Currently married (in union) 0.678 0.058 515 402 1.174 0.086 0.562 0.794 Had first sexual intercourse before age 18 0.101 0.017 464 347 1.191 0.164 0.068 0.134 Knows any contraceptive method 0.898 0.024 352 272 1.478 0.027 0.850 0.946 Knows any modern contraceptive method 0.898 0.024 352 272 1.478 0.027 0.850 0.946 Want no more children 0.150 0.019 352 272 0.993 0.126 0.112 0.188 Want to delay birth at least 2 years 0.345 0.023 352 272 0.903 0.066 0.299 0.391 Ideal number of children 7.698 0.234 210 173 1.013 0.030 7.230 8.167 Had HIV test and received results in past 12 months 0.011 0.006 353 273 1.063 0.544 0.000 0.022 Accepting attitudes towards people with HIV 0.060 0.015 223 174 0.913 0.242 0.031 0.089 na = Not applicable Appendix B • 331 Table B.11 Sampling errors: Laghman sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.031 0.006 800 583 1.059 0.210 0.018 0.044 Literacy 0.071 0.011 800 583 1.201 0.154 0.049 0.092 No education 0.922 0.021 800 583 2.193 0.023 0.881 0.964 Secondary or higher education 0.028 0.008 800 583 1.286 0.266 0.013 0.044 Never married (never in union) 0.511 0.088 1070 805 1.359 0.172 0.335 0.687 Currently married (in union) 0.704 0.040 1070 805 1.487 0.057 0.624 0.785 Married before age 20 0.602 0.028 838 604 1.850 0.047 0.546 0.658 Had sexual intercourse before age 18 0.342 0.021 838 604 1.343 0.063 0.299 0.384 Currently pregnant 0.192 0.011 1070 805 0.837 0.059 0.169 0.214 Children ever born 3.542 0.286 1070 805 1.580 0.081 2.971 4.113 Children surviving 3.276 0.269 1070 805 1.609 0.082 2.738 3.813 Children ever born to women age 40-49 7.894 0.413 191 140 1.954 0.052 7.069 8.719 Know any contraceptive method 0.996 0.002 780 567 1.033 0.002 0.992 1.001 Know a mordern method 0.995 0.003 780 567 0.985 0.003 0.990 1.000 Currently using any method 0.144 0.022 780 567 1.767 0.154 0.100 0.189 Currently using a modern method 0.136 0.019 780 567 1.531 0.139 0.098 0.173 Currently using pill 0.062 0.014 780 567 1.625 0.227 0.034 0.090 Currently using IUD 0.006 0.003 780 567 0.974 0.455 0.001 0.011 Currently using condoms 0.022 0.005 780 567 0.989 0.235 0.012 0.033 Currently using injectables 0.032 0.007 780 567 1.162 0.230 0.017 0.046 Currently using implants 0.000 0.000 780 567 na na na na Currently using female sterilization 0.014 0.005 780 567 1.216 0.366 0.004 0.024 Using public sector source 0.372 0.047 107 77 0.998 0.126 0.278 0.465 Want no more children 0.240 0.022 780 567 1.468 0.094 0.195 0.285 Want to delay next birth at least 2 years 0.295 0.019 780 567 1.139 0.063 0.258 0.333 Ideal number of children 7.004 0.140 649 465 1.575 0.020 6.725 7.284 Mothers received antenatal care for last birth 0.754 0.047 584 428 2.631 0.062 0.660 0.847 Mothers protected against tetanus for last birth 0.679 0.029 584 428 1.500 0.043 0.621 0.737 Births with skilled attendant at delivery 0.622 0.074 1101 809 3.645 0.119 0.474 0.769 Had diarrhea in the last 2 weeks 0.340 0.021 1051 770 1.312 0.063 0.297 0.383 Treated with ORS 0.771 0.030 386 262 1.215 0.038 0.712 0.830 Sought medical treatment for diarrhea 0.819 0.034 386 262 1.437 0.041 0.751 0.886 Vaccination card seen 0.611 0.046 172 128 1.236 0.075 0.519 0.702 Received BCG vaccination 0.936 0.018 172 128 0.976 0.019 0.899 0.972 Received Pentavalent vaccination (3 doses) 0.649 0.054 172 128 1.488 0.084 0.540 0.758 Received polio vaccination (3 doses) 0.706 0.049 172 128 1.397 0.069 0.608 0.804 Received measles vaccination 0.726 0.033 172 128 0.977 0.046 0.659 0.793 Received all vaccinations 0.548 0.048 172 128 1.257 0.087 0.452 0.643 Had an HIV test and received results in past 12 months 0.002 0.002 800 583 1.194 0.911 0.000 0.006 Accepting attitudes towards people with HIV 0.001 0.001 404 272 0.779 1.031 0.000 0.004 Ever experienced any physical violence since age 15 0.612 0.064 575 437 3.108 0.104 0.484 0.739 Ever experienced any physical/sexual violence by any husband 0.598 0.061 575 437 2.977 0.103 0.475 0.721 Physical/sexual violence in the last 12 months by any husband 0.531 0.055 575 437 2.629 0.104 0.421 0.641 Total fertility rate (last 3 years) 7.307 0.341 3015 2199 1.355 0.047 6.626 7.988 Neonatal mortality (last 0-9 years) 32 8.009 2151 1574 1.663 0.253 15.676 47.713 Post-neonatal mortality (last 0-9 years) 13 2.874 2156 1577 0.994 0.218 7.454 18.95 Infant mortality (last 0-9 years) 45 7.13 2154 1577 1.244 0.159 30.636 59.157 Child mortality (last 0-9 years) 12 2.834 2138 1579 0.978 0.246 5.842 17.177 Under-five mortality (last 0-9 years) 56 6.86 2158 1581 1.164 0.123 42.17 69.608 MEN Urban residence 0.029 0.006 334 227 0.606 0.191 0.018 0.041 Literacy 0.478 0.063 334 227 2.278 0.131 0.353 0.604 No education 0.516 0.068 334 227 2.476 0.132 0.380 0.653 Secondary or higher education 0.294 0.062 334 227 2.471 0.212 0.169 0.418 Never married (in union) 0.419 0.054 581 390 1.029 0.130 0.310 0.527 Currently married (in union) 0.580 0.054 581 390 1.025 0.093 0.472 0.687 Had first sexual intercourse before age 18 0.078 0.016 466 314 1.227 0.201 0.046 0.109 Knows any contraceptive method 0.997 0.003 333 226 1.031 0.003 0.990 1.003 Knows any modern contraceptive method 0.997 0.003 333 226 1.031 0.003 0.990 1.003 Want no more children 0.157 0.029 333 226 1.462 0.186 0.098 0.215 Want to delay birth at least 2 years 0.325 0.030 333 226 1.182 0.094 0.264 0.386 Ideal number of children 7.393 0.175 276 190 1.186 0.024 7.043 7.744 Had HIV test and received results in past 12 months 0.000 0.000 334 227 na na na na Accepting attitudes towards people with HIV 0.015 0.011 257 172 1.510 0.775 0.000 0.037 na = Not applicable 332 • Appendix B Table B.12 Sampling errors: Panjsher sample, Afghanistan DHS 2015 Variable Value ( R ) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Unweighted (N) Weighted (WN) (R-2SE) (R+2SE) WOMEN Urban residence 0.000 0.000 681 54 na na na na Literacy 0.211 0.031 681 54 1.956 0.145 0.150 0.273 No education 0.824 0.024 681 54 1.660 0.029 0.775 0.872 Secondary or higher education 0.107 0.016 681 54 1.349 0.150 0.075 0.139 Never married (never in union) 0.078 0.004 1168 91 0.926 0.048 0.071 0.086 Currently married (in union) 0.581 0.035 1168 91 0.797 0.060 0.511 0.651 Married before age 20 0.480 0.019 949 75 1.086 0.039 0.443 0.518 Had sexual intercourse before age 18 0.291 0.016 949 75 1.011 0.054 0.260 0.323 Currently pregnant 0.119 0.014 1168 91 1.111 0.116 0.091 0.147 Children ever born 3.002 0.215 1168 91 0.851 0.072 2.572 3.433 Children surviving 2.899 0.207 1168 91 0.849 0.072 2.484 3.314 Children ever born to women age 40-49 7.019 0.153 248 20 1.057 0.022 6.712 7.325 Know any contraceptive method 0.686 0.023 665 53 1.303 0.034 0.639 0.733 Know a mordern method 0.686 0.023 665 53 1.303 0.034 0.639 0.733 Currently using any method 0.122 0.018 665 53 1.452 0.151 0.085 0.159 Currently using a modern method 0.116 0.018 665 53 1.472 0.158 0.080 0.153 Currently using pill 0.025 0.007 665 53 1.075 0.261 0.012 0.038 Currently using IUD 0.014 0.006 665 53 1.237 0.407 0.003 0.025 Currently using condoms 0.013 0.005 665 53 1.102 0.377 0.003 0.022 Currently using injectables 0.048 0.010 665 53 1.213 0.210 0.028 0.068 Currently using implants 0.002 0.001 665 53 0.775 0.730 0.000 0.004 Currently using female sterilization 0.011 0.004 665 53 0.930 0.347 0.003 0.018 Using public sector source 0.875 0.032 83 6 0.882 0.037 0.811 0.939 Want no more children 0.187 0.022 665 53 1.462 0.119 0.142 0.231 Want to delay next birth at least 2 years 0.177 0.021 665 53 1.393 0.117 0.136 0.219 Ideal number of children 6.584 0.156 618 49 1.650 0.024 6.271 6.897 Mothers received antenatal care for last birth 0.694 0.038 320 26 1.484 0.055 0.618 0.770 Mothers protected against tetanus for last birth 0.546 0.040 320 26 1.449 0.074 0.466 0.627 Births with skilled attendant at delivery 0.648 0.055 480 40 1.998 0.085 0.538 0.758 Had diarrhea in the last 2 weeks 0.030 0.009 471 39 1.221 0.310 0.011 0.049 Treated with ORS 0.901 0.078 13 1 0.999 0.086 0.746 1.057 Sought medical treatment for diarrhea 0.700 0.111 13 1 0.92