From antenatal contact to facility-based delivery: a provincial analysis of dropout along the maternal continuum of care in Afghanistan using the 2022-23 MICS.

BACKGROUND

Although 77.7% of ever-married women with a recent live birth in Afghanistan attended at least one antenatal care (ANC) contact, 74.5% of ANC-attending women delivered in a health facility. Provincial variation in this transition remains poorly characterised.

OBJECTIVE

To examine associations of ANC contact frequency and measured clinical content with facility-based delivery and to characterise provincial patterns of continuity.

METHODS

We analysed the Afghanistan Multiple Indicator Cluster Survey 2022-23. The cohort included 9,268 ANC-attending ever-married women aged 15-49 years. Survey-weighted logistic regression examined ANC contact frequency (1-3, 4-7, ≥8) and a three-item measured clinical-content score (0-3). Province-specific ANC 4+ coverage and facility-based delivery were also examined.

RESULTS

Facility-based delivery was 74.5%. Compared with 1-3 contacts, adjusted odds were higher with 4-7 contacts (adjusted odds ratio 1.49; 95% confidence interval 1.25-1.77) and ≥8 contacts (adjusted odds ratio 1.93; 95% confidence interval 1.45-2.57), corresponding to adjusted probability differences of 6.5 and 10.3% points. For measured clinical content, a score of 3 versus 0 was associated with a 4.6-point higher adjusted probability, while intermediate scores showed no clear gradient. Provincial facility-based delivery ranged from 16.8% to 93.3%, with substantial heterogeneity in joint ANC and delivery patterns.

CONCLUSIONS

Among women who had initiated ANC, approximately one quarter delivered outside a health facility. Greater ANC contact frequency was consistently associated with facility-based delivery, while marked provincial variation highlights the importance of continuity between antenatal and childbirth care.