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.
- 1Department of Management Science, University of Strathclyde, Glasgow, UK.
- 2Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Abstract
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.
Related
- Antenatal care, birth outcomes, health, development, maternal bonding and nutrition among children of women seeking abortion in a health facility in Nepal (2019-2024): a prospective cohort study.
- Factors associated with actual mode of delivery among women attending antenatal education at a university hospital in Türkiye: a retrospective observational study
- Interpretation of the ERAS Society's "Guidelines for antenatal and postoperative care in cesarean delivery:2025 update"
- Early antenatal care initiation and associated factors in Hohoe Municipality, Ghana: A five-year multi-facility repeated cross-sectional record review study
- Determinants of institutional delivery in Afghanistan: evidence from the 2022/2023 Multiple Indicator Cluster Survey (MICS).
BibTeX
@article{ranjan2026from,
title = {{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.}},
author = {Rajeev Ranjan and Palwasha Anwari and Abigail Colson and Robert van der Meer},
journal = {Global health action},
year = {2026},
month = oct,
doi = {10.1080/16549716.2026.2750043},
url = {https://europepmc.org/article/MED/42897985},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Rajeev Ranjan
AU - Palwasha Anwari
AU - Abigail Colson
AU - Robert van der Meer
PY - 2026
DA - 2026/10/20
JO - Global health action
DO - 10.1080/16549716.2026.2750043
UR - https://europepmc.org/article/MED/42897985
AB - 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.
SN - 1654-9716
SN - 1654-9880
ER -