Determinants of Institutional Delivery in Afghanistan: A Secondary Analysis of Multi Indicator Cluster Surevey(MICS) 2022 and 2023 Data

Determinants of Institutional Delivery in Afghanistan: A Secondary Analysis of Multi Indicator Cluster Surevey(MICS) 2022 and 2023 Data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Institutional Delivery in Afghanistan: A Secondary Analysis of Multi Indicator Cluster Surevey(MICS) 2022 and 2023 Data Humayoon Gardiwal, Ataullah Saeedzai Saeedzai, Ferozuddin Feroz Feroz, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5008241/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Maternal mortality remains a critical public health issue in Afghanistan, with the country exhibiting one of the highest maternal mortality ratios (MMR) globally. Delivery of a baby within an institution is a vital indicator of maternal and newborn health. This study explored the association between institutional delivery and various socioeconomic factors, particularly maternal education, using data from the Multi-Indicator Cluster Survey (MICS) 2022 and 2023. We analyzed data from over 12578 women of childbearing age to determine the influence of education, economic status, and geographic location on institutional delivery rates. Our findings indicate that higher maternal education and better economic conditions significantly increase the likelihood of institutional delivery, whereas rural residency and lower socioeconomic status remain substantial barriers. This study underscores the need for targeted interventions to address educational disparities and economic inequalities to improve maternal and child health outcomes in Afghanistan. This study provides critical insights for policymakers and public health professionals aiming to reduce the MMR in Afghanistan by promoting education and socioeconomic development. Institutional Delivery Maternal Mortality Maternal Education Socioeconomic Factors Afghanistan MICS (Multi-Indicator Cluster Survey) Cultural Determinants INTRODUCTION Global and Local Context Maternal mortality, particularly in low- and middle-income countries (LMICs), remains a significant global health challenge. 1 The World Health Organization (WHO) estimates that approximately 95% of maternal deaths occur in LMICs, with sub-Saharan Africa and South Asia bearing the highest burden. 2 Despite global efforts and a 34% reduction in maternal mortality between 2000 and 2020, Afghanistan continues to have one of the highest maternal mortality ratios in the world. 3 , 4 The maternal mortality ratio (MMR) in Afghanistan has decreased from 1346 per 100,000 live births in 2000 to an estimated 620 per 100,000 in 2023, mainly due to the implementation of the Basic Package of Health Services (BPHS). 3 , 5 However, this progress is insufficient to meet the Sustainable Development Goal (SDG) target of reducing global MMR to less than 70 per 100,000 live births by 2030. 3 , 6 Rationale and Significance Education is a powerful determinant of health, particularly maternal health. 7 , 8 Studies have shown that women with higher education levels are more likely to seek and utilize healthcare services, including institutional delivery, which significantly reduces the risk of maternal and neonatal mortality. 9 , 10 In Afghanistan, where female literacy rates are low, understanding the impact of education on maternal health is crucial for designing effective public health interventions. Furthermore, the socioeconomic divide between urban and rural areas exacerbates health disparities. 7 Rural women, who are often less educated and economically disadvantaged, face significant barriers to accessing healthcare services, leading to higher rates of home deliveries and maternal mortality. 5 , 7 This study provides a comprehensive analysis of the factors influencing institutional delivery in Afghanistan focusing on maternal education, economic status, and area of residence. By exploring these determinants, this study seeks to inform policies and programs to address health disparities and improve maternal health outcomes in Afghanistan. METHODS Study Design Utilizing the 2022/23 MICS survey data in Afghanistan, we conducted a secondary analysis focusing on institutional and home delivery as an outcome. Multi-indicator cluster survey 2022/23 methodology The MICS Afghanistan 2022/23 survey was conducted by the United Nations Children’s Fund (UNICEF) in collaboration with the National Statistics and Information Authority (NSIA) (UNICEF, 2023). 9 Oversight was provided by a technical committee comprising MICS Head Quarter, UNICEF regional office teams, and staff from the UNICEF Afghanistan country office. The sample design aimed to provide estimates for various indicators at the national, urban-rural, and provincial levels. Using a two-stage sampling approach based on the 2019 Satellite Imagery frame, primary sampling units (enumeration areas) were systematically selected, resulting in a sample size of 23,568 households across 982 enumeration areas. A two-stage cluster sampling method was used for each province, and Afghanistan was divided into 34 provinces. Security issues prevented visits to the 10 selected enumeration areas. The non-self-weighting sample necessitated the use of sample weights to report results. Four questionnaires were employed by UNICEF and NSIA, covering the household demographics of individual women (15–49 years), children under 5 years, and children aged 5–17 years old (UNICEF, 2023). 9 Dependent Variable Place of delivery (Health facility vs. home delivery) . Independent Variables Maternal education (no education, primary, lower secondary, upper secondary, higher) , economic status (wealth quintiles) , area of residence (urban vs. rural) , and the language spoken by the household head. Analysis Plan Quantitative data analysis was conducted using the STATA software. Proportions are presented for categorical variables, whereas means and standard deviations are reported for continuous data. A logistic regression was performed to assess the association between independent predictors and institutional delivery, adjusting for the survey design effect. A univariate approach was first applied to each predictor with the outcome variable, and then variables with a p-value less than 0.25 were included in the multivariate analysis. The final model fitted using forward procedures and the variables were retained variables with a p-value of ≤ 0.05. All the results were adjusted for survey design, including weighting and clustering effects. RESULTS Descriptive Analysis Table 1 shows the overall percentages of births that took place in a health facility versus at home, along with confidence intervals. Overall, 66.3% of the women delivered at a health facility, while 33.7% delivered at home ( Table 1 ) . Table 1 Coverage of Institutional Delivery in Afghanistan 2022/23:This table shows the overall percentages of births that took place in a health facility versus at home, along with confidence intervals. Delivery Type Proportion Confidence Interval Lower Bound Upper Bound Institutional Delivery Home Delivery 66.33% 64.51% 68.09% 33.67% 31.91% 35.49% The sample size for this analysis included 12,587 women of childbearing age who had given birth in the past two years. Of these, 15.4% were from urban areas (N = 1,934), while 84.6% were from rural areas (N = 10,644). The average age of the women was 28.6 years. In terms of language, 34.66% were Dari-speaking (N = 4,360), 50.29% were Pashto-speaking (N = 6,326), 7% were Uzbeki-speaking (N = 884), 1.56% were Turkmani-speaking (N = 196), 2.67% were Nuristani-speaking (N = 336), 0.72% were Balochi-speaking (N = 91), and 2.59% were Pashaie-speaking (N = 326), while 0.47% spoke other languages (N = 59). Regarding education among the heads of households, 64.56% had pre-primary education (N = 8,120), 10.93% had primary education (N = 1,375), 6.15% had lower secondary education (N = 774), and 5.02% had upper secondary education (N = 322). Additionally, 7.8% had higher education (N = 981). Among the women, 80.39% had pre-primary education (N = 10,111), 8.42% had primary education (N = 1,059), 3.62% had lower secondary education (N = 455), and 5.02% had upper secondary education, while 2.56% had higher education (N = 322). In terms of the wealth index, 22.21% were in the poorest quintile (N = 2,793), 23.26% were in the second quintile (N = 2,926), 22.75% were in the middle quintile (N = 2,861), 18.73% were in the fourth quintile (N = 2,356), and 13.02% were in the richest quintile (N = 1,642). Table 2 provides a detailed breakdown of the demographic and socioeconomic characteristics of the households and women included in the MICS 2023 survey in Afghanistan. Table 2 Characteristics of households and women in MICS 2023 (N = 12587), Afghanistan Characteristics of households, mothers n % (Sample) % (Population)* Head of Household Language Dari 4,360 34.66 40.2 Pashto 6,326 50.29 48.2 Uzbeki 884 7.03 7.6 Turkmani 196 1.56 1.5 Nooristani 336 2.67 0.5 Balochi 91 0.72 0.4 Pashaie 326 2.59 1.3 Other Languages 59 0.47 0.3 Education of household head Pre-primary/ECE or none 8,120 64.56 61.9 Primary 1,375 10.93 12.9 Lower Secondary 774 6.15 6.9 Upper Secondary 1,303 10.36 10.3 Higher 981 7.8 7.8 Don't know/Missing 25 0.2 0.2 Mother's Education Pre-primary/ECE or none 10,111 80.39 76.2 Primary 1,059 8.42 10.3 Lower Secondary 455 3.62 4.6 Upper Secondary 631 5.02 5.8 Higher 322 2.56 3.2 Mean number of members in a household 12,578 10.85 10.39 Wealth index quintile Poorest 2,793 22.21 20.9 Second 2,926 23.26 20.8 Middle 2,861 22.75 20.5 Fourth 2,356 18.73 19.7 Richest 1,642 13.05 18.2 Living area Urban 1,934 15.4 23.1 Rural 10,644 84.6 76.9 Mean women age 12,578 28.6 28.4 %* Weighted percentage The logistic regression analysis results provide important insights into the determinants of institutional delivery in Afghanistan. Language of the Household Head The language spoken by the household head was significantly associated with the likelihood of institutional delivery, as indicated by the Odds Ratios (ORs). For example, Nooristani-speaking households had significantly higher odds of not having institutional deliveries, with an adjusted OR of 7.54 (95% CI: 3.03, 18.74; p < 0.001), compared to women from Dari-speaking households. Conversely, Pashto-speaking households were associated with a higher likelihood of institutional deliveries, as shown by an adjusted OR of 0.79 (95% CI: 0.65, 0.95; p = 0.014). ( Tables 3 and 4 ) Women’s Education Education level was a strong determinant of institutional delivery. Women with higher education levels were significantly more likely to deliver in a health facility. For example, women with higher education were 0.14 times less likely (95% CI: 0.07, 0.31; p < 0.001) to deliver at home compared to women with no formal education. ( Tables 3 and 4 ) Economic and Rural/Urban Status Economic status also played a critical role. Women from the richest households were 0.09 times less likely (95% CI: 0.07, 0.13; p < 0.001) to have a home delivery compared to those from the poorest households. Conversely, those in rural areas were 1.89 times more likely (95% CI: 1.40, 2.55; p < 0.001) to have a home delivery compared to urban residents. ( Tables 3 and 4 ) Table 3 presents the cross-tabulation of sociodemographic variables with institutional delivery among Afghan women aged 15–49 years based on a sample size of 12,578 This table cross-tabulates different sociodemographic variables with the place of delivery, helping to see the relationships between these factors and whether the birth took place in a health facility or at home. The p-values are derived from chi-square tests applied to all categories. Variables Category Institutional Delivery (N) Institutional Delivery (%) 95% CI Home Delivery (N) Home Delivery (%) 95% CI P-value Head of the Household Language Dari 3,444 68.5 [65.32, 71.58] 1,582 31.5 [28.42, 34.68] < 0.001 Pashto 3,929 65.2 [62.64, 67.67] 2,097 34.8 [32.33, 37.36] Uzbeki 661 69.2 [62.75, 74.97] 294 30.8 [25.03, 37.25] Turkmani 146 76.8 [64.84, 85.61] 44 23.2 [14.39, 35.16] Nooristani 11 18.3 [7.62, 37.83] 51 81.7 [62.17, 92.38] Balochi 28 61.8 [44.92, 76.17] 17 38.3 [23.83, 55.08] Pashaie 45 28.2 [19.07, 39.47] 115 71.8 [60.53, 80.93] Other Languages 31 74.3 [55.07, 87.20] 11 25.7 [12.80, 44.93] Area Urban 2,566 88.7 [85.50, 91.19] 326 11.4 [8.81, 14.50] < 0.001 Rural 5,730 59.6 [57.44, 61.74] 3,883 40.4 [38.26, 42.56] Women's Education No Education 5,829 61.2 [59.15, 63.14] 3,702 38.8 [36.86, 40.85] < 0.001 Primary 972 75.5 [71.13, 79.38] 316 24.5 [20.62, 28.87] Lower Secondary 475 83.5 [78.48, 87.54] 94 16.5 [12.46, 21.52] Upper Secondary 639 88.0 [84.05, 91.08] 87 12.0 [8.92, 15.95] Higher 381 96.7 [93.47, 98.32] 13 3.3 [1.68, 6.53] Economic Status Poorest 1,071 41.0 [37.95, 44.19] 1,539 59.0 [55.81, 62.05] < 0.001 Second 1,438 55.3 [52.11, 58.34] 1,165 44.8 [41.66, 47.89] Middle 1,720 67.2 [64.23, 70.05] 839 32.8 [29.95, 35.77] Fourth 1,952 79.4 [76.82, 81.78] 506 20.6 [18.22, 23.18] Richest 2,115 92.9 [90.70, 94.56] 162 7.1 [5.44, 9.30] Table 4 Multivariate analysis of determinants of Institutional Delivery Among Afghan Women Aged 15–49 (n = 12,578) This table provides both unadjusted and adjusted odds ratios with confidence intervals for each variable, summarizing the results of the univariate and multivariate logistic regression analyses. Variable Category Unadjusted Odds Ratio 95% CI Lower 95% CI Upper P-Value Adjusted Odds Ratio 95% CI Lower 95% CI Upper P-Value Head of the Household Language Dari 1 - - - 1 - - - Pashto 1.16 0.96 1.40 0.116 0.79 0.65 0.95 0.014 Uzbeki 0.97 0.70 1.34 0.853 0.75 0.55 1.03 0.071 Turkmani 0.66 0.36 1.20 0.173 0.58 0.31 1.08 0.087 Nooristani 9.72 3.54 26.70 < 0.001 7.54 3.03 18.74 < 0.001 Balochi 1.35 0.67 2.71 0.400 0.70 0.37 1.30 0.261 Pashaie 5.56 3.26 9.46 < 0.001 3.32 2.14 5.16 < 0.001 Other Languages 0.75 0.31 1.81 0.526 1.01 0.34 2.97 0.987 Number of Members in the Household Number 1.00 0.99 1.01 0.799 1.02 1.01 1.04 < 0.001 Women's Education No Education 1 - - - 1 - - - Primary 0.51 0.41 0.64 < 0.001 0.70 0.57 0.86 0.001 Lower Secondary 0.31 0.22 0.43 < 0.001 0.48 0.36 0.66 < 0.001 Upper Secondary 0.21 0.15 0.30 < 0.001 0.40 0.28 0.58 < 0.001 Higher 0.05 0.03 0.11 < 0.001 0.14 0.07 0.31 < 0.001 Economic Status Poorest 1.00 - - - 1.00 - - - Second 0.56 0.48 0.67 < 0.001 0.58 0.49 0.69 < 0.001 Middle 0.34 0.28 0.40 < 0.001 0.36 0.31 0.44 < 0.001 Fourth 0.18 0.15 0.22 < 0.001 0.22 0.18 0.27 < 0.001 Richest 0.05 0.04 0.07 < 0.001 0.09 0.07 0.13 < 0.001 Area Urban 1.00 - - - 1.00 - - - Rural 5.29 3.94 7.11 < 0.001 1.89 1.40 2.55 < 0.001 DISCUSSION The findings of this study have profound implications for public health policies in Afghanistan. The strong association between maternal education and institutional delivery underscores the critical need for policies prioritizing female education as a cornerstone of maternal health strategies. Research consistently demonstrates that educated women are more likely to seek and utilize healthcare services, including institutional delivery, which is vital for reducing maternal and neonatal mortality. (10,11,12) Therefore, expanding access to education for girls, particularly in rural areas, should be a top priority for the Afghan government and its international partners. The economic disparities highlighted in this study provide a strong association of poverty with home delivery. Hence, it highlights that targeted financial support and incentives, such as conditional cash transfers or maternal and neonatal gift packs for healthcare services, could significantly increase institutional delivery rates among the poorest women. 13 This is especially crucial in rural areas, where most home deliveries occur due to economic barriers such as transportation costs and the affordability of healthcare services. 13 , 14 Past interventions, such as the introduction of the Basic Package of Health Services (BPHS) and the Essential Package of Health Services (EPHS), have played a significant role in enhancing access to health facilities across Afghanistan. Still, more targeted efforts are needed to address persistent economic inequalities. 15 Cultural barriers to institutional delivery, as evidenced by the disparities in delivery rates among different linguistic and ethnic groups, must also be addressed. Public health campaigns and interventions should be culturally sensitive and tailored to the specific needs of these communities. 16 Engaging community leaders, leveraging local languages, and incorporating culturally relevant messaging in health promotion activities could enhance the effectiveness of these interventions. 17 , 18 For example, Turkmani-speaking families had the highest rates of institutional deliveries, while Nuristani-speaking families had the lowest, highlighting the need for culturally nuanced approaches to health promotion (UNICEF, 2023). 9 Future research should focus on longitudinal studies to track the impact of educational and economic interventions on maternal health outcomes. Additionally, qualitative studies exploring cultural barriers to institutional delivery in different ethnic groups would provide valuable insights for designing more effective interventions. There is also a need to examine the impact of health system-strengthening initiatives, such as the expansion of midwifery services, on maternal health outcomes. For example, community midwifery education programs, supported by various donors, have been instrumental in improving access to maternal health services in Afghanistan. 19 , 20 Evaluating the long-term impact of such programs could inform future efforts to reduce maternal mortality in Afghanistan and other LMICs. CONCLUSION This study provides an in-depth analysis of the factors influencing institutional delivery in Afghanistan, focusing on maternal education, economic status, and geographic location. It highlights the critical importance of maternal education, economic empowerment, and culturally tailored interventions to improve institutional delivery rates and consequently, maternal and child health outcomes in Afghanistan. By addressing these determinants through targeted and culturally sensitive interventions, Afghanistan can make significant progress toward achieving the Sustainable Development Goals (SDGs) related to maternal health. The findings of this study should inform public health policy and program development in Afghanistan, focusing on reducing maternal mortality and promoting equitable access to healthcare for all women, regardless of their educational level, economic status, or cultural background. Although Afghanistan has made progress in improving maternal health, significant challenges remain, particularly among rural and less-educated women. Future research should continue to explore the root causes of non-institutional deliveries and evaluate the long-term impacts of educational and economic interventions on maternal health outcomes. Continued efforts are necessary to ensure that all women in Afghanistan have access to safe institutional delivery services, ultimately reducing maternal and neonatal mortality. Declarations Data Access Statement The data utilized in this study were obtained from the Multi-Indicator Cluster Survey (MICS) 2022 and 2023, conducted by UNICEF in collaboration with the National Statistics and Information Authority (NSIA) of Afghanistan. These data are publicly available through UNICEF's MICS database ( https://mics.unicef.org/ ) and can be accessed upon request and following proper data use protocols. Ethics Statement This study is based on secondary data analysis of publicly available data from the Multi-Indicator Cluster Survey (MICS) 2022 and 2023. UNICEF obtained ethical approval for the original MICS survey, and all procedures followed adhered to ethical standards involving informed consent from all participants. The analysis conducted in this study did not involve direct contact with human subjects, and therefore, additional ethical approval was not required. Disclaimer The views expressed in this paper are those of the authors and do not necessarily reflect the official policies or positions of affiliated organizations. Competing Interests The authors declare that they have no conflicts of interest. Patient Consent for Publication Not applicable. Funding This study was conducted without any specific grants from the public, commercial, or not-for-profit sectors. Author Contribution Humayoon Gardiwal served as the Principal Investigator, leading the research, conceptualizing and designing the study, and drafting the article. Ataullah Saeedzai developed the Methods section, and conducted data analysis and result tables, Mohammad Hassan Ukasha contributed to data visualization and manuscript writing, with Dr. Ferozuddin Feroz assisting in the writing process. Jo Knight reviewed the manuscript and provided insight. The remaining authors provided additional support throughout the study. All authors have agreed to submit this manuscript. Acknowledgement We are deeply grateful to UNICEF-Afghanistan for providing access to MICS 2023 data, which made this research possible. We also acknowledge the contributions of all women who participated in the survey, whose experiences informed us of this important work. Data Availability The data set was requested from UNICEF-MICS team and they authorized the team to use the data for the this specific purpose. References Ekwuazi EK, Chigbu CO, Ngene NC. Reducing maternal mortality in low- and middle-income countries. Case Rep Womens Health. 2023;39:e00542. 10.1016/j.crwh.2023.e00542 . Maternal mortality. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality . Accessed August 11, 2024. UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Trends in maternal mortality 2000 to 2020: estimates by WHO. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO. Tharwani ZH, Kumar P, Shaeen SK, Islam Z, Essar MY, Ahmad S. Maternal mortality in Afghanistan: Challenges, efforts, and recommendations. Clin Epidemiol Global Health. 2022;15:101038. 10.1016/j.cegh.2022.101038 . Saeedzai SA, Blanchet K, Alwan A, et al. Lessons from the development process of the Afghanistan integrated package of essential health services. BMJ Global Health. 2023;8(9):e012508. 10.1136/bmjgh-2023-012508 . World Health Organization. Ending preventable maternal mortality (EPMM): a renewed focus for improving maternal and newborn health and well-being. Geneva: World Health Organization. 2021. ISBN 978-92-4-004051-9 (electronic version), 978-92-4-004052-6 (print version). Licence: CC BY-NC-SA 3.0 IGO. Rahman M, Saha P, Uddin J. Associations of antenatal care visit with utilization of institutional delivery care services in Afghanistan: intersections of education, wealth, and household decision-making autonomy. BMC Pregnancy Childbirth. 2022;22(1):255. 10.1186/s12884-022-04588-0 . Wayessa ZJ, Dukale UG. Factors associated with institutional delivery among women in Bule Hora Town, Southern Ethiopia. Midwifery. 2021;97:102968. 10.1016/j.midw.2021.102968 . United Nations Children’s Fund (UNICEF). Afghanistan Multiple Indicator Cluster Survey 2022-23, Survey Findings Report. Kabul, Afghanistan: United Nations Children’s Fund (UNICEF). Greenaway ES, Leon J, Baker DP. Understanding the association between maternal education and use of health services in Ghana: exploring the role of health knowledge. J Biosoc Sci. 2012;44(6):733–47. 10.1017/S0021932012000041 . Glass N, Jalalzai R, Spiegel P, Rubenstein L. The crisis of maternal and child health in Afghanistan. Confl Health. 2023;17(1):28. 10.1186/s13031-023-00522-z . Azimi MD, Najafizada SA, Khaing IK, Hamajima N. Factors influencing non-institutional deliveries in afghanistan: secondary analysis of the afghanistan mortality survey 2010. Nagoya J Med Sci. 2015;77(1–2):133–43. Glassman A, Duran D, Fleisher L, et al. Impact of Conditional Cash Transfers on Maternal and Newborn Health. J Health Popul Nutr. 2013;31(4 Suppl 2):S48–66. Ezenwaka U, Manzano A, Onyedinma C, et al. Influence of Conditional Cash Transfers on the Uptake of Maternal and Child Health Services in Nigeria: Insights From a Mixed-Methods Study. Front Public Health. 2021;9:670534. 10.3389/fpubh.2021.670534 . Published 2021 July 6. Saeedzai SA, Blanchet K, Alwan A, et al. Lessons from the development process of the Afghanistan integrated package of essential health services. BMJ Glob Health. 2023;8:e012508. 10.1136/bmjgh-2023-012508 . Joo JY, Liu MF. Culturally tailored interventions for ethnic minorities: A scoping review. Nurs Open. 2021;8(5):2078–90. 10.1002/nop2.733 . Barrera M Jr, Castro FG, Strycker LA, Toobert DJ. Cultural adaptations of behavioral health interventions: A progress report. J Consult Clin Psychol. 2013;81(2):196–205. 10.1037/a0027085 . World health statistics 2023. monitoring health for the SDGs, sustainable development goals. https://www.who.int/publications/i/item/9789240074323 . Accessed August 13, 2024. General, OSG) O of the S. (. Strategies and actions: improving maternal health and reducing maternal mortality and morbidity. In: The Surgeon General’s Call to Action to Improve Maternal Health [Internet]. US Department of Health and Human Services; 2020. https://www.ncbi.nlm.nih.gov/books/NBK568218/ . Accessed August 13, 2024. Homer CS, Turkmani S, Wilson AN, et al. Enhancing quality midwifery care in humanitarian and fragile settings: a systematic review of interventions, support systems and enabling environments. BMJ Glob Health. 2022;7(1):e006872. 10.1136/bmjgh-2021-006872 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 06 Sep, 2024 Editor assigned by journal 06 Sep, 2024 Submission checks completed at journal 06 Sep, 2024 First submitted to journal 31 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5008241","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":350643472,"identity":"865486c3-a8c1-4bcd-b3fa-60be78e24a38","order_by":0,"name":"Humayoon 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Feroz","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ferozuddin","middleName":"Feroz","lastName":"Feroz","suffix":""},{"id":350643475,"identity":"242886ce-d8fd-461b-8e9c-d3c9bd8abfec","order_by":3,"name":"Jo Knight Knight","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Jo","middleName":"Knight","lastName":"Knight","suffix":""},{"id":350643476,"identity":"2d004d2a-ec43-447f-9b58-45d798dd4e6f","order_by":4,"name":"Mohammad Hassan Ukasha Ukasha","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Hassan Ukasha","lastName":"Ukasha","suffix":""},{"id":350643477,"identity":"b38dec22-dac5-4be4-b5c0-5be0efd8d996","order_by":5,"name":"Naseer Ahmad Durrani Durrani","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Naseer","middleName":"Ahmad Durrani","lastName":"Durrani","suffix":""},{"id":350643478,"identity":"56ed92d9-5044-4eb5-9b85-6b9f5058146f","order_by":6,"name":"Saifullah Sayedzai Sayedzai","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Saifullah","middleName":"Sayedzai","lastName":"Sayedzai","suffix":""}],"badges":[],"createdAt":"2024-08-31 09:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5008241/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5008241/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66346547,"identity":"15b8fb46-4fcb-4718-b337-c1b15e357e59","added_by":"auto","created_at":"2024-10-10 17:10:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":866168,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5008241/v1/ea06c7f2-e832-4ddf-bc6e-82e1347f8b61.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of Institutional Delivery in Afghanistan: A Secondary Analysis of Multi Indicator Cluster Surevey(MICS) 2022 and 2023 Data","fulltext":[{"header":"INTRODUCTION","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eGlobal and Local Context\u003c/h2\u003e \u003cp\u003eMaternal mortality, particularly in low- and middle-income countries (LMICs), remains a significant global health challenge.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The World Health Organization (WHO) estimates that approximately 95% of maternal deaths occur in LMICs, with sub-Saharan Africa and South Asia bearing the highest burden.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Despite global efforts and a 34% reduction in maternal mortality between 2000 and 2020, Afghanistan continues to have one of the highest maternal mortality ratios in the world.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e The maternal mortality ratio (MMR) in Afghanistan has decreased from 1346 per 100,000 live births in 2000 to an estimated 620 per 100,000 in 2023, mainly due to the implementation of the Basic Package of Health Services (BPHS).\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e However, this progress is insufficient to meet the Sustainable Development Goal (SDG) target of reducing global MMR to less than 70 per 100,000 live births by 2030.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRationale and Significance\u003c/h3\u003e\n\u003cp\u003eEducation is a powerful determinant of health, particularly maternal health.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Studies have shown that women with higher education levels are more likely to seek and utilize healthcare services, including institutional delivery, which significantly reduces the risk of maternal and neonatal mortality.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e In Afghanistan, where female literacy rates are low, understanding the impact of education on maternal health is crucial for designing effective public health interventions. Furthermore, the socioeconomic divide between urban and rural areas exacerbates health disparities.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Rural women, who are often less educated and economically disadvantaged, face significant barriers to accessing healthcare services, leading to higher rates of home deliveries and maternal mortality.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study provides a comprehensive analysis of the factors influencing institutional delivery in Afghanistan focusing on maternal education, economic status, and area of residence. By exploring these determinants, this study seeks to inform policies and programs to address health disparities and improve maternal health outcomes in Afghanistan.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eUtilizing the 2022/23 MICS survey data in Afghanistan, we conducted a secondary analysis focusing on institutional and home delivery as an outcome.\u003c/p\u003e \u003cp\u003eMulti-indicator cluster survey 2022/23 methodology\u003c/p\u003e \u003cp\u003eThe MICS Afghanistan 2022/23 survey was conducted by the United Nations Children\u0026rsquo;s Fund (UNICEF) in collaboration with the National Statistics and Information Authority (NSIA) (UNICEF, 2023).\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Oversight was provided by a technical committee comprising MICS Head Quarter, UNICEF regional office teams, and staff from the UNICEF Afghanistan country office. The sample design aimed to provide estimates for various indicators at the national, urban-rural, and provincial levels. Using a two-stage sampling approach based on the 2019 Satellite Imagery frame, primary sampling units (enumeration areas) were systematically selected, resulting in a sample size of 23,568 households across 982 enumeration areas. A two-stage cluster sampling method was used for each province, and Afghanistan was divided into 34 provinces. Security issues prevented visits to the 10 selected enumeration areas. The non-self-weighting sample necessitated the use of sample weights to report results. Four questionnaires were employed by UNICEF and NSIA, covering the household demographics of individual women (15\u0026ndash;49 years), children under 5 years, and children aged 5\u0026ndash;17 years old (UNICEF, 2023).\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDependent Variable\u003c/strong\u003e \u003cp\u003ePlace of delivery \u003cem\u003e(Health facility vs. home delivery)\u003c/em\u003e.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIndependent Variables\u003c/strong\u003e \u003cp\u003eMaternal education \u003cem\u003e(no education, primary, lower secondary, upper\u003c/em\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003esecondary, higher)\u003c/em\u003e, economic status \u003cem\u003e(wealth quintiles)\u003c/em\u003e, area of residence \u003cem\u003e(urban vs. rural)\u003c/em\u003e, and the language spoken by the household head.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis Plan\u003c/h2\u003e \u003cp\u003eQuantitative data analysis was conducted using the STATA software. Proportions are presented for categorical variables, whereas means and standard deviations are reported for continuous data. A logistic regression was performed to assess the association between independent predictors and institutional delivery, adjusting for the survey design effect. A univariate approach was first applied to each predictor with the outcome variable, and then variables with a p-value less than 0.25 were included in the multivariate analysis. The final model fitted using forward procedures and the variables were retained variables with a p-value of \u0026le;\u0026thinsp;0.05. All the results were adjusted for survey design, including weighting and clustering effects.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive Analysis\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003eshows the overall percentages of births that took place in a health facility versus at home, along with confidence intervals.\u003c/em\u003e Overall, 66.3% of the women delivered at a health facility, while 33.7% delivered at home \u003cem\u003e(\u003c/em\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCoverage of Institutional Delivery in Afghanistan 2022/23:This table shows the overall percentages of births that took place in a health facility versus at home, along with confidence intervals.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDelivery Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProportion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower Bound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper Bound\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInstitutional Delivery\u003c/p\u003e \u003cp\u003eHome Delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.51%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.09%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.91%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.49%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe sample size for this analysis included 12,587 women of childbearing age who had given birth in the past two years. Of these, 15.4% were from urban areas (N\u0026thinsp;=\u0026thinsp;1,934), while 84.6% were from rural areas (N\u0026thinsp;=\u0026thinsp;10,644). The average age of the women was 28.6 years. In terms of language, 34.66% were Dari-speaking (N\u0026thinsp;=\u0026thinsp;4,360), 50.29% were Pashto-speaking (N\u0026thinsp;=\u0026thinsp;6,326), 7% were Uzbeki-speaking (N\u0026thinsp;=\u0026thinsp;884), 1.56% were Turkmani-speaking (N\u0026thinsp;=\u0026thinsp;196), 2.67% were Nuristani-speaking (N\u0026thinsp;=\u0026thinsp;336), 0.72% were Balochi-speaking (N\u0026thinsp;=\u0026thinsp;91), and 2.59% were Pashaie-speaking (N\u0026thinsp;=\u0026thinsp;326), while 0.47% spoke other languages (N\u0026thinsp;=\u0026thinsp;59). Regarding education among the heads of households, 64.56% had pre-primary education (N\u0026thinsp;=\u0026thinsp;8,120), 10.93% had primary education (N\u0026thinsp;=\u0026thinsp;1,375), 6.15% had lower secondary education (N\u0026thinsp;=\u0026thinsp;774), and 5.02% had upper secondary education (N\u0026thinsp;=\u0026thinsp;322). Additionally, 7.8% had higher education (N\u0026thinsp;=\u0026thinsp;981). Among the women, 80.39% had pre-primary education (N\u0026thinsp;=\u0026thinsp;10,111), 8.42% had primary education (N\u0026thinsp;=\u0026thinsp;1,059), 3.62% had lower secondary education (N\u0026thinsp;=\u0026thinsp;455), and 5.02% had upper secondary education, while 2.56% had higher education (N\u0026thinsp;=\u0026thinsp;322). In terms of the wealth index, 22.21% were in the poorest quintile (N\u0026thinsp;=\u0026thinsp;2,793), 23.26% were in the second quintile (N\u0026thinsp;=\u0026thinsp;2,926), 22.75% were in the middle quintile (N\u0026thinsp;=\u0026thinsp;2,861), 18.73% were in the fourth quintile (N\u0026thinsp;=\u0026thinsp;2,356), and 13.02% were in the richest quintile (N\u0026thinsp;=\u0026thinsp;1,642).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003eprovides a detailed breakdown of the demographic and socioeconomic characteristics of the households and women included in the MICS 2023 survey in Afghanistan.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of households and women in MICS 2023 (N\u0026thinsp;=\u0026thinsp;12587), Afghanistan\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics of households, mothers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% (Sample)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% (Population)*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead of Household Language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePashto\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6,326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUzbeki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTurkmani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNooristani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBalochi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePashaie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Languages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation of household head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-primary/ECE or none\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8,120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon't know/Missing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother's Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-primary/ECE or none\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10,111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean number of members in a household\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12,578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWealth index quintile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoorest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,861\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRichest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,934\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10,644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean women age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12,578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e%* Weighted percentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe logistic regression analysis results provide important insights into the determinants of institutional delivery in Afghanistan.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eLanguage of the Household Head\u003c/h2\u003e \u003cp\u003eThe language spoken by the household head was significantly associated with the likelihood of institutional delivery, as indicated by the Odds Ratios (ORs). For example, Nooristani-speaking households had significantly higher odds of not having institutional deliveries, with an adjusted OR of 7.54 (95% CI: 3.03, 18.74; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), compared to women from Dari-speaking households. Conversely, Pashto-speaking households were associated with a higher likelihood of institutional deliveries, as shown by an adjusted OR of 0.79 (95% CI: 0.65, 0.95; p\u0026thinsp;=\u0026thinsp;0.014). \u003cem\u003e(\u003c/em\u003eTables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eWomen\u0026rsquo;s Education\u003c/h2\u003e \u003cp\u003eEducation level was a strong determinant of institutional delivery. Women with higher education levels were significantly more likely to deliver in a health facility. For example, women with higher education were 0.14 times less likely (95% CI: 0.07, 0.31; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) to deliver at home compared to women with no formal education. \u003cem\u003e(\u003c/em\u003eTables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEconomic and Rural/Urban Status\u003c/h2\u003e \u003cp\u003eEconomic status also played a critical role. Women from the richest households were 0.09 times less likely (95% CI: 0.07, 0.13; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) to have a home delivery compared to those from the poorest households. Conversely, those in rural areas were 1.89 times more likely (95% CI: 1.40, 2.55; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) to have a home delivery compared to urban residents. \u003cem\u003e(\u003c/em\u003eTables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003epresents the cross-tabulation of sociodemographic variables with institutional delivery among Afghan women aged 15\u0026ndash;49 years based on a sample size of 12,578 \u003cem\u003eThis table cross-tabulates different sociodemographic variables with the place of delivery, helping to see the relationships between these factors and whether the birth took place in a health facility or at home. The p-values are derived from chi-square tests applied to all categories.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstitutional Delivery (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInstitutional Delivery (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHome Delivery (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHome Delivery (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eHead of the Household Language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[65.32, 71.58]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[28.42, 34.68]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePashto\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[62.64, 67.67]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2,097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[32.33, 37.36]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUzbeki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[62.75, 74.97]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[25.03, 37.25]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTurkmani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[64.84, 85.61]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[14.39, 35.16]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNooristani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[7.62, 37.83]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e81.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[62.17, 92.38]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBalochi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[44.92, 76.17]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e38.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[23.83, 55.08]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePashaie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[19.07, 39.47]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e71.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[60.53, 80.93]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther Languages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[55.07, 87.20]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[12.80, 44.93]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eArea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[85.50, 91.19]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[8.81, 14.50]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,730\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[57.44, 61.74]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3,883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[38.26, 42.56]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eWomen's Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[59.15, 63.14]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3,702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[36.86, 40.85]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[71.13, 79.38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[20.62, 28.87]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[78.48, 87.54]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[12.46, 21.52]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[84.05, 91.08]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[8.92, 15.95]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[93.47, 98.32]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[1.68, 6.53]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEconomic Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoorest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[37.95, 44.19]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,539\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[55.81, 62.05]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[52.11, 58.34]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1,165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e44.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[41.66, 47.89]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[64.23, 70.05]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e32.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[29.95, 35.77]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[76.82, 81.78]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e20.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[18.22, 23.18]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRichest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[90.70, 94.56]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e[5.44, 9.30]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis of determinants of Institutional Delivery Among Afghan Women Aged 15\u0026ndash;49 (n\u0026thinsp;=\u0026thinsp;12,578) \u003cem\u003eThis table provides both unadjusted and adjusted odds ratios with confidence intervals for each variable, summarizing the results of the univariate and multivariate logistic regression analyses.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnadjusted Odds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI Lower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI Upper\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95% CI Lower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95% CI Upper\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e\u003cb\u003eHead of the Household Language\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDari\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePashto\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUzbeki\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTurkmani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNooristani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBalochi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePashaie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther Languages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Members in the Household\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.799\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eWomen's Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eEconomic Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoorest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRichest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eArea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe findings of this study have profound implications for public health policies in Afghanistan. The strong association between maternal education and institutional delivery underscores the critical need for policies prioritizing female education as a cornerstone of maternal health strategies. Research consistently demonstrates that educated women are more likely to seek and utilize healthcare services, including institutional delivery, which is vital for reducing maternal and neonatal mortality. \u003csup\u003e(10,11,12)\u003c/sup\u003e Therefore, expanding access to education for girls, particularly in rural areas, should be a top priority for the Afghan government and its international partners.\u003c/p\u003e \u003cp\u003eThe economic disparities highlighted in this study provide a strong association of poverty with home delivery. Hence, it highlights that targeted financial support and incentives, such as conditional cash transfers or maternal and neonatal gift packs for healthcare services, could significantly increase institutional delivery rates among the poorest women.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e This is especially crucial in rural areas, where most home deliveries occur due to economic barriers such as transportation costs and the affordability of healthcare services.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Past interventions, such as the introduction of the Basic Package of Health Services (BPHS) and the Essential Package of Health Services (EPHS), have played a significant role in enhancing access to health facilities across Afghanistan. Still, more targeted efforts are needed to address persistent economic inequalities.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCultural barriers to institutional delivery, as evidenced by the disparities in delivery rates among different linguistic and ethnic groups, must also be addressed. Public health campaigns and interventions should be culturally sensitive and tailored to the specific needs of these communities.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Engaging community leaders, leveraging local languages, and incorporating culturally relevant messaging in health promotion activities could enhance the effectiveness of these interventions.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e For example, Turkmani-speaking families had the highest rates of institutional deliveries, while Nuristani-speaking families had the lowest, highlighting the need for culturally nuanced approaches to health promotion (UNICEF, 2023).\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFuture research should focus on longitudinal studies to track the impact of educational and economic interventions on maternal health outcomes. Additionally, qualitative studies exploring cultural barriers to institutional delivery in different ethnic groups would provide valuable insights for designing more effective interventions. There is also a need to examine the impact of health system-strengthening initiatives, such as the expansion of midwifery services, on maternal health outcomes. For example, community midwifery education programs, supported by various donors, have been instrumental in improving access to maternal health services in Afghanistan.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Evaluating the long-term impact of such programs could inform future efforts to reduce maternal mortality in Afghanistan and other LMICs.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study provides an in-depth analysis of the factors influencing institutional delivery in Afghanistan, focusing on maternal education, economic status, and geographic location. It highlights the critical importance of maternal education, economic empowerment, and culturally tailored interventions to improve institutional delivery rates and consequently, maternal and child health outcomes in Afghanistan. By addressing these determinants through targeted and culturally sensitive interventions, Afghanistan can make significant progress toward achieving the Sustainable Development Goals (SDGs) related to maternal health. The findings of this study should inform public health policy and program development in Afghanistan, focusing on reducing maternal mortality and promoting equitable access to healthcare for all women, regardless of their educational level, economic status, or cultural background.\u003c/p\u003e \u003cp\u003eAlthough Afghanistan has made progress in improving maternal health, significant challenges remain, particularly among rural and less-educated women. Future research should continue to explore the root causes of non-institutional deliveries and evaluate the long-term impacts of educational and economic interventions on maternal health outcomes. Continued efforts are necessary to ensure that all women in Afghanistan have access to safe institutional delivery services, ultimately reducing maternal and neonatal mortality.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eData Access Statement\u003c/h2\u003e \u003cp\u003eThe data utilized in this study were obtained from the Multi-Indicator Cluster Survey (MICS) 2022 and 2023, conducted by UNICEF in collaboration with the National Statistics and Information Authority (NSIA) of Afghanistan. These data are publicly available through UNICEF's MICS database (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://mics.unicef.org/\u003c/span\u003e\u003cspan address=\"https://mics.unicef.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) and can be accessed upon request and following proper data use protocols.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics Statement\u003c/strong\u003e \u003cp\u003eThis study is based on secondary data analysis of publicly available data from the Multi-Indicator Cluster Survey (MICS) 2022 and 2023. UNICEF obtained ethical approval for the original MICS survey, and all procedures followed adhered to ethical standards involving informed consent from all participants. The analysis conducted in this study did not involve direct contact with human subjects, and therefore, additional ethical approval was not required.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eDisclaimer\u003c/h2\u003e \u003cp\u003eThe views expressed in this paper are those of the authors and do not necessarily reflect the official policies or positions of affiliated organizations.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003ePatient Consent for Publication\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was conducted without any specific grants from the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHumayoon Gardiwal served as the Principal Investigator, leading the research, conceptualizing and designing the study, and drafting the article. Ataullah Saeedzai developed the Methods section, and conducted data analysis and result tables, Mohammad Hassan Ukasha contributed to data visualization and manuscript writing, with Dr. Ferozuddin Feroz assisting in the writing process. Jo Knight reviewed the manuscript and provided insight. The remaining authors provided additional support throughout the study. All authors have agreed to submit this manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe are deeply grateful to UNICEF-Afghanistan for providing access to MICS 2023 data, which made this research possible. We also acknowledge the contributions of all women who participated in the survey, whose experiences informed us of this important work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data set was requested from UNICEF-MICS team and they authorized the team to use the data for the this specific purpose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEkwuazi EK, Chigbu CO, Ngene NC. Reducing maternal mortality in low- and middle-income countries. 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In: The Surgeon General\u0026rsquo;s Call to Action to Improve Maternal Health [Internet]. US Department of Health and Human Services; 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK568218/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK568218/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed August 13, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHomer CS, Turkmani S, Wilson AN, et al. Enhancing quality midwifery care in humanitarian and fragile settings: a systematic review of interventions, support systems and enabling environments. BMJ Glob Health. 2022;7(1):e006872. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjgh-2021-006872\u003c/span\u003e\u003cspan address=\"10.1136/bmjgh-2021-006872\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Institutional Delivery, Maternal Mortality, Maternal Education, Socioeconomic Factors, Afghanistan, MICS (Multi-Indicator Cluster Survey), Cultural Determinants","lastPublishedDoi":"10.21203/rs.3.rs-5008241/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5008241/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMaternal mortality remains a critical public health issue in Afghanistan, with the country exhibiting one of the highest maternal mortality ratios (MMR) globally. Delivery of a baby within an institution is a vital indicator of maternal and newborn health. This study explored the association between institutional delivery and various socioeconomic factors, particularly maternal education, using data from the Multi-Indicator Cluster Survey (MICS) 2022 and 2023. We analyzed data from over 12578 women of childbearing age to determine the influence of education, economic status, and geographic location on institutional delivery rates. Our findings indicate that higher maternal education and better economic conditions significantly increase the likelihood of institutional delivery, whereas rural residency and lower socioeconomic status remain substantial barriers. This study underscores the need for targeted interventions to address educational disparities and economic inequalities to improve maternal and child health outcomes in Afghanistan. This study provides critical insights for policymakers and public health professionals aiming to reduce the MMR in Afghanistan by promoting education and socioeconomic development.\u003c/p\u003e","manuscriptTitle":"Determinants of Institutional Delivery in Afghanistan: A Secondary Analysis of Multi Indicator Cluster Surevey(MICS) 2022 and 2023 Data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-10 17:02:06","doi":"10.21203/rs.3.rs-5008241/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-06T18:56:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-06T08:02:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-06T08:01:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-08-31T09:35:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"41aa750a-eecc-4509-8f3b-d2587fd5f60e","owner":[],"postedDate":"October 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-10-10T17:02:06+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-10 17:02:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5008241","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5008241","identity":"rs-5008241","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}