2015 Afghanistan Demographic and Health Survey (AfDHS) Key Indicators Report

The 2015 Afghanistan Demographic and Health Survey (2015 AfDHS) was implemented by the Central Statistics Organization (CSO) and the Ministry of Public Health from 15 June 2015 to 23 February The funding for the AfDHS was provided by the United States Agency for International Development (USAID). ICF International provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide.

Objectives The primary objective of the 2015 AfDHS project is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the AfDHS collected information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutrition, childhood and maternal mortality, maternal and child health, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), and other health-related issues such as smoking, knowledge of tuberculosis, and cancer.

The Survey The 2015 AfDHS is the 1 st Demographic and Health Survey conducted in Afghanistan as part of The DHS Program. It is designed to provide estimates at the national level, for urban and rural areas, and Afghanistan’s 34 provinces.

Sample Design Sampling Frame: Household Listing Frame from CSO, updated in 2009 First Stage: 260 urban and 690 rural clusters selected; 101 “replacement” clusters were pre-selected in case some of the selected enumeration areas (EAs) were inaccessible due to security Second Stage: 27 households were selected per cluster, for a total sample size of 25,650 households Use of Replacement Clusters: 70 clusters were identified as insecure; all 101 replacement clusters were added Selected households were visited and interviewed; ever-married women age in all selected households and ever-married men age in half of the selected households were interviewed.

Questionnaires Household Questionnaire Woman’s Questionnaire Man’s Questionnaire Questionnaires were translated into Dari and Pashto

Questionnaires: Household Questionnaire Lists usual members and visitors to identify eligible individuals Basic characteristics of each person in the household collected (age, sex, education, etc.) Housing characteristics (access to drinking water, sanitation facilities, etc.) Identify women and men eligible for individual interview

Questionnaires: Woman’s Questionnaire Background characteristics (education, marital status, media exposure, etc.) Reproductive history Knowledge and use of family planning methods Fertility preferences Antenatal and delivery care Breastfeeding and infant feeding practices Vaccinations and childhood illnesses Women’s work and husband’s background characteristics Childhood mortality Awareness and behaviour about HIV and other STIs Adult mortality, including maternal mortality

Questionnaires: Man’s Questionnaire Background characteristics Reproductive history Knowledge of family planning methods Fertility preferences Employment Awareness and behaviour about HIV and other STIs

Survey Trainings Pretest March 2015: 12 days of training Fieldwork in 4 locations in and around Kabul Training of Trainers: 1 week training in May 2015 with 17 trainers who were trained during pretest and worked as trainers in the main survey training and then as fieldwork coordinators during data collection Main Survey Training: 4 week training with 300 participants at Rana University in May-June 2015

Fieldwork and Data Processing Total of 33 teams (consisting of 1 supervisor, 1 field editor, 3 female interviewers, 3 male interviewers) Fieldwork conducted from 15 June 2015 – 23 February 2016 Data editing done in the field before questionnaires were sent to CSO/Kabul for data processing Secondary editing completed in March 2016 All data were entered twice followed by data processing, which included secondary editing, data cleaning, and validation

Results of the Household and Individual Interviews All Household Interviews Households selected25,741 Households occupied24,941 Households interviewed24,395 Response rate98% All Interviews with Women age Eligible women30,434 Women interviewed29,461 Response rate97% Interviews with Men age Eligible men11,778 Men interviewed10,760 Response rate91%

2015 Afghanistan Demographic and Health Survey (AfDHS) Key Indicators

Educational Attainment of Respondents Age Percent of women and men age 15-49

Fertility Births per woman for the 3-year period before the survey

Teenage Childbearing by Education Percent of women age who are mothers or pregnant with their first child Too few cases

Fertility Preferences of Married Women Percent distribution of currently married women age by desire for children

Current Use of Contraception Percent of currently married women age 15-49

Current Use of Contraception by Wealth Percent of currently married women age Poorest

Demand for Family Planning Percent of currently married women age 15-49

Antenatal Care Percent of women age with a live birth in the 5 years before the survey

Delivery Care

Childhood Vaccinations Percent of children age months vaccinated PentavalentPolio

Child Vaccination by Mother’s Education Percent of children age months with all basic vaccinations

Childhood Illnesses Among children under 5 with symptoms of acute respiratory infection (ARI), fever, or diarrhoea, percent whom advice or treatment was sought from a health facility or provider

Treatment of Diarrhoea Among children under 5 with diarrhoea, percent who received the following:

Breastfeeding Status Under 6 Months Percent distribution of youngest children under 6 months who are living with their mother by breastfeeding status

Ownership of and Access to ITNs Percent of households Percent of household population *Assuming one ITN covers 2 people

Use of ITNs Percent who slept under an ITN the night before the survey among all households Percent who slept under an ITN the night before the survey among households with at least one ITN

Fever in Children In the 2 weeks before the survey, 29% of children under 5 had a fever. 63% were taken to a health facility or provider for advice or treatment. 8% had blood taken from a finger or heel for testing. <1% took ACT.

Knowledge of HIV Prevention Methods Percent of women and men age who know that HIV can be prevented by:

Comprehensive Knowledge of HIV among Youth by Residence Percent of ever-married women and men age with comprehensive knowledge* of HIV *Comprehensive knowledge means knowing that the risk of getting HIV can be reduced by using condoms and limiting sex to one uninfected partner, knowing that a healthy looking person can have HIV, and rejecting the two most common local misconceptions about HIV prevention and transmission.

HIV Testing Percent of ever-married women and men age 15-49

Cancer 3% of households have a member diagnosed with cancer.

Key Findings Women have an average of 5.3 children. The contraceptive prevalence rate of any contraceptive method among married women is 23%. 48% of births were delivered in a health facility. 46% of children are fully vaccinated. 3% of household population has access to an ITN. <1% of women and 4% of men were tested for HIV in past 12 months and received the results of the test. 3% of households have a member diagnosed with cancer.