title: Determinants of skilled birth attendant utilization in Afghanistan: a cross-sectional study.
abstract: OBJECTIVE
  We sought to identify characteristics associated with use of skilled birth attendants where health services exist in Afghanistan.
  
  
  METHODS
  We conducted a cross-sectional study in all 33 provinces in 2004, yielding data from 617 health facilities and 9917 women who lived near the facilities and had given birth in the past 2 years.
  
  
  RESULTS
  Only 13% of respondents had used skilled birth attendants. Women from the wealthiest quintile (vs the poorest quintile) had higher odds of use (odds ratio [OR] = 6.3; 95% confidence interval [CI] = 4.4, 8.9). Literacy was strongly associated with use (OR = 2.5; 95% CI = 2.0, 3.2), as was living less than 60 minutes from the facility (OR = 1.5; 95% CI = 1.1, 2.0) and residing near a facility with a female midwife or doctor (OR = 1.4; 95% CI = 1.1, 1.8). Women living near facilities that charged user fees (OR = 0.8; 95% CI = 0.6, 1.0) and that had male community health workers (OR = 0.6; 95% CI = 0.5, 0.9) had lower odds of use.
  
  
  CONCLUSIONS
  In Afghanistan, the rate of use of safe delivery care must be improved. The financial barriers of poor and uneducated women should be reduced and culturally acceptable alternatives must be considered.
authors.affiliation: Vancouver Coastal Health, and Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Ave, Vancouver, BC V6T 1Z3, Canada. mmayhew07@shaw.ca
authors.forename: Maureen
authors.initials: M
authors.lastname: Mayhew
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hansen
authors.forename: David H
authors.initials: DH
authors.lastname: Peters
authors.forename: Anbrasi
authors.initials: A
authors.lastname: Edward
authors.forename: Lakhwinder P
authors.initials: LP
authors.lastname: Singh
authors.forename: Vikas
authors.initials: V
authors.lastname: Dwivedi
authors.forename: Ashraf
authors.initials: A
authors.lastname: Mashkoor
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
mesh_terms: D000346:Afghanistan; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008880:Midwifery / Q000193:education / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009721:Nurse Midwives / Q000193:education / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000193:education / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011247:Pregnancy; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014186:Transportation / Q000706:statistics & numerical data; D014195:Travel; D014857:Warfare