PRB

The UNICEF-supported survey examined women’s attitudes toward domestic violence as part of a larger study on maternal and child health. Women were asked a series of questions posing scenarios, or reasons, under which a husband would hit or beat his wife.

Overall, 92 percent of women in Afghanistan feel that a husband is justified in hitting or beating his wife for at least one of these reasons: going out without telling the husband, neglecting the children, arguing with the husband, refusing sex, and burning the food. Seventy-eight percent of women believe that going out without telling the husband is justification for beating, while 31 percent think the same about burning the food.

This same list of reasons has been used by the Demographic and Health Surveys in dozens of countries worldwide to measure attitudes toward domestic violence. The Afghanistan survey added an additional question to reflect local attitudes—wearing inappropriate clothes. Sixty-three percent of Afghan women feel a husband is justified in hitting or beating his wife if she wears inappropriate clothing.

Women’s acceptance of wife beating in Afghanistan is much higher than in other countries in the region: 54 percent in India; 36 percent in Bangladesh; and 23 percent in Nepal. Women’s level of education clearly has an effect on attitudes toward domestic violence (see table). In India, 62 percent of women with no education accept domestic violence compared with 31 percent of those with secondary education or higher. In Afghanistan, 82 percent of all women have no education.

Percent of Women Who Approve of a Husband Beating His Wife for a Specific Reason, by Education Level

Sources: UNICEF, Multiple Indicator Cluster Surveys; and ICF Macro, Demographic and Health Surveys.

Younger women and wealthier women in Afghanistan are slightly less accepting of husbands’ violence in Afghanistan. Among women ages 15 to 19, as well as women in the richest fifth of the population, 85 percent believe a husband is justified in beating his wife. Among never-married women, the proportion is 83 percent. Nearly half of all women ages 20 to 49 in Afghanistan were married by age 18.

Along with attitudes toward domestic violence, the survey linked women’s level of education to many measures of well-being for mothers and children. Specifically, children of Afghan women with education are less likely to die in infancy and childhood, more likely to be immunized, and more likely to complete primary school than children whose mothers had no education. Among Afghan women, those who had attended school are more likely to use a method of contraception and have adequate prenatal care than their peers with no education. However, among Afghan women ages 15 to 24 who reported completing primary school, only 29 percent are literate, according to the survey.

The Afghanistan Multiple Indicator Cluster Survey was carried out in 2010-2011 by UNICEF and the Afghan government’s statistical agency; it is one of a number of similar national surveys facilitated in countries worldwide by UNICEF.

Donna Clifton is a communications specialist in International Programs at the Population Reference Bureau.

(December 2009) For a long time, Afghanistan has been a country with a high and stable birth rate, a country where women averaged about eight children each, and a country in which one-fourth of its children were likely to die before reaching their fifth birthday. But in recent years, these once-stable trends appear to be changing. Given the extensive and growing media coverage that Afghanistan’s political situation receives, it is important to take a close look at its demographic situation as well.

Afghanistan’s first and only census was conducted in 1979, shortly before the country was invaded by the then-Soviet Union. As a result, there has been considerable doubt about its population size. A census was planned for 2008 but has now been delayed to September 2010, according to the United Nations. The UN Population Division estimates that the population was about 14 million in 1979, but the U.S. Census Bureau puts it at a little below 16 million. The Afghanistan census count was about 13 million. An anomaly in Afghanistan is the reporting of population by sex. Females are underreported relative to males in the younger age groups (below age 15). Son preference is prevalent in the country. Sex-selective abortion is not a likely cause for the underreporting of females, especially given the lack of ultrasound machines. More than likely, some girls are reported as boys since some stigma is attached to families who have only girl children and some families may not wish to report the presence of girls.

Using estimates derived from a number of recent surveys, the UN estimates the current total fertility rate (TFR) at 6.6 children per woman and the U.S. Census Bureau estimates 5.7. Not only do these TFRs, as high as they are, represent quite a decline from the past, but the onset of decline has been quite recent. The real question now is what about the country’s demographic future? The UN has quantified the effect of such high TFRs in its constant-fertility projection. If the TFR remains at 6.6, by 2050 the country’s population would reach 111 million and be growing at 3.6 percent per year, a rate that would double a population in 19 years.

In 2003, the government embarked on an ambitious program, the Basic Package of Health Services (BPHS), to rebuild the country’s shattered health sector and to introduce services to many underserved rural areas where the bulk of the population lives. The delivery of reproductive health services is essential for couples that wish to limit their family size and there appears to have been good progress, judging by contraceptive use rates.

In a 2000 survey, 5.3 percent of married woman used some form of family planning, and 3.6 percent used a modern method.¹ By 2003, the percentage had risen to 10.3 percent, 6.1 percent in rural areas.² In 2006, the reported use of modern contraception had risen to 15.5 percent, a considerable increase in only three years.³ The three most commonly used methods were pills (8.1 percent), injectables (5.4 percent), and condoms (2.2 percent), methods which require a continuing supply. The pill has been the most popular method in every survey taken in the country. Despite the increase, knowledge of contraception remains rather low with only about one in three women saying that they knew of a modern method. Not surprisingly, contraceptive use varied greatly with travel time to a health facility. Among women whose travel time was less than two hours (about 60 percent of respondents), modern usage was 19.4 percent but among women with two hours or more travel time, it was 9.1 percent. About 75 percent of travel to a health center was on foot, reflecting the rural nature of the population and the general lack of motorized transport.

Figure 1
Percent of Married Women Using Modern Contraception in Rural Afghanistan, 2003-2006

Sources: UNICEF, 2003 Multiple Index Cluster Survey (MICS); Johns Hopkins Bloomberg School of Public Health, 2005 National Risk and Vulnerability Assessment (NRVA); and Afghan Ministry of Health, 2006 Afghanistan Health Survey (AHS).

Afghanistan has one of the world’s highest rates of infant, child, and maternal mortality. A lack of antenatal care for pregnant women and low levels of child immunization have been major contributors to this situation. Despite many obstacles, the number of Afghan women who received antenatal care from a skilled attendant (doctors, midwives, and nurses) rose from 5 percent in 2003 to 32 percent in the 2006 Afghanistan Health Survey (AHS). It would appear that the BPHS program has had some success. Distance to the nearest health facility played an important role in the likelihood that skilled care was sought. Women who lived within two hours of a facility (61 percent of all respondents) were almost twice as likely to have had antenatal care. The proportion of women who delivered their baby in a health facility has not risen very much, however. In the 2003 Multiple Indicator Cluster Survey (MICS), only 11 percent of women had an institutional delivery. That figure rose to 15 percent in the 2006 AHS. This is undoubtedly related to the fact that adequate transportation is not available. Pregnant women should also receive at least two doses of tetanus toxoid to prevent their newborn from contracting tetanus. Slightly less than one-fourth of women had done so in 2006.

Figure 2
Percent of Mothers With Skilled Attendants at Delivery in Rural Afghanistan, 2003-2006

Sources: UNICEF, 2003 Multiple Index Cluster Survey (MICS); Johns Hopkins Bloomberg School of Public Health, 2005 National Risk and Vulnerability Assessment (NRVA); and Afghan Ministry of Health, 2006 Afghanistan Health Survey (AHS).

Child health measures have also shown improvement but full immunization remains at a low level. Tuberculosis immunization rose from 57 percent to 70 percent and children with three doses of polio increased dramatically from 30 percent in 2003 to 70 percent in 2006. However, only 27 percent of children had received all recommended immunizations, but that figure was up from 16 percent in 2003.

These figures all point to significant change in Afghanistan, a country that still has the potential for tremendous population growth against a background of poverty, illiteracy, and inadequate health systems. As Richard Cincotta of the Stimson Center has remarked, “population factors, if unaddressed, diminish the possibility that a coherent state, if one emerges, could remain intact.”⁴

Carl Haub is senior demographer at the Population Reference Bureau.

References

1. UNICEF, 2000 Multiple Indicator Cluster Survey (MICS) (New York: UNICEF, 2000).
2. UNICEF, 2003 MICS (New York: UNICEF, 2003).
3. Afghan Ministry of Health, 2006 Afghanistan Health Survey (AHS). The AHS was taken in rural areas only. The provinces of Helmad, Kandahar, Nuristan, Uruzgan, and Zabul could not be covered due to the security situation.
4. Richard Cincotta, “Could Demography Save Afghanistan?” Foreign Policy, accessed online at www.foreignpolicy.com/articles/2009/11/16/could_demography_save_afghanistan.

(June 2000) The gap in male-female literacy in Afghanistan, which will undoubtedly widen as a result of the current government’s draconian policies, offers a striking illustration of women’s marginal status in that country.

While the inequalities in education are significant within South Asia as a whole, the situation in Afghanistan is especially dramatic. Within South Asia, 1.75 times as many men as women can read and write. In Afghanistan, more than three times as many men as women are literate. Some 47 percent of Afghan men and a tiny 15 percent of women can read and write, according to the UN Children’s Fund (UNICEF).

In highlighting the inequality, a recent UNICEF report points to the rigid controls set for women by Afghanistan’s Taliban rulers since the religious-based movement took power in September 1996.

“Discrimination is most severe in war-torn Afghanistan, where Taliban authorities have barred girls from school,” says UNICEF’s State of the World’s Children 1999.

The stringent rules that have kept Afghan women and girls out of sight for the last three years have been well documented. A 1999 report published by the Boston-based Physicians for Human Rights (PHR) stresses that one of the first edicts issued by the Taliban regime was to prohibit girls and women from attending school. Taliban authorities have also barred women from working outside the home. In fact, women are not allowed to leave their homes unless accompanied by a male family member. And when they appear in public, women must wear the burqa, a garment that covers the entire body, allowing only a mesh opening for the purposes of seeing and breathing.

“The Taliban’s edicts restricting women’s rights have had a disastrous impact on Afghan women’s and girls’ access to education, as well as health care,” according to the PHR report, titled The Taliban War on Women: A Health and Human Rights Crisis in Afghanistan.

The ascendancy of the Taliban in Afghanistan represents the latest of several stages in a civil war that has lasted more than 20 years. During the past two decades, the Afghan population experienced a Communist revolution, a Soviet invasion and occupation, and a guerrilla war fueled by external forces. Throughout this period, the indiscriminate use of force, massacres of combatants as well as noncombatants, torture, and other serious human rights abuses were routine occurrences, according to the United Nations and several international human rights organizations.

In this largely rural, war-torn country of nearly 27 million people, men have a longer life expectancy than women. The average girl born today in Afghanistan is expected to live to a meager 45 years, one year less than her male counterpart, according to the Population Reference Bureau. This is one of only a few countries in which male longevity is greater than that of females.

In the meantime, the gap between male and female literacy is certain to widen. The difference, which was 27 percentage points in the 1980s, grew to 32 percentage points in the 1990s. Ironically, literacy rates among females were improving faster than the rates for males as recently as 1995. While the literacy rate among males was 5.5 times that of females in 1980, the 1995 male rate was just three times that of females. With girls having had no formal schooling for more than three years, however, the gap in literacy between males and females could turn into a gulf.

Afghanistan

• Total population (mid-2000): 26.7 million
• Estimated population in 2025: 48.0 million
• Life expectancy at birth: 46 years
• Total fertility rate: 6.1 children per woman
• Per capita income (1998 US$): not available

Yvette Collymore is a senior editor at the Population Reference Bureau.