Afghanistan Multiple Indicator Cluster Survey 2010-2011 Central Statistics Organisation (CSO) UNICEF (United Nations Children s Fund) January 2013 The Afghanistan Multiple Indicator Cluster Survey (AMICS) was carried out in 2010-2011 by the Central Statistics Organisation (CSO) of the Government of the Islamic Republic of Afghanistan in collaboration with United Nations Children s Fund (UNICEF). Financial and technical support was provided by UNICEF. MICS is an international household survey programme developed by UNICEF. The Afghanistan MICS was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women, and measures key indicators to monitor progress towards the Millennium Development Goals (MDGs), the Afghanistan National Development Strategy (ANDS) and other internationally agreed upon commitments. Suggested citation: Central Statistics Organisation (CSO) and UNICEF (2012). Afghanistan Multiple Indicator Cluster Survey 2010-2011: Final Report. Kabul: Central Statistics Organisation (CSO) and UNICEF. Photos Copyright: Chapter 1: © UNICEF/NYHQ2007-1196/Noorani Report Cover Photos: Chapter 2: © UNICEF/NYHQ2000-0859/LeMoyne © UNICEF/AFGA2007-00819/Noorani Chapter 3: © UNICEF/AFGA2011-00116/Aziz Froutan © UNICEF/AFGA2009-00802/Shehzad Noorani Chapter 4: © UNICEF/AFGA2009-00654/Noorani © UNICEF/AFGA2010-01134/Noorani Chapter 5: © UNICEF/NYHQ2001-0491/Noorani Chapter 6: © UNICEF/AFGA2011-00010/Jalali Chapter 7: © UNICEF/AFGA2009-00546/Noorani Chapter 8: © UNICEF/NYHQ1992-0344/Isaac Chapter 9: © UNICEF/NYHQ2001-0486/Noorani Chapter 10: © UNICEF/NYHQ2007-1106/Noorani Chapter 11: © UNICEF/AFGA2010-00211/Noorani Chapter 12: © UNICEF/AFGA2007-00043/Khemka Report Copyright © Central Statistics Organization, 2012 ii Foreword After over three decades of armed conflict, Afghanistan has made great strides in overcoming some of the legacies of the past, amidst ongoing challenges and hope for the future. The Government of Afghanistan has worked closely with the international community to lead in progress achieved in a number of key social and economic indicators since 2002. Article 54 of the Afghanistan Constitution (2004) stipulates that the family is the fundamental pillar of society, and that the Government shall adopt all necessary measures to attain the physical and spiritual health of the family, especially that of children and mothers. Article 22 declares non- discrimination and equality in rights and duties between men and women, while Article 49 prohibits the forced labour of children. Several government ministries such as the Ministry of Women s Affairs (MoWA), the Ministry of Education (MoE), the Ministry of Labour, Social Affairs, Martyrs and Disabled (MoLSAMD), and organizations as well as departments within other ministries have been tasked with addressing the needs of children, women, and families. The Afghanistan Independent Human Rights Commission (AIHRC) came into being in 2002, and includes a Child s Rights Desk focused on protecting the basic human rights of children. Based on the global commitment to meeting the Millenium Development Goals (MDGs), several national policies and strategies aimed at improving the wellbeing of children and women have been adopted. These include the National Action Plan for the Women of Afghanistan, 2007-2017 (NAPWA), the National Child and Adolescent Health Policy, 2009-2013, the National Strategy for Street Working Children, the National Strategy for the Protection of Children at Risk, the National Education Strategic Plan of Afghanistan (NESP), the National Social Protection policy, among others. Afghanistan is also considering the development of a comprehensive Child Act. The Child Protection Action Plan (CPAN) was adopted in 2003 by MoLSAMD, and has the goal of protecting children against all forms of exploitation, violence and abuse. CPAN promotes and disseminates the principles embodied in the Convention on the Rights of the Child (CRC) in Afghanistan. However, the 2011 concluding observations of the CRC Committee urged the Government to apply to a much greater extent the provisions of the CRC in our domestic legal framework. As the main poverty reduction strategy policy, the Afghanistan National Development Strategy (ANDS) 2008-2013 was developed to identify national development priorities and to outline a plan of action for achieving Afghanistan s MDGs, through the enhanced delivery of health services, expanded access to education, improved water and sanitation facilities, and the entrenchment of the rule of law. To protect the legal rights of children in conflict, ANDS calls upon the Government to enhance the legal and policy framework related to the juvenile offenders and children in conflict, and also calls for improved access to the formal legal system for women and children. Recognizing the plight of children in Afghanistan, ANDS underlines the commitments made by the Government to focus on supporting the most vulnerable and the poorest of the poor. This includes in particular, children at risk, chronically poor women, and poor and disabled people; and the obligation to develop social protection programmes to meet the needs of these most vulnerable groups. iii Further, the Government and the donor community affirmed their commitment to realizing identified national priorities through the National Priority Programmes (NPP). These commitments were reaffirmed at the Bonn Conference in November 2011 where pledges were made to support Afghanistan beyond 2014. The Afghanistan MICS for 2010-2011 contributes greatly towards our efforts to monitor the progress of the Afghan MDGs for 2020, as well as other national priorities defined in the ANDS and NPPs. The present report highlights the status of children and women in Afghanistan, and will prove to be of great value to planners, administrators, policy makers, researchers, and to all of our development partners. The data here will serve to develop and prescribe appropriate programmes and to develop responsive policies for the development and welfare of children and women in Afghanistan, which is ultimately aimed at helping us achieve important national goals. I am grateful to all the team members who provided various forms of technical assistance that allowed for the publication of this report. And last but not least, I would like to extend my sincere thanks to UNICEF for extending their financial and technical support towards the realization of the report. Abdul Rahman Ghafoori President General Central Statistics Organization Government of the Islamic Republic of Afghanistan Kabul iv Summary Table of Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Afghanistan, 2010-2011 MICS4 MDG Indicator Indicator Topic Number Number Indicator Value Unit CHILD MORTALITY Child mortality 1.1 4.1 Under-five mortality rate 102 per thousand 1.2 4.2 Infant mortality rate 74 per thousand NUTRITION Nutritional status 1.8 Underweight prevalence 2.1a Moderate and Severe (- 2 SD) 25.0 percent 2.1b Severe (- 3 SD) 10.6 percent Stunting prevalence 2.2a Moderate and Severe (- 2 SD) 51.6 percent 2.2b Severe (- 3 SD) 34.1 percent Wasting prevalence 2.3a Moderate and Severe (- 2 SD) 13.9 percent 2.3b Severe (- 3 SD) 7.2 percent Breastfeeding and 2.4 Children ever breastfed 93.4 percent infant feeding 2.5 Early initiation of breastfeeding 53.6 percent 2.6 Exclusive breastfeeding under 6 months 54.3 percent 2.7 Continued breastfeeding at 1 year 87.8 percent 2.8 Continued breastfeeding at 2 years 69.4 percent 2.9 Predominant breastfeeding under 6 69.2 percent months 2.10 Duration of breastfeeding 23.7 percent 2.11 Bottle feeding 28.2 percent 2.12 Introduction of solid, semi-solid or soft 20.1 percent foods 2.13 Minimum meal frequency 17.8 percent 2.14 Age-appropriate breastfeeding 36.7 percent 2.15 Milk feeding frequency for non-breastfed 59.5 percent children Salt iodization 2.16 Iodized salt consumption 20.4 percent Vitamin A 2.17 Vitamin A supplementation (children 50.6 percent under age 5) Anaemia Child Anaemia prevalence 33.7 percent Non-pregnant women anaemia 21.4 percent prevalence Pregnant women anaemia prevalence 16.3 percent CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage 64.2 percent 3.2 Polio immunization coverage 48.0 percent 3.3 Immunization coverage for diphtheria, 40.2 percent pertussis and tetanus (DPT) 3.4 4.3 Measles immunization coverage 55.5 percent v Tetanus toxoid 3.7 Neonatal tetanus protection 40.8 percent Care of illness 3.8 Oral rehydration therapy with continued 47.5 percent feeding 3.9 Care seeking for suspected pneumonia 60.5 percent 3.10 Antibiotic treatment of suspected 63.9 percent pneumonia Solid fuel use 3.11 Solid fuels 84.2 percent WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 56.7 percent 4.2 Water treatment 14.9 percent 4.3 7.9 Use of improved sanitation facilities 28.5 percent 4.4 Safe disposal of child's faeces 45.8 percent Hand washing 4.5 Place for hand washing 70.8 percent 4.6 Availability of soap 74.4 percent REPRODUCTIVE HEALTH Early childbearing and 5.2 Early childbearing 25.6 percent contraception 5.3 5.3 Contraceptive prevalence rate 21.2 percent Maternal and 5.5 Antenatal care coverage newborn health 5.5a At least once by skilled personnel 47.9 percent 5.5b At least four times by any provider 14.6 percent 5.6 Content of antenatal care 12.1 percent 5.7 5.2 Skilled attendant at delivery 38.6 percent 5.8 Institutional