Skip to main content

Barriers to healthcare utilization among married women in Afghanistan: the role of asset ownership and women’s autonomy


Women face multiple socio-economic, cultural, contextual, and perceived barriers in health service utilization. Moreover, poor autonomy and financial constraints act as crucial factors to their healthcare accessibility. Therefore, the objective of the present study is to study the association between health care utilization barriers and women empowerment, including asset ownership among currently married women in Afghanistan. Data of 28,661 currently married women from Afghanistan demographic health survey (2015) was used to carry out this study. Barriers to access healthcare were computed based on problems related to permission, money, distance, and companionship, whereas women empowerment and asset ownership were computed as potential covariates along with other socio-economic risk factors. Bivariate and logistic analysis was carried out to study the association and odds of explanatory variables. Our results confirm the significant and strong association between the barriers to access healthcare and various explanatory variables. Women having any decision-making autonomy are less likely to face any odds [(AOR = 0.56, p < 0.001), CI: 0.51–0.61] among the currently married women than those who don’t have any decision-making authority. Similarly, women who justify their beating for some specific reasons face the greater difficulty of accessing health care [(AOR = 1.76, p < 0.001), CI: 1.61–1.93]. In terms of asset ownership, women having any asset ownership (land or household) are less likely to face any barriers in health services utilization given the lower odds [(AOR = 0.91, p < 0.001), CI: 0.90–0.98]. Accessing maternal health is a crucial policy challenge in Afghanistan. A substantial proportion of women face barriers related to approval, money, distance, and companionship while accessing the health services utilization in Afghanistan. Similarly, women empowerment and asset ownership are significantly associated with health service accessibility. This paper therefore suggests for some policy interventions to strengthen the healthcare needs of women and ensure healthcare accessibility by scaling down these potential barriers like poor autonomy, asset ownership and domestic violence.

Peer Review reports


Maternal health remains a pressing global concern despite substantial advancements in health systems during the 21st century [1]. Regions such as South Asia and Sub-Saharan Africa continue to grapple with profound challenges, marked by significant disparities in maternal health outcomes [2, 3]. This inequality is attributed to various socio-economic and cultural factors encompassing inadequate pregnancy methods, a lack of pre and post-natal care, healthcare costs, economic constraints, and limited women’s autonomy [4,5,6]. Additionally, various barriers impede access to healthcare services, contributing to health disparities and increased mortality risk among reproductive women [7,8,9].

Afghanistan is one of the most war-torn countries globally, characterized by a fragile public health system and constrained healthcare availability and accessibility [10, 11]. Women in Afghanistan face heightened vulnerability, experiencing a greater likelihood of healthcare vulnerability and disease burden [12,13,14]. Basic health services and information related to family planning and reproductive health are often inaccessible to women in Afghanistan, with a substantial proportion of births going unattended by healthcare professionals [15, 16]. Moreover, a significant portion of currently married women lacks essential pre and post-natal care [17]. A large proportion of births are still unattended by health care professionals, whereas pre and post-natal care is also lacked by a large proportion of currently married women [18]. Existing studies highlight pronounced inequality in the utilization, availability, and accessibility of healthcare services across socio-economic groups in Afghanistan [2, 19]. Despite efforts to address maternal health, persistent challenges prevail, such as low utilization of antenatal care and a concerning lack of post-natal care among married women in Afghanistan [20]. Women’s also face multiple other challenges to access these health services involving money, transportation and cultural barriers, including poverty, awareness and cultural rigidity, which make them susceptible to access these basic health services [21, 22]. The fragile health system in Afghanistan, heavily reliant on foreign donors, exacerbates challenges in healthcare utilization, both in terms of availability and accessibility [22]. While previous studies shed light on the broader challenges of maternal healthcare, ante natal care and other predictors of healthcare utilization in Afghanistan [18, 23, 24]. There is a conspicuous gap in research specifically examining the barriers to accessing these healthcare services. Considering this, this study seeks to fill this gap by conducting a comprehensive analysis of the barriers to health service utilization among currently married mothers in Afghanistan. We aim to explore associated risk factors, including women’s empowerment and asset ownership, factors that have not been extensively studied in this context. By addressing these gaps in the literature, our research aspires to contribute valuable insights that can inform targeted interventions and policies to improve maternal health outcomes in Afghanistan. Furthermore, this research can serve as a foundation for crafting fresh initiatives and underscore the importance of conducting sociodemographic surveys in Afghanistan.

Literature review

Barriers to access healthcare services are a crucial concern in public policy research. Studies on healthcare service equality and excess have primarily focused on coverage indicators, neglecting analysis of individuals who encounter challenges in accessing healthcare services despite their availability [25]. Various perceived barriers contribute to the underutilization of healthcare services among reproductive women. Studies have explored factors impeding progress in healthcare service accessibility, including socio-economic vulnerability, affordability, and the availability of health services in developing countries, such as Afghanistan [26]. Similarly, a range of barriers from cultural to contextual barriers hinders free and equitable access to healthcare services, including issues related to women’s empowerment [27, 28]. Other obstacles in seeking healthcare, such as time constraints, unwillingness due to cultural norms, and associated costs, also impact women’s health [29]. Furthermore, additional studies have identified critical factors like women’s empowerment and asset ownership due to their close association with the utilization of maternal health services [27,28,29].

Previous studies have documented the close association between women’s health and their socio-economic settings [30, 31]. Women with greater autonomy and higher status are likely to have increased freedom to access healthcare [32]. Similarly access to education, employment, and resource ownership is crucial for women’s well-being and overall sustainable development [33]. Moreover, greater access to healthcare is directly dependent on women’s empowerment and socio-economic well-being [34]. Research indicates that women with a more significant role in decision-making are likely to have the freedom to choose healthcare services available to them [35]. Empowered women are more likely to have better access to healthcare services, facing fewer financial and companionship constraints when seeking healthcare services [36].

Afghanistan faces challenges in both socio-economic and healthcare services on a large scale. Women’s empowerment is a highly debated issue in Afghanistan, particularly considering the impact of conflict over the years [19]. There is limited knowledge about women’s empowerment and their significant role in the Afghanistan given the fragile environment. Similarly, little exploration has been undertaken to study the connection between women’s status and healthcare service utilization. Although health indicators have significantly improved over the past decade in Afghanistan, the country’s health system remains vulnerable [37]. Afghanistan is still far from achieving the sustainable development goals given the high rates of child and maternal mortality [38]. Similarly, the utilization of child and maternal health services is suboptimal within the country [39]. Afghanistan exhibits the highest maternal health risks in South Asia, with women facing significant challenges in accessing healthcare [18]. Therefore, this study aims to examine the association between women’s empowerment, asset ownership, and the challenges women encounter in accessing healthcare services in Afghanistan.

Data and methods

This study utilized the Afghanistan demographic health survey AFDHS- 2015 data conducted by the Central Statistics Organization and Ministry of Public Health Afghanistan. The detailed information about the survey, sampling design and available indicators is provided at [40, 41]. AFDHS is the first standard demographic and health survey conducted in Afghanistan collecting information on a broad range of issues on demographic and health indicators such as family planning, maternal and child health, the nutritional status of women and children, and knowledge and attitudes about HIV/AIDS and domestic violence and so on [41]. Although this survey was conducted in 2015, but it is the latest available comprehensive survey on health and wellbeing indicators in country. Thus, in this scenario, the study findings can be used as baseline research to develop new proposals as well as to highlight the need for conducting sociodemographic surveys to have access to updated data from Afghanistan.

Outcome variable

Access to health care was the primary dependent variable in our study. The AFDHS recorded a set of information on barriers to access healthcare among currently married women. These include the following four variables 1; permission to go to the doctor 2; getting money for receiving treatment, 3; distance from health facility and 4; not wanting to go alone. All four variables were binary. Therefore, we combined them to create a binary variable with (0 = no barriers at all, 1 = faced any barrier). Since the main aim of the study was to estimate the probability of one outcome relative to the other rather than making a comparison of probabilities across categories, so we employed the logistic model. The detailed information about dependent variables and question used for collected in this survey are provided in the Additional file 1.

Exposure variables

Two key exposure variables were considered in this study based on the available information in the study. First, we computed the women’s empowerment based on two dimensions involving decision making and reasons for justifying the beating as used by earlier studies [28]. While women empowerment is a multidimensional measure involving measures related to various key factors such as economic participation, work opportunity, political empowerment, educational attainment and health and wellbeing [42]. We included only two of the critical variables, decision making and reasons for justifying beating as a proxy for women empowerment in our study. These variables provide better picture of women’s empowerment and their self-dependency than the factors like level of education and labor force participation [40,41,42]. Similarly, many studies have also included these measures in their respective studies, since both they assess freedom and autonomy in decision making of women [43, 44]. The other measure included in the study was asset ownership, which was computed from house and land ownership in this study. These two ownerships are strongly associated with greater autonomy of women and their better status in society [45, 46]. The detailed information on both variables is given in the Additional file 1.

Other covariates

The other covariates selected in the study were determined based on the available literature. These included a set of socio-demographic characteristics of the mothers: maternal age, number of living children, level of education for both mother and father, work status, Place of residence, wealth index and other covariates. The detailed account of these variables can be found in the Table T1 Additional file 1.

Statistical analysis

Bivariate analysis was carried out to study the relationship between variables of interest. We used chi-square test to study the association between our dependent variables (barriers to access health care) with independent variables like women empowerment, and asset ownership and similarly other independent variables which include socio-economic, demographic, and other contextual factors. The Chi-square test was measured at the 5% level of significance (alpha = 0.05). A logistic model was then computed to examine the risk factors associated with any barrier among the currently married women in the present study. The results were reported in adjusted odds ratios (AOR) at 1, 5 and 10% levels of significance respectively adjusted for various socio-economic and associated risk factors. All analysis was carried using Stata 15 in this paper.


Figure 1 shows the barriers faced by currently married women in Afghanistan. Of the total sample (28,671) more than 88% currently married women face any problem in utilization of healthcare services in Afghanistan. Around 70% women face any problem to access healthcare due to not being accompanied by anyone. The figure also shows that 67% of women also face problems due to being distant healthcare facility. Similarly financial challenges account for 66%, whereas 50% face any barrier due to lack of permission to go out.

Fig. 1
figure 1

Problems faced by currently married women in accessing health care services in Afghanistan

Table 1 shows the barriers to healthcare access among currently married women in Afghanistan, categorized by socio-economic status, women’s empowerment, and ownership of assets. Higher barriers were found among women belonging to marginalized groups. Only 55% of women with higher education faced any barriers compared to 91% of those without any education. Similarly, 87% of women with decision-making power faced barriers compared to 91% without such authority. Only 9% of women who owned land did not faced any problems in accessing healthcare, compared to 12% who did not own any land. The chi-square value at the bottom of the table indicates that all these factors were significantly associated with barriers to healthcare access at a 5% level of significance (p < 0.05).

Table 1 Barriers in accessing health care services according to socio-demographic characteristics, women empowerment indicators and asset ownership by currently married women in Afghanistan (AfDHS − 2015)

Table 2 presents the results for risk factors associated with barriers to accessing health care among women in Afghanistan. AOR stands for adjusted odds ratio which measures the strength of the association between a particular exposure or risk factor and an outcome, while controlling for the effects of other variables that may influence the relationship. The results in the Table 1 shows that women aged 40–49 are more likely to access health care services than the women aged 15–19 [(AOR = 0.53, p < 0.001), CI: 0.42–0.67]. Similarly, rural women are more likely to face barriers to access healthcare [(AOR = 2.08, p < 0.001), CI: 1.85–2.34] as compared to urban women. Working women [(AOR = 0.82, p < 0.001), CI: 0.72–0.94] and women with higher education [(AOR = 0.76, p < 0.001), CI: 0.65–0.88] are less likely to face the healthcare excess barriers as compared to women who are not working and are illiterate respectively. Regarding the wealth index, as we move towards better affluent groups, odds of having any barrier significantly decreases. Women belonging to richer households are less likely to face any barrier compared to the women belonging to poorest households [(AOR = 0.48, p < 0.001), CI: 0.41–0.57]. While examining our exposure variables our results clearly found a significant association between women’s decision-making freedom and barriers to health care accessibility. Women having any decision-making ability are less likely to face any challenges in accessing health care [(AOR = 0.56, p < 0.001), CI: 0.51–0.61] as compared to those who are not independent in their decision making on critical issues. We also found that the women’s who justify their beating for some specific reasons face the greater odds of accessing health care [(AOR = 1.76, p < 0.001), CI: 1.61–1.93]. In terms of asset ownership, we also found the significant and negative association with women having any asset ownership of facing barriers in healthcare accessibility [(AOR = 0.91, p < 0.001), CI: 0.90–0.98].

Table 2 Association between problems in health care access, women’s empowerment and asset ownership adjusted for socio-economic and demographic risk factors (AfDHS − 2015)


Women face socio-economic and healthcare challenges throughout their lives and are often vulnerable to multiple barriers, including cultural constraints, financial limitations, and health-related obstacles [47]. Developing countries are often more challenging, with population at risk in these areas are more likely to face greater risk due to poor living conditions, limited access to healthcare, and ongoing conflicts [48, 49]. Moreover, cultural rigidity and gender bias adds to this burden, resulting in the vulnerability of women to accessing healthcare services [50, 51]. Therefore, considering these factors, this study aimed to understand the health care access barriers among currently married women in Afghanistan. Our results show a significant and clear correlation between barriers to accessing healthcare and socio-economic and other risk factors, including asset ownership and women’s empowerment.

Results from our study show significant and positive association between women living in rural areas and barriers to health care accessibility. These findings corroborated earlier research, where greater risk was associated with healthcare accessibility among rural women [52]. The main reasons for these barriers are the limited access to healthcare facilities and socio-economic disadvantages experienced by rural women, in contrast to their urban counterparts. Additionally, factors such as limited transportation options and financial resources make it even more difficult for women in rural areas to access high-quality healthcare services [52, 53].

Socio-economic factors, such as literacy, partners education and wealth status are key to greater accessibility of health care services and their utilization [54]. Women with higher literacy rates, educated partners, and belonging to wealthier demographics tend to have better access to healthcare facilities and encounter fewer barriers, as indicated by our findings. Our study unequivocally showed that illiterate women from impoverished backgrounds face heightened risks of encountering obstacles in accessing healthcare, compared to their educated counterparts and those from higher income brackets. These results align with various previous studies underscoring the pivotal role of education and income levels in healthcare access, both in Afghanistan and other developing countries [28, 52,53,54].

Work opportunity provides women better excess to health care utilization and enhance their empowerment through the availability and accessibility of resources to utilize these services. Our findings are in line with earlier studies, suggesting that employment status is associated with a lower likelihood of facing barriers in accessing healthcare services, specifically, working women were found to have a lower likelihood of experiencing such barriers [55].

Research shows that empowerment factors like autonomy in decision-making, wealth status, and asset ownership are essential for accessing health care services [56, 57]. However, in Afghanistan, these factors are vital barriers, as women are vulnerable to limited decision-making power and lack of asset ownership, which can hinder their autonomy and impact their health and wellbeing. The results of our study indicate that women with greater decision-making power are less likely to face barriers in accessing healthcare, a finding supported by previous research [58, 59].

The study also found a significant association between asset ownership and barriers to accessing health care. Women with greater ownership are less likely to encounter barriers in Afghanistan. This can be attributed to the fact that higher income affords women more autonomy and influence in household decision-making regarding healthcare and other wellbeing issues [60].

Limitation of the study

To our knowledge this study is a first of its kind in Afghanistan to analyze barriers to accessing healthcare services and linking them with key factors like asset ownership and women empowerment. However, despite this, the study has inherent limitations primarily stemming from the reliance on secondary data which is not the latest in our case. The term women empowerment is broad and encompasses more than just decision-making and overcoming obstacles. But due to the nature of our data source, we had to confine our analysis to these two aspects. Similarly, our exploration of asset ownership was restricted to land and household, even though it could have been examined in a more comprehensive manner. Additionally, the use of secondary data introduces the potential for reporting bias. We also acknowledge that our study did not account for areas of conflict, a critical control variable that would have enhanced our analysis. Lastly, the cross-sectional nature of the data poses challenges in establishing causality in our findings.


Maternal health access is a key policy challenge in Afghanistan, given the barriers currently, married women face in the country. The above results reveal a significant proportion of women facing barriers related to approval, money, distance, and company by a family member while accessing the health services in the country. Similarly, women empowerment and asset ownership were also significantly associated with the barriers to accessing healthcare services apart from education of their husbands. This paper recommends a comprehensive policy intervention to address the challenges faced by women in accessing healthcare. This intervention should focus on enhancing women’s healthcare needs, providing economic incentives to empower them, and removing perceived barriers to accessibility through awareness-raising campaigns and incentives. Moreover, the provision of healthcare services at the grassroot level can be essential in ensuring that poor and socio-economically marginalized women utilize healthcare services, thereby promoting health equity and improving the utilization of health services in Afghanistan.

Availability of data and materials

The data that supports the findings of this study are available on request. The dataset used in the study is available in the public domain and can be accessed on a request from DHS at Dataset and materials used in this study are available on request from the corresponding author



Afghanistan Demographic Health Survey


Millennium Development Goals


Sustainable Development Goals


  1. Lassi ZS, Middleton PF, Crowther C, Bhutta ZA. Interventions to improve neonatal health and later survival: an overview of systematic reviews. EBioMedicine. 2015;2:985–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Akseer N, Kamali M, Arifeen SE, Malik A, Bhatti Z, Thacker N, et al. Progress Maternal Child Health: how has South Asia Fared? BMJ. 2017;357:j1608.

    Article  PubMed  Google Scholar 

  3. Ataguba JEO. A reassessment of global antenatal care coverage for improving maternal health using sub-saharan Africa as a case study. PLoS ONE. 2018;13:e0204822.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Blas E, Gilson L, Kelly MP, Labonté R, Lapitan J, Muntaner C, et al. Addressing social determinants of health inequities: what can the state and civil society do? Lancet. 2008;372:1684–9.

    Article  PubMed  Google Scholar 

  5. Fusco CL, Andreoni S. Unsafe abortion: social determinants and health inequities in a vulnerable population in São Paulo, Brazil. Cad Saude Publica. 2012;28:709–19.

    Article  PubMed  Google Scholar 

  6. Crear-Perry J, Correa-de-Araujo R, Lewis Johnson T, McLemore MR, Neilson E, Wallace M. Social and structural determinants of health inequities in maternal health. J Womens Health. 2021;30:230–5.

    Article  Google Scholar 

  7. Banik BK. Barriers to access in maternal healthcare services in the northern Bangladesh. South East Asia J Public Health. 2016;6:23–36.

    Article  Google Scholar 

  8. Cheptum JJ, Gitonga MM, Mutua EM, Mukui SJ, Ndambuki JM, Koima WJ. Barriers to access and utilization of maternal and infant health services in Migori, Kenya. 2014.

    Google Scholar 

  9. Silal SP, Penn-Kekana L, Harris B, Birch S, McIntyre D. Exploring inequalities in access to and use of maternal health services in South Africa. BMC Health Serv Res. 2012;12:1–12.

    Article  Google Scholar 

  10. Fujita N, Zwi AB, Nagai M, Akashi H. A comprehensive framework for human resources for health system development in fragile and post-conflict states. PLoS Med. 2011;8: e1001146.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Salama P, Alwan A. Building health systems in fragile states: the instructive example of Afghanistan. Lancet Glob Health. 2016;4:e351-352.

    Article  PubMed  Google Scholar 

  12. Maguen S, Cohen B, Cohen G, Madden E, Bertenthal D, Seal K. Gender differences in health service utilization among Iraq and Afghanistan veterans with posttraumatic stress disorder. J Womens Health. 2012;21:666–73.

    Article  Google Scholar 

  13. Trani J-F, Bakhshi P, Noor AA, Lopez D, Mashkoor A. Poverty, vulnerability, and provision of healthcare in Afghanistan. Soc Sci Med. 2010;70:1745–55.

    Article  PubMed  Google Scholar 

  14. Tomlinson M, Chaudhery D, Ahmadzai H, Gómez SR, Gómez CR, van Heyningen T, et al. Identifying and treating maternal mental health difficulties in Afghanistan: a feasibility study. Int J Ment Health Syst. 2020;14:1–8.

    Google Scholar 

  15. Stanikzai MH, Tawfiq E, Jafari M, Wasiq AW, Seddiq MK, Currie S, et al. Contents of antenatal care services in Afghanistan: findings from the national health survey 2018. BMC Public Health. 2023;23:2469.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tawfiq E, Fazli MR, Wasiq AW, Stanikzai MH, Mansouri A, Saeedzai SA. Sociodemographic predictors of initiating Antenatal Care visits by pregnant women during first trimester of pregnancy: findings from the Afghanistan Health Survey 2018. Int J Womens Health. 2023;15:475–85.

    Article  PubMed  PubMed Central  Google Scholar 

  17. WHO WH. Increasing access to health care services in Afghanistan with gender sensitive health service delivery. 2013.

    Google Scholar 

  18. Mumtaz S, Bahk J, Khang Y-H. Current status and determinants of maternal healthcare utilization in Afghanistan: analysis from Afghanistan demographic and health survey 2015. PLoS ONE. 2019;14: e0217827.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Kim C, Saeed KMA, Salehi AS, Zeng W. An equity analysis of utilization of health services in Afghanistan using a national household survey. BMC Public Health. 2016;16:1–11.

    Article  Google Scholar 

  20. Khankhell RMK, Ghotbi N, Hemat S. < Editors’ Choice > Factors influencing utilization of postnatal care visits in Afghanistan. Nagoya J Med Sci. 2020;82:711.

    PubMed  PubMed Central  Google Scholar 

  21. Devkota B, van Teijlingen ER. Understanding effects of armed conflict on health outcomes: the case of Nepal. Confl Health. 2010;4: 20.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Morgan R, Tetui M, Muhumuza Kananura R, Ekirapa-Kiracho E, George AS. Gender dynamics affecting maternal health and health care access and use in Uganda. Health Policy Plan. 2017;32 suppl_5:v13-21.

    Article  Google Scholar 

  23. Hamidazada M, Cruz AM, Yokomatsu M. Vulnerability factors of Afghan rural women to disasters. Int J Disaster Risk Sci. 2019;10:573–90.

    Article  Google Scholar 

  24. Tawfiq E, Azimi MD, Feroz A, Hadad AS, Soroush MS, Jafari M, et al. Predicting maternal healthcare seeking behaviour in Afghanistan: exploring sociodemographic factors and women’s knowledge of severity of illness. BMC Pregnancy Childbirth. 2023;23:561.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Boerma T, AbouZahr C, Evans D, Evans T. Monitoring intervention coverage in the context of universal health coverage. PLoS Med. 2014;11: e1001728.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rogers AC. Vulnerability, health and health care. J Adv Nurs. 1997;26:65–72.

    Article  CAS  PubMed  Google Scholar 

  27. Houghton N, Bascolo E, del Riego A. Socioeconomic inequalities in access barriers to seeking health services in four Latin American countries. Rev Panam Salud Pública. 2020;44:e11.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Htun NMM, Hnin ZL, Khaing W. Empowerment and health care access barriers among currently married women in Myanmar. BMC Public Health. 2021;21:139.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Báscolo E, Houghton N, Del Riego A. Leveraging household survey data to measure barriers to health services access in the Americas. Rev Panam Salud Pública. 2020;44:e100.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ganle JK, Parker M, Fitzpatrick R, Otupiri E. Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study. Int J Equity Health. 2014;13:1–19.

    Article  Google Scholar 

  31. McNamee P, Ternent L, Hussein J. Barriers in accessing maternal healthcare: evidence from low-and middle-income countries. Expert Rev Pharmacoecon Outcomes Res. 2009;9:41–8.

    Article  PubMed  Google Scholar 

  32. Stephenson R, Hennink M. Barriers to family planning service use among the urban poor in Pakistan. Asia Pac Popul J. 2004;19:5–26.

    Google Scholar 

  33. Abreha SK, Walelign SZ, Zereyesus YA. Associations between women’s empowerment and children’s health status in Ethiopia. PLoS ONE. 2020;15: e0235825.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Duflo E. Women empowerment and Economic Development. J Econ Lit. 2012;50:1051–79.

    Article  Google Scholar 

  35. Pratley P. Associations between quantitative measures of women’s empowerment and access to care and health status for mothers and their children: a systematic review of evidence from the developing world. Soc Sci Med. 2016;169:119–31.

    Article  PubMed  Google Scholar 

  36. Collins JH, Bowie D, Shannon G. A descriptive analysis of health practices, barriers to healthcare and the unmet need for cervical cancer screening in the Lower Napo River region of the Peruvian Amazon. Womens Health. 2019;15:1745506519890969.

    CAS  Google Scholar 

  37. Mirzazada S, Padhani ZA, Jabeen S, Fatima M, Rizvi A, Ansari U, et al. Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan. Confl Health. 2020;14:1–13.

    Article  Google Scholar 

  38. Yousofi Z. The millennium development goals: women’s empowerment and gender equality in Afghanistan. 2017.

    Google Scholar 

  39. Naziri M, Higgins-Steele A, Anwari Z, Yousufi K, Fossand K, Amin SS, et al. Scaling up newborn care in Afghanistan: opportunities and challenges for the health sector. Health Policy Plan. 2018;33:271–82.

    Article  PubMed  Google Scholar 

  40. Rutstein SO, Rojas G. Guide to DHS statistics. Calverton: ORC Macro; 2006. p. 38.

    Google Scholar 

  41. Central Statistics Organization. MoPHM, ICF. Afghanistan Demographic and Health Survey 2015. Kabul, Afghanistan: Central Statistics Organization; 2017.

    Google Scholar 

  42. Schwab K, Samans R, Zahidi S, Leopold TA, Ratcheva V, Hausmann R, et al. The global gender gap report 2017. Geneva: World Economic Forum; 2017.

  43. Guracho YD, Bifftu BB. Women’s attitude and reasons toward justifying domestic violence in Ethiopia: a systematic review and meta-analysis. Afr Health Sci. 2018;18:1255–66.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Khan MN, Islam MM. Women’s attitude towards wife-beating and its relationship with reproductive healthcare seeking behavior: a countrywide population survey in Bangladesh. PLoS ONE. 2018;13:e0198833.

    Article  PubMed  PubMed Central  Google Scholar 

  45. van der Meulen Rodgers Y, Kassens AL. Women’s asset ownership and children’s nutritional status: evidence from Papua New Guinea. Soc Sci Med. 2018;204:100–7.

    Article  PubMed  Google Scholar 

  46. Wuneh AD, Medhanyie AA, Bezabih AM, Persson LÅ, Schellenberg J, Okwaraji YB. Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia. Int J Equity Health. 2019;18:1–9.

    Article  Google Scholar 

  47. Das AC. Exploring the constraints regarding maternal health in reproductive age among the rural women in Bangladesh. Mediscope. 2016;3:1–10.

    CAS  Google Scholar 

  48. Martin MA, Garcia G, Kaplan HS, Gurven MD. Conflict or congruence? Maternal and infant-centric factors associated with shorter exclusive breastfeeding durations among the tsimane. Soc Sci Med. 2016;170:9–17.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Teela KC, Mullany LC, Lee CI, Poh E, Paw P, Masenior N, et al. Community-based delivery of maternal care in conflict-affected areas of eastern Burma: perspectives from lay maternal health workers. Soc Sci Med. 2009;68:1332–40.

    Article  PubMed  Google Scholar 

  50. Jambai A, MacCormack C. Maternal health, war, and religious tradition: authoritative knowledge in Pujehun District, Sierra Leone. Med Anthropol Q. 1996;10:270–86.

    Article  CAS  PubMed  Google Scholar 

  51. Jambai A, MacCormack C. 16. Maternal Health, War, and Religious Tradition. In: Childbirth and Authoritative Knowledge. University of California Press; 1997. p. 421–40.

    Chapter  Google Scholar 

  52. Nisingizwe MP, Tuyisenge G, Hategeka C, Karim ME. Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda? BMC Pregnancy Childbirth. 2020;20:1–10.

    Article  Google Scholar 

  53. Tessema ZT, Kebede FB. Factors associated with perceived barriers of health care access among reproductive-age women in Ethiopia: a secondary data analysis of 2016 Ethiopian Demographic and Health Survey. 2020.

    Google Scholar 

  54. Kalule-Sabiti I, Amoateng AY, Ngake M. The effect of socio-demographic factors on the utilization of maternal health care services in Uganda. Afr Popul Stud. 2014;28:515–25.

    Article  Google Scholar 

  55. Seidu A-A. Mixed effects analysis of factors associated with barriers to accessing healthcare among women in sub-saharan Africa: insights from demographic and health surveys. PLoS ONE. 2020;15: e0241409.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Almeida APSC, Nunes BP, Duro SMS, Facchini LA. Socioeconomic determinants of access to health services among older adults: a systematic review. Rev Saude Publica. 2017;51:50.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Srivastava D, McGuire A. The determinants of access to health care and medicines in India. Appl Econ. 2016;48:1618–32.

    Article  Google Scholar 

  58. Kiani Z, Simbar M, Dolatian M, Zayeri F. Correlation between social determinants of health and women’s empowerment in reproductive decision-making among Iranian women. Glob J Health Sci. 2016;8:312.

    Article  PubMed Central  Google Scholar 

  59. Upadhyay UD, Hindin MJ. Do higher status and more autonomous women have longer birth intervals? Results from Cebu, Philippines. Soc Sci Med. 2005;60:2641–55.

    Article  PubMed  Google Scholar 

  60. Thandar M, Naing W, Moe HH. Women’s empowerment in Myanmar: an analysis of DHS data for married women age 15–49. 2019.

    Google Scholar 

Download references


We extend our sincere gratitude to Mohammad Hammad for diligently formatting the manuscript in strict accordance with the journal guidelines.


No funding available for this study.

Author information

Authors and Affiliations



Conceived and designed the research paper: M.A.M. and M.H.U.R.; analysed the data: M.A.M.; Contributed agents/materials/analysis tools: M.A.M. and M.H.U.R.; Wrote the manuscript: M.A.M. and M.H.U.R.; Refined the manuscript: A.P. and R.S. All authors read, reviewed and approved the final manuscript.

Corresponding author

Correspondence to Mohammad Hifz Ur Rahman.

Ethics declarations

Ethics approval and consent to participate

Not applicable. This study has utilized data from secondary sources that are already available in the public domain. As such, formal ethical approval and explicit consent to participate were not required for this research.

Consent for publication

Not applicable. As this study is based on secondary data and does not involve direct interaction with subjects, formal consent for publication is not required.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Malik, M.A., Sinha, R., Priya, A. et al. Barriers to healthcare utilization among married women in Afghanistan: the role of asset ownership and women’s autonomy. BMC Public Health 24, 613 (2024).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: