Authors

1 Psychology Department, Faculty of Economics, Administrative and Social Sciences, Istanbul Gelisim University, Istanbul, Turkey

2 Midwifery Faculty, Khatam Al Nabieen University, Kabul, Afghanistan, 3 School of Medicine, International Campus, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

3 School of Medicine, International Campus, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran

4 Life Science, and Biomedical Engineering Application and Research Center, Istanbul Gelisim University, Istanbul, Turkey

Abstract

BACKGROUND: A healthy pregnancy and its outcomes are highly dependent on maternal health
literacy. This is the first study that targets the association between maternal health literacy and
pregnancy outcomes of women in Afghanistan.
MATERIALS AND METHODS: This is a cross‑sectional study on 200 women who received a
prenatal care program and have given birth at Barchi National – 100 beds hospital in Kabul, the
capital city of Afghanistan. As a convenient sample, they answered Maternal Health Literacy and
Pregnancy Outcome Questionnaire with 5‑point Likert scales. We tested the correlation between
maternal health literacy and pregnancy outcome scores via the Pearson’s correlation coefficient. The
potential association of socio‑demographic and fertility variables with both maternal health literacy
and pregnancy outcome was tested via independent samples t‑test or one‑way ANOVA. All analysis
was performed with a 95% confidence level and a significant level was defined as a P value ≤0.05.
RESULTS: The maternal health literacy of Afghan women is inadequate. Maternal health literacy
is linked to pregnancy outcome, and both were associated with education level, age, number of
gravidities, number of received care, and time that onset the prenatal care. Nutshell, we found evidence
of a positive and significant correlation between maternal health literacy and pregnancy outcome.
CONCLUSION: This study brings forth the novel data on maternal health literacy of Afghan women, the
members of society that face health crises for more than half a century. This study calls for recognition
that inadequate maternal health literacy in Afghanistan significantly influences prenatal care quality
and perpetuates the biggest challenge for maternal and child health through pregnancy outcomes.

Keywords

1. UNFPA. Midwives deployed to remote Afghanistan to lower
maternal death rate. 10 Jul 2018.[Online]. Available from: https://
www.unfpa.org/news/midwives-deployed-remote-afghanistan
‑lower‑maternal‑death‑rate.
2. WHO. Global Health Observatory: Afghanistan. 2019. [Online].
Available from: https://www.who.int/data/gho/data/
countries/country‑details/GHO/afghanistan?countryProfile
Id=5f0ca8ad‑037c‑4241‑a792‑b3f06bddd40e. [Last accessed in
2019May 20].
3. Jung E, Maroof H. Giving birth under the Taliban.
2022. [Online]. Available from: https://www.bbc.com/news/
world‑asia‑58585323. [Last accessed 2022 Jan 06].
4. McKinn S, Linh DT, Foster K. Distributed health literacy
in the maternal health context in Vietnam.Health Lit Res
Pract2019;3:e31‑42.
5. Morrison AK, Glick A, Yin HS. Health literacy: Implications for
child health.PediatrRev2019;40:263–77.
6. Guler DS, Sahin S, Ozdemir K, Unsal A, Uslu Yuvacı H. Health
literacy and knowledge of antenatal care among pregnant women.
Health Soc Care Community2021;29:1815–23.
7. Harsch S, JawidA, JawidE, Saboga‑NunesL, Sørensen K, SahraiD,
Bittlingmayer UH. Health literacy and health behavior among
women in Ghazni, Afghanistan.FrontPublic Health2021;9:629334.
doi: 10.3389/fpubh. 2021.629334.
8. World Fact Book Afghanistan. 2019. [Online]. Available: https://
www.cia.gov/library/publications/the‑world‑factbook/geos/
af.html.[Last accessed on 2019 May 30].
9. UN. UN commits to long‑term support for Afghan mothers and
newborns: Najaba’s story. 28 October 2021. [Online]. Available
from: https://news.un.org/en/story/2021/10/1104262.
10. Rowlands G. Health literacy.HumVaccin Immunother
2014;10:2130–5.
11. TaheriS, TavousiM, MomenimovahedZ, Direkvand‑MoghadamA,
Tiznobaik A, Suhrabi Z, et al. Development and psychometric
properties of maternal health literacy inventory in pregnancy.
PLoS One2020;15:e0234305.
12. Kandula NR, Nsiah‑Kumi PA, Makoul G, SagerJ, Zei CP, Glass S,
et al.The relationship between health literacy and knowledge
improvement after a multimedia type 2 diabetes education
program.Patient Educ Counsel 2009;75:321–7.
13. Amiresmaili MR, Nekoei Moghadam M, Saberi anari SH,
Sadeghi A, Saber M, Taheri G, et al. Study of health literacy level
of women referring to health centers‑2010. J North Khorasan Univ
Med Sci 2013;5:1071‑8.
14. McNaughton CD, Kripalani S, Cawthon C, Mion LC, Wallston KA,
Roumie CL. Association of health literacy with elevated blood
pressure: Acohort study of hospitalized patients.Medical
Care2014;52:346‑53.
15. Cho YI, Lee SYD, Arozullah AM, Crittenden KS. Effects of health
literacy on health status and health service utilization amongst
the elderly.SocSci Med2008;66:1809–16.
16. Cha E, Kim KH, Dawkins CR, Bello MK, Umpierrez G, Dunbar SB.
Health literacy, self‑efficacy, food label use, and diet in young
adults.AmJHealth Behav2014;38:331–9.
17. Howard DH, Gazmararian J, Parker RM.The impact of low health
literacy on the medical costs of Medicare managed care enrollees.
AmJMed2005;118:371–7.18. MacLean L. A literature review of health literacy of adolescents
during pregnancy.NursWomen’s Health2020;24:431–9.
19. Harsch S, Jawid A, Jawid ME, Nunes LS, Sahrai D,
Bittlingmayer UH. The relationship of health literacy, wellbeing
and religious beliefs in neglected and unequal contexts‑Results
of a survey study in central Afghanistan.Health PromotJ
Austr2021;32(Suppl 1):80–7.
20. Mojoyinola J. Influence of maternal health literacy on healthy
pregnancy and pregnancy outcomes of women attending public
hospitals in Ibadan, Oyo State, Nigeria.Afr Res Rev2011;5:28‑39.
21. Kharazi SS, Peyman N, Esmaily H. Association between maternal
health literacy level with pregnancy care and its outcomes. Iran J
Obstet Gynecol Infertil 2016;19:40‑50.
22. ChenM, Luo Y, Fu J, Wang T, Meng Y, Xu C, et al. Reproductive
health status and related knowledge among women aged
20‑39 years in rural China: Across‑sectional study. Reprod Health
2020;17:90.
23. Wångdahl J, Lytsy P, Mårtensson L, Westerling R. Health literacy
among refugees in Sweden‑Across‑sectional study.BMC Public
Health 2014;14:1030.
24. Banerjee N. Center of international policy studies. 06 January
2022. [Online]. Available from: https://www.cips‑cepi.ca/.
25. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A,
Crotty K, et al.Health literacy interventions and outcomes: An
updated systematic review. Evid Rep Technol Assess 2011;1‑941.
26. Khorasani EC, Peyman N, Esmaily H. Measuring maternal
health literacy in pregnant women referred to the healthcare
centers of Mashhad, Iran, in 2015. J Midwifery Reprod Health
2018;6:1157‑62.
27. Safaie SZ, Rahebi SM, Mir Haghjou SN, Kazemnejad Leili E. The
relationship between maternal health literacy and pregnancy
outcome in postnatal wards. J Biochem Technol 2018;2:120‑7.
ISSN: 0974‑2328.
28. Pirzadeh A, Nodooshan T, Nasirian M. Association between
maternal health literacy level and prenatal care in Iran. J Health
Lit 2019;4:60‑7.
29. Morad Abadi AS, Agha Molaei T, Ramezankhani A, Dadipoor S.
The health literacy of pregnant women in Bandar Abbas, Iran. Sch
Public Health Inst Public Health Res 2017;15:121‑32.
30. Sørensen K, Broucke SVD, Fullam J, Doyle G, Pelikan J, Slonska Z,
et al. Health literacy and public health: Asystematic review
and integration of definitions and models. BMC Public Health
2012;12:80.
31. Kickbusch I, Pelikan JM, Apfel F, Tsouros AD. Health literacy. The
solid facts (2013). 5 Feb 2022. [Online]. Available from: https://
apps.who.int/iris/handle/10665/326432.
32. Nutbeam D. Health literacy as a public health goal: A challenge
for contemporary health education and communication strategies
into the 21st century. Health Promot Int 2000;15:259–67.
33. Forghani T, Ahmadian M, Rezaeisharif F, Ahadi M. Survey
of health literacy during pregnancy and its relationship with
prenatal care. J Health Lit 2021;6:20‑30
34. Morad Abadi AS, Agha Molaei T, Ramezankhani A, Dadipoor S.
The health literacy of pregnant women in Bandar Abbas, Iran.
J School Public Health Institute Public Health Res2017;15:121‑32.
35. Quillin JM, Silberg J, Board P, Pratt L, Bodurtha J. College women’s
awareness and consumption of folic acid for the prevention of
neural tube defects. GenetMed2000;2:209‑13.
36. Yee LM, Simon MA. The role of health literacy and numeracy
in contraceptive decision‑making for urban Chicago women.
J Community Health2014;39:394‑9.
37. Ashraf‑Ganjoei T, Mirzaei F, Anari‑Dokht F. Relationship
between prenatal care and the outcome of pregnancy in low‑risk
pregnancies. Open J Obstet Gynecol2011;1:109‑12.
38. Ratzan SC. Promoting Health Literacy to Encourage Prevention
and Wellness: Workshop Summary. Washington, DC: Institute of
Medicine. The National Academies Press; 2011. Available from:
https://doi.org/10.17226/13186.
39. Horsager R, Roberts S, Rogers V, Santiago‑Munoz P, Worley K,
Hoffman B. Williams Obstetrics, Study Guide. 24th ed. McGraw
Hill Professional; 2014.
40. Silva LM, Jansen PW, Steegers EA, Jaddoe VW, Arends LR,
Tiemeier H, et al.Mother’s educational level and fetal growth: The
genesis of health inequalities. Int J Epidemiol 2010;39:1250‑61.
41. Afghanistan ‑ Literacy rate. 05 Feb 2022. [Online]. Available
from: https://countryeconomy.com/demography/literacy‑rate/
afghanistan.
42. Asadi L, Amiri F, Safinejad H. Investigating the effect of health
literacy level on improving the quality of care during pregnancy
in pregnant women covered by health centers. J Educ Health
Promot 2020;9:286.
43. Akbarinejad F, Soleymani MR, Shahrzadi L. The relationship
between media literacy and health literacy among pregnant
women in health centers of Isfahan. J Educ Health Promot
2017;6:17