The association between the number of Antenatal Care (ANC) visits and neonatal mortality in Afghanistan: a cross-sectional study based on the 2015 Demographic and Health Survey.

BackgroundNeonatal mortality in Afghanistan is among the highest worldwide, driven by rural-urban disparities, low maternal education, and poor healthcare access. Antenatal care (ANC) remains severely underutilized, with fewer than one in five women meeting minimum visits despite its link to neonatal survival, highlighting the need to assess its impact in conflict-affected settings. ObjectivesDetermine whether the number of antenatal care visits during pregnancy is associated with neonatal mortality in Afghanistan and investigate whether 4 ANC visits could be a sufficient minimum requirement to prevent neonatal mortality in conflict settings such as Afghanistan. MethodsAnalytic, population-based, cross-sectional study. Using data from the 2015 DHS for Afghanistan, logistic regression was performed to assess the association between fewer than 4 ANC visits and neonatal mortality. ResultsThe overall prevalence of neonatal mortality was 1.85% (CI:1.56-2.20). The odds of neonatal mortality for children whose mothers attended ANC less than 4 times were 1.8 times higher in comparison to those whose mothers attended ANC 4 times or more. After adjusting for the age of the mother, sex, ANC provider, place of residence (urban/rural), wealth index, education of mother, and education of father, the odds of neonatal mortality were 1.1 (95% CI 0.72-1.71) with not enough evidence against the null hypothesis (p-value 0.637). While the mothers education, place of residence, wealth index, ANC provider, and fathers education confounded the relationship, sex showed an interactive effect on the main relationship. ConclusionsANC visits less than 4 times were 1.8 times more likely to result in neonatal mortality than ANC visits 4 or more times. This study confirmed the importance of setting 4 visits as a minimal threshold for improved pregnancy outcomes, even where access to health care could be challenging, such as in Afghanistan.