Achieving success with family planning in rural Afghanistan |
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Authors: | Douglas Huber Nika Saeedi and Abdul Khalil Samadi |
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Institution: | aManagement Sciences for Health, 784 Memorial Drive, Cambridge, MA, 02139, United States of America.;bEarly Recovery Team, Bureau for Crisis Prevention and Recovery, United Nations Development Programme, Kabul, Afghanistan.;cSTEP Health and Development Organization, Kabul, Afghanistan. |
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Abstract: | ProblemAfghan women have one of the world’s highest lifetime risks of maternal death. Years of conflict have devastated the country’s health infrastructure. Total fertility was one of the world’s highest, contraceptive use was low and there were no Afghan models of success for family planning.ApproachWe worked closely with communities, providing information about the safety and non-harmful side-effects of contraceptives and improving access to injectable contraceptives, pills and condoms. Regular interaction with community leaders, mullahs (religious leaders), clinicians, community health workers and couples led to culturally acceptable innovations. A positive view of birth spacing was created by the messages that contraceptive use is 300 times safer than pregnancy in Afghanistan and that the Quran (the holy book of Islam) promotes two years of breastfeeding. Community health workers initiated the use of injectable contraceptives for the first time.Local settingThe non-for-profit organization, Management Sciences for Health, Afghan nongovernmental organizations and the Ministry of Public Health implemented the Accelerating Contraceptive Use project in three rural areas with different ethnic populations.Relevant changesThe contraceptive prevalence rate increased by 24–27% in 8 months in the project areas. Men supported modern contraceptives once they understood contraceptive safety, effectiveness and non-harmful side-effects. Injectable contraceptives contributed most to increases in contraceptive use.Lessons learntCommunity health workers can rapidly increase contraceptive use in rural areas when given responsibility and guidance. Project innovations were adopted as best practices for national scale-up. |
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