Achieving success with family planning in rural Afghanistan.
OBJECTIVE
Afghan 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.


METHODS
We 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.


METHODS
The 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.


RESULTS
The 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.


CONCLUSIONS
Community 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.
Huber
Douglas
D
Management Sciences for Health, 784 Memorial Drive, Cambridge, MA, 02139, USA. DouglasHuber777@yahoo.com
Saeedi
Nika
N
Samadi
Abdul Khalil
AK
D000346:Afghanistan; D017280:Condoms / Q000706:statistics & numerical data; D003270:Contraceptive Agents / Q000627:therapeutic use; D017598:Efficiency, Organizational; D005193:Family Planning Services / Q000379:methods / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D012068:Religion and Medicine; D019035:Rural Health Services
D003270:Contraceptive Agents