The family planning conundrum in Afghanistan.
BACKGROUND
In Afghanistan, despite the high awareness levels of contraceptive methods, the contraceptive prevalence is low and short birth spacing is common. The aim of this study was to understand the perception about family planning and contraceptive utilization among reproductive-aged married women, their husbands, their mothers-in-law, religious leaders and healthcare providers.


METHODS
Focus group discussions and semi-structured interviews were conducted among married women of reproductive age (n = 482), their husbands (n = 133), their mothers-in-law (n = 194), their religious leaders (n = 16), and healthcare providers (n = 36) in rural and urban areas in five provinces.


RESULTS
Bigger family size was generally considered as desirable for emotional, economic and social well-being. The majority endorsed contraception. However, some religious scholars and their followers argued that contraception is a sinful act in Islam by interpreting contraception as equivalent to infanticide and suppression of the increase of the Muslim population. Healthcare providers attempted to disseminate health benefits of modern contraception on a family basis. However, fear of various side effects and doubts about their effectiveness due to irregular supply were prevalent in communities.


CONCLUSIONS
It is important to increase awareness on the health benefits of appropriate birth spacing at community level. Public health campaigns supported by Islamic religious scholars and a system that ensures appropriate counselling and a steady supply of contraceptives are likely to increase contraceptive utilization.
Health Promotion, Ministry of Public Health, Afghanistan.|Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
Hemat
H
Shafiqullah
Department of Global Health Promotion, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
Ayako
A
Morita
Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
Keiko
K
Nakamura
Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
Kaoruko
K
Seino
D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D001721:Birth Intervals / Q000523:psychology; D003267:Contraception; D003268:Contraception Behavior; D003469:Culture; D003906:Developing Countries; D005190:Family / Q000523:psychology; D005193:Family Planning Services / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D007514:Islam; D008297:Male; D008875:Middle Aged