Women behind locked doors: Training male health providers in family planning/reproductive health as a portal to women in Afghanistan

Afghanistan is a strongly patriarchal society, and women require men's permission to seek health care. Recognizing the vital role male health providers play as respected and trusted members of the community, Family Health Alliance (FHA) designed a program to train male doctors/nurses from rural areas to promote and expand birth spacing and contraceptive use among their male patients. In 2007, this program was implemented as the first family planning/reproductive health training program for male health providers in Afghanistan.

Program objectives were to promote male involvement in family planning; increase contraceptive knowledge (particularly condoms/vasectomy); improve detection/treatment of STIs; and expand STIs/HIV education for men. The program employed an empowerment model of teaching which included role models, using Muslim health professionals, self-reliance, and teamwork strategies to address numerous challenges trainees face in a post-conflict environment.

Program evaluation found a significant increase in trainee knowledge (mean pre- and post- scores 47% and 85% respectively). Trainees were monitored for 60 days after completion of the program to assess their participation/behavior change. Monitoring data indicates that male providers demonstrated a clear effort to apply knowledge and skills acquired. Male doctors and nurses provided counseling to 2,245 male patients in five subcategories: 78% of patients received counseling in birth spacing, 88% in male involvement, 85% in HIV/AIDS, 79% in condom as prevention, and 72% in referring wife to family planning clinic.

FHA's male health provider training program has found that education of Afghan male health providers in family planning/reproductive health leads to their active participation in counseling their male patients on family planning to address low contraceptive use and high maternal mortality. While originally considered controversial by some members of the Ministry of Public Health and local NGOs, the success of this program prompted policy changes at the Ministry of Public Health to expand reproductive health training programs to include training of male providers. The results have also led to the expansion of the program in 2008. Presentation will discuss achievements of the program that led to the policy changes.