Increased Contraceptive Use beyond Expectation in Afghanistan: Advocacy from the Community to National Policy

Our purpose was to accelerate contraceptive use in three Afghan rural sites through innovations to strengthen rural community health workers (CHWs) in Afghan organizations, gain support from community leaders, and build on the USAID/MSH health initiative. The initiative was thought to be politically sensitive by both Afghan and international colleagues.

Following in-depth community assessments, we developed guidance to remove fears and misconceptions about modern contraceptives among clients, CHWs, clinicians and community leaders. The project introduced Afghanistan's first injectable services with CHWs initiating the method. Contraceptive prevalence data was collected directly from CHW community maps from October 2005 to June 2006 and externally verified by household visits.

In the three areas, we found major increases in contraceptive prevalence rates (CPR): from 9 to 34; 20 to 44; and 24 to 51 in eight months. Method-specific changes in CPR in Ghazni, Herat, and Kabul sites showed: injectables increased substantially in all three areas; oral contraceptives and condoms each increased in one area only. Diversity of contraceptive method preferences was notable, despite similar services.

Following dialogue and discussion, religious leaders, Sunni and Shia, supported the health rationale for increased birth spacing and modern contraceptives. Some provided contraceptive education during Friday prayers. CHWs successfully and safely provided first injections, convincing the MOPH to change its policy for CHWs to initiate injectable contraceptives. Documented achievements at the community level resulted in policy changes to improve access for injectable and oral contraceptives nation-wide.