Community-based Postpartum Family Planning in Afghanistan

Purpose: To introduce and expand community-based postpartum family planning (PPFP) services in Afghanistan.

Methods: The four-pronged program approach includes: 1) advocacy to educate on PPFP messages; 2) in-service training to build capacity of health workers to deliver PPFP services; 3) supportive supervision; and 4) integration of PPFP into national policies to create an enabling environment. Household visits are conducted by trained community health workers (CHWs) to women during pregnancy and postpartum for education on essential maternal and newborn care and complementary information on PPFP, including promotion of the lactational amenorrhea method and exclusive breastfeeding, benefits of birth-to-pregnancy intervals of at least 24 months, and return to fertility. Based upon the mother's fertility intentions, the CHW can provide oral contraceptive pills, injection, or condoms, and refers to the health facility for other contraceptive methods.

Results: Since the intervention was launched in2007, activities have expanded to 34 provinces. The Ministry of Public Health household survey results in 13 USAID supported provinces from 2007 to 2010 show that contraceptive prevalence rate increased from 35.7% to 40.6% and knowledge on the number of modern contraceptive methods increased from 63.2% to 70.5%. Health Management Information System Data for family planning services in health posts in 13 provinces reveal an increase in clients in all four quarters from 2006 to 2011.

Recommendations: Other opportunities to integrate PPFP services into maternal and child health, expanded program for immunization, and infant and young child nutrition should be explored so no opportunities are missed to provide essential PPFP services.