Afghanistan's Mullahs Help Accelerate Family Planning Use

Women in post-conflict Afghanistan have one of the world's highest lifetime risks of maternal death, one in eight. Years of conflict devastated the country's health infrastructure, total fertility rates remained high, 6.8, contraceptive prevalence rates (CPR) were below 10%, and Afghan models of success for family planning were non-existent. The majority (80%) of the 32.7 million Afghans lived in rural areas and women could not access health services outside their community. With the new Basic Package of Health Services in 2004, rural Afghanistan had 14,000 community health workers (CHWs), half being women. However, family planning was perceived as culturally sensitive, particularly among religious leaders requiring a slow and cautious approach. CHWs were often reluctant providers. INNOVATION TESTED: Modern contraceptives--pills, injectables, condoms--could be introduced rapidly, combining three key approaches: • Program innovations that simultaneously engaged religious and community leaders, CHWs, and couples • Expertise in contraceptive technology and a new health paradigm comparing contraceptive safety to risks of pregnancy • In-depth knowledge of couples and communities