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Introduction of Jadelle in

AfghanistanApril 2, 2014

Family Planning to Prevent High Risk Pregnancies

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TFR: 5.1

Rural: 5.2

Urban: 4.7 Age: Higher rural fertility rate

particularly evident in

15-24 year olds

40-49 year olds

Source: Afghanistan Mortality Survey

2010

BACKGROUND

FERTILITY RATES

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BACKGROUND

MATERNAL MORTALITY

No national vital registration system in Afghanistan

Afghanistan Mortality Survey 2010:

Pregnancy Related Mortality Ratio (PRMR): 327deaths/100,000 live births

Risk of Pregnancy Related Mortality highest in younger(15-19 years) and older (35-49 years)

Rural vs. Urban (417 vs. 95 with 79% population rural)

Lower than previous estimates Higher than Bangladesh, Nepal, Pakistan

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BACKGROUND

CONTRACEPTIVE USE

Current use of contraception by married women ages 15-49 years

Modern Methods: 20% (Urban: 31.7%; Rural: 17.2%)

Injectables: 7.2%

Pills: 6.0%LAM: 4.0%

Condoms: 2.0%

IUD: 1.4%

Implants: 0.0%

Source: Afghanistan Mortality Survey 2010

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Islam and Birth Spacing/Family PlanningNational Conference 2012

RESOLUTION

Temporary birth spacing by withdrawal and using

medications such as tablets, capsules, injections and

subcutaneous implants, intrauterine device insertionand use of condom is allowed

Permanent sterilization of a man or woman is not

allowed, as sterilization is permanent contraception.

ISLAM AND BIRTH SPACING

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BACKGROUND FOR INTRODUCTION OF JADELLE

Ministry of Public Health collaboration with UNFPA, Marie Stopes

International, Afghan Family Guidance Association

3 year advocacy effort to get contraceptive implants on the

National Essential Drug List

Challenges of this effort

Previous provider trainings by MSI, but no product available

UNFPA donated 5000 units of Jadelle to the MOPH

Pathfinder International program: introduction of Jadelle

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PROJECT OBJECTIVES

Collaborative Stakeholder Meeting: Review, revision, finalization of

training and clinical guidelines

IEC/BCC Materials - development and translation

Stakeholders, providers, clients

Demand creation

Training of the trainers5 master trainers

Training Resource Package (TRP) for implants

Training and translation

Training of provincial trainers15 provincial providers

Trainers returned to their home provinces with supply of Jadelle

and necessary supplies

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IEC/BCC MATERIALS

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Training Resource Package

(TRP) for Implants (WHO,

UNFPA, USAID)

Classroom Curriculum

Clinical Curriculum

Comprehensive checklist

JADELLE TRAINING

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TRANSLATION OF THE TRP

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TRAINING RESULTS

Training of Trainers

Five obstetrician gynecologists and one midwife

31 clients received Jadelle during training

Training of Provincial Trainers

16 provincial providers

106 clients received Jadelle during training

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LIMITED DEMOGRAPHIC DATA : CLIENTS SERVED

Age distribution of clients served/Jadelle acceptors:

15-24 years: 14%

25-39 years: 80%

40-49 years: 6%

Average parity by client age:

15-24 years: 2.2 children

25-39 years: 5.3 children 40-49 years: 7.8 children

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SUMMARY

In Afghanistan, a Muslim country which recognizes the importance of birth

spacing, but prohibits abortion and birth limiting by sterilization, long acting

reversible methods such as contraceptive implants can be important in

addressingunmet need and reducing maternal mortality throughout thereproductive life course of women.

This limited program suggests that 1) there is demand for long acting

reversible contraception amongst Afghan women of all reproductive ages

(often supported by their husbands), and 2) contraceptive implants can be an

acceptable and desirable method in such settings.

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OPPORTUNITIES

In a Muslim country, such as Afghanistan, withhigh maternal mortality, high unmet need, and alarge underserved rural population, long actingreversible contraception can potentially servemany women through out their reproductive lifecourse.

CHALLENGES

Commodity supply

Provider/work force shortage in less

accessible regions Continued conflict

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For more information contact Linda Suttenfield

Lsuttenfield@pathfinder.org