Religious Leaders and Accelerating Religious Leaders and Accelerating Contraceptive Use in AfghanistanContraceptive Use in Afghanistan

Douglas HuberDouglas HuberChristian Connections for International Health Conf.Christian Connections for International Health Conf.

26 May, 200826 May, 2008Bishop Claggett Center, Buckeystown, MDBishop Claggett Center, Buckeystown, MD

Management Sciences for Health, Ministry of Management Sciences for Health, Ministry of Public Health and Afghan NGOsPublic Health and Afghan NGOs

Supported by the William and Flora Hewlett FoundationSupported by the William and Flora Hewlett Foundation

Why a pilot project on birth spacing?Why a pilot project on birth spacing?

Reduce maternal deaths through Reduce maternal deaths through increased contraception useincreased contraception use

Identify elements of success for family Identify elements of success for family planningplanning

Advocacy for contraceptive use with Advocacy for contraceptive use with community, religious leaders, and health community, religious leaders, and health professionals professionals

The fastest, easiest, cheapest way The fastest, easiest, cheapest way to prevent maternal deaths is with to prevent maternal deaths is with

contraceptioncontraception

One in seven women will die from pregnancy and One in seven women will die from pregnancy and childbirth in Afghanistanchildbirth in Afghanistan

Main messageMain message

Wait 2 years after childbirth before trying to Wait 2 years after childbirth before trying to become pregnant again, achieving 3 years birth become pregnant again, achieving 3 years birth spacing spacing

Effective contraceptive method needed for 18+ Effective contraceptive method needed for 18+ months, starting about 2 months after deliverymonths, starting about 2 months after delivery– (many Afghan women supplement (many Afghan women supplement

breastfeeding early)breastfeeding early)

3 years birth spacing important for child and 3 years birth spacing important for child and maternal health maternal health

Three years birth spacing needed Three years birth spacing needed for health of children and mothersfor health of children and mothers

Main approachMain approach Main message supported by Holy Quran:Main message supported by Holy Quran:

And mothers shall suckle their children two And mothers shall suckle their children two full years for those who wish to complete full years for those who wish to complete

breast-feeding breast-feeding Bagara (Sura 2:233) Bagara (Sura 2:233)

Birth spacing in community based on Birth spacing in community based on updating correct information on updating correct information on contraceptives contraceptives

Teachings of Islam and Rationale for Healthy Teachings of Islam and Rationale for Healthy Timing and Spacing of Pregnancy (HTSP)Timing and Spacing of Pregnancy (HTSP)

““The Prophet Mohammed taught the The Prophet Mohammed taught the importance of birth spacing 1400 years importance of birth spacing 1400 years before science documented the health before science documented the health benefits for women and children” benefits for women and children” Pashtoon Pashtoon Mullah, Farza, Kabul Pr.*Mullah, Farza, Kabul Pr.*

**Discussion in Farza when explaining improved health outcomes Discussion in Farza when explaining improved health outcomes with 3+ year birth intervals-D. Huber, 2005with 3+ year birth intervals-D. Huber, 2005

““Myths and Reality” about family planning Myths and Reality” about family planning methods—correct misconceptionsmethods—correct misconceptions

Disseminated “Myths and Reality” based Disseminated “Myths and Reality” based on misconceptions about contraception: on misconceptions about contraception: e.g. pills and injectables cause infertilitye.g. pills and injectables cause infertility

Distributed through NGOs and widely Distributed through NGOs and widely through REACH to 2400 health providersthrough REACH to 2400 health providers

Pilot InterventionsPilot Interventions Injection initiative: CHWs giving first injection--Mullahs & Injection initiative: CHWs giving first injection--Mullahs & community approvalcommunity approval

Simple materialsSimple materials 1) essential contraceptive guidance for all 1) essential contraceptive guidance for all households; 2) providers received same & management of households; 2) providers received same & management of side effectsside effects

Health Post sign boardHealth Post sign board

Condom pictorial instructions: acceptance and use; relig Condom pictorial instructions: acceptance and use; relig leaders key leaders key

Contraceptive prevalence from community Contraceptive prevalence from community mapsmaps

Community awarenessCommunity awareness

Religious leaders awareness on FPReligious leaders awareness on FP

Mullah, Sayed Hasson:Mullah, Sayed Hasson: “I examined the issue of “I examined the issue of contraception planning from the perspective of Islam. contraception planning from the perspective of Islam. The prophet of Islam was aware that some Moslems The prophet of Islam was aware that some Moslems were using a simple method. He did not forbid them. were using a simple method. He did not forbid them. Also we can find verses in the Holy Quran that Also we can find verses in the Holy Quran that persuade people to prevent life risks. We see persuade people to prevent life risks. We see frequent births as a risk to life--these should be frequent births as a risk to life--these should be prevented. I always pass this message to the people prevented. I always pass this message to the people on Friday before the pray. on Friday before the pray.

Reception of Contraceptive Reception of Contraceptive Guidance BrochuresGuidance Brochures

People used and welcomed brochures; illiterate People used and welcomed brochures; illiterate women asked others to readwomen asked others to read

Many people retained the brochure in their Many people retained the brochure in their households, especially with quote from the Holy Quranhouseholds, especially with quote from the Holy Quran

Lessons learnedLessons learned

Correcting misinformation about contraceptives Correcting misinformation about contraceptives is very important for RL, community, and health is very important for RL, community, and health staffstaff

Brochures with brief contraceptive guidance Brochures with brief contraceptive guidance useful for women, men and CHWs, including useful for women, men and CHWs, including quote from Holy Quranquote from Holy Quran

CHWs can be very effective for increasing CHWs can be very effective for increasing contraceptive usecontraceptive use

Lessons learned (cont)Lessons learned (cont)

Ethnic and cultural differences not a barrier for Ethnic and cultural differences not a barrier for contraceptioncontraception

Community and religious leaders, when well informed, Community and religious leaders, when well informed, will support birth spacing and modern contraceptives will support birth spacing and modern contraceptives

Contraceptive method preferences vary widely; Contraceptive method preferences vary widely; leadership of mullahs may determine method mixleadership of mullahs may determine method mix

NGOs, MoPH, and donors should plan for increased NGOs, MoPH, and donors should plan for increased contraceptive use with RL supportcontraceptive use with RL support

Religious Leader Support for Afghan Religious Leader Support for Afghan Birth Spacing ProjectBirth Spacing Project

Approval crucial for new birth spacing Approval crucial for new birth spacing initiative in communityinitiative in community

RL concerns addressed with correct RL concerns addressed with correct information on methods—of 37 mullahs in information on methods—of 37 mullahs in areas, none disapproved and many actively areas, none disapproved and many actively supported the projectsupported the project

RL advocated for 3+ year birth intervals and RL advocated for 3+ year birth intervals and need for contraceptionneed for contraception

Religious Leaders and Afghan Religious Leaders and Afghan Birth Spacing Project, cont.Birth Spacing Project, cont.

Reviewed and approved each innovation—Reviewed and approved each innovation—e.g., CHWs giving first injection, quotations e.g., CHWs giving first injection, quotations from the Holy Quran on brochuresfrom the Holy Quran on brochures

Actively educated the communityActively educated the community

Advocated contraceptive use on national Advocated contraceptive use on national televisiontelevision

Scaling Up: Next StepsScaling Up: Next Steps

Expand correct contraceptive information for Expand correct contraceptive information for public, relig ldrs, health professionalspublic, relig ldrs, health professionals

Make contraception Make contraception easy and simpleeasy and simple for for providers and clients—use HTSP providers and clients—use HTSP

Strengthen community services with CHWsStrengthen community services with CHWs

Link CHWs with community leaders’ committee Link CHWs with community leaders’ committee (Shura) and health facilities(Shura) and health facilities

Scaling Up: Plans for SuccessScaling Up: Plans for Success

Ministry of Health endorsed project as Ministry of Health endorsed project as “best practice”“best practice”

USAID plans nationwide scale-up of USAID plans nationwide scale-up of projectproject