Afghanistan: Accelerating contraceptive use with religious leaders—global

lessons for faith to action

Douglas Huber, MD, MScDouglas Huber, MD, MSc

Christian Connections for International HealthChristian Connections for International Healthwww.ccih.org

American Public Health Association, American Public Health Association, Boston, MA 4 November 2013Boston, MA 4 November 2013

Implemented by Management Sciences for Health, the Afghan Ministry of Implemented by Management Sciences for Health, the Afghan 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

Reception of Health Post SignsReception of Health Post Signs

The signboards helped improve The signboards helped improve effort and quality of CHWs work.effort and quality of CHWs work.

Visible for the newly returned Visible for the newly returned people.people.

Looks more official Looks more official     

Afghanistan: MMR 1600; TFR 6.7; CPR 5-10 Afghanistan: MMR 1600; TFR 6.7; CPR 5-10 “the fastest, easiest, cheapest way to prevent “the fastest, easiest, cheapest way to prevent

maternal deaths is with contraception”maternal deaths is with contraception”

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

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

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 1) essential contraceptive guidance for all households; 2) providers received same & all households; 2) providers received same & management of side effectsmanagement of side effects

Condom pictorial instructions: partial acceptance and Condom pictorial instructions: partial acceptance and use; religious leaders key use; religious leaders key

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

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

Contraceptive prevalence from community Contraceptive prevalence from community mapsmaps

Midwife providing Midwife providing Injection of DMPA Injection of DMPA (Depo-Provera)(Depo-Provera)

Mullah (also a Mullah (also a CHW) CHW) demonstrating demonstrating injectable injectable contraceptioncontraception

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

Approval of each innovation crucial for new Approval of each innovation crucial for new birth spacing initiative in communitybirth spacing initiative in community

RL needed correct information on methods—RL needed correct information on methods—of 37 mullahs in areas, none disapprovedof 37 mullahs in areas, none disapproved

RL educated communities for 3+ year birth RL educated communities for 3+ year birth intervals and need for contraceptionintervals and need for contraception

Advocated for contraceptive use on national Advocated for contraceptive use on national televisiontelevision

Lessons learnedLessons learnedChange agentsChange agents: Minister of Public Health, : Minister of Public Health, Afghan NGOs, MSH, Donors—USAID, Wld Bk, Afghan NGOs, MSH, Donors—USAID, Wld Bk, EU, Islamic leadersEU, Islamic leaders

Ministry of Health endorsed project as a “best Ministry of Health endorsed project as a “best practice” for national scale-uppractice” for national scale-up

DisseminationDissemination: Afghan TV (Minister), WHO : Afghan TV (Minister), WHO Bulletin, conferences, print media (Associated Bulletin, conferences, print media (Associated Press), BBC/The World, internet/GooglePress), BBC/The World, internet/Google

The “Nairobi Declaration”, June 2011The “Nairobi Declaration”, June 2011

In this Declaration, we commit to leveraging our networks to support family health by providing education and services that enable families to plan the timing and spacing of their pregnancies consistent with their faith. We call on others to support this initiative to influence government and donor policies and funding.

Endorsed by over 200 organizations, Muslim, Christian, Hindu, Buddhist

Faith to Action (F2A) Network Faith to Action (F2A) Network A global interfaith Network of faith organizations A global interfaith Network of faith organizations advocating for advocating for family health and wellbeing--family health and wellbeing--maternal and child health, reproductive health, & maternal and child health, reproductive health, & family planningfamily planning

F2A calls on governments & other partners to F2A calls on governments & other partners to collaborate collaborate

Network recognises the importance of access to Network recognises the importance of access to information and quality services on family planning information and quality services on family planning to enable families to plan the timing and spacing of to enable families to plan the timing and spacing of pregnancies pregnancies consistent with their faithconsistent with their faith. .