Individual Counseling, Religious Support Increase Contraceptive Use In Afghanistan, WHO Study Finds

Birth control use in three rural areas of Afghanistan increased over an eight-month period after health workers explained the benefits of contraception in individual counseling sessions, according to a report published Monday in the World Health Organization's journal Bulletin, the AP/Yahoo! News reports. Afghanistan has one of the highest fertility rates in the world, with an average of more than six infants per woman. Awareness and use of contraception remains low among many Afghans, with about 10% of women using some form of birth control, according to UNICEF estimates. The country has a maternal mortality rate of 1,800 maternal deaths per 100,000 live births, making it second only to Sierra Leone worldwide, according to UNICEF. The U.S. maternal mortality rate is 11 maternal deaths per 100,000 live births.

For the study, the Afghanistan Health Ministry from 2005 to 2006 worked with not-for-profit organizations to reach out to 3,700 families. The families covered three rural areas with different ethnic groups, including both Sunni and Shia Muslims. The health workers told participants that using birth control was 300 times safer than giving birth in Afghanistan and tried to dispel beliefs that contraception can have negative side effects, such as infertility. They also used quotes from the Quran to encourage women to breastfeed for at least two years and to promote longer breaks between births. The discussions included husbands and local religious leaders called mullahs. According to the AP/Yahoo! News, Islam does not fundamentally oppose birth control, and various parts of the Muslim world support "[e]verything from vasectomies to abortions."

According to the study, contraceptive use increased to 27% in all three areas, reaching up to 50% of women in one area. Thirty-seven mullahs endorsed contraceptive use as a way to increase time between births, with some offering the message during Friday prayers. Douglas Huber -- lead author of the study, conducted for the U.S.-based Management Sciences for Health -- said, "The main take-home point is that for women who do not want to be pregnant now, it can be a double tragedy for her to die from a pregnancy she did not want especially when we could have helped her." He added that the "fastest, cheapest, easiest way to reduce maternal deaths in Afghanistan is with contraception."

According to Huber, the Health Ministry plans to expand the program with help from USAID, the European Union and the World Bank. Matthews Mathai, a maternal health expert at WHO, said, "It's good to see there are results coming out of Afghanistan," adding, "Clearly, it takes the religious leaders and the men to get some change." However, he cautioned that the program's costs, combined with continuing conflict in the region, could make it difficult to expand nationally (Mason, AP/Yahoo! News, 3/2).


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