Religious Leaders and Religious Leaders and Accelerating Contraceptive Accelerating Contraceptive Use in Afghanistan Use in Afghanistan Douglas Huber Douglas Huber Christian Connections for International Christian Connections for International Health Conf. Health Conf. 26 May, 2008 26 May, 2008 Bishop Claggett Center, Buckeystown, MD Bishop Claggett Center, Buckeystown, MD Management Sciences for Health, Ministry of Management Sciences for Health, Ministry of Public Health and Afghan NGOs Public Health and Afghan NGOs Supported by the William and Flora Hewlett Supported by the William and Flora Hewlett Foundation Foundation
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Religious Leaders and Accelerating Contraceptive Use in Afghanistan Douglas Huber Christian Connections for International Health Conf. 26 May, 2008 Bishop.
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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
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