Afghanistan: Accelerating contraceptive use with religious leaders—global lessons for faith to action Douglas Huber, MD, MSc Christian Connections for International Health American Public Health Association, Boston, MA 4 November 2013 Implemented by Management Sciences for Health, the Afghan Ministry of Public Health and Afghan NGOs Supported by the William and Flora Hewlett Foundation

Reception of Health Post Signs The signboards helped improve effort and quality of CHWs work. Visible for the newly returned people. Looks more official Looks more official

Afghanistan: MMR 1600; TFR 6.7; CPR 5-10 “the fastest, easiest, cheapest way to prevent maternal deaths is with contraception” One in seven women will die from pregnancy and childbirth in Afghanistan

Why a pilot project on birth spacing? Reduce maternal deaths through increased contraception use Identify elements of success for family planning Advocacy for contraceptive use with community, religious leaders, and health professionals

Pilot Interventions Pilot Interventions Injection initiative: CHWs giving first injection--Mullahs & community approval Simple materials 1) essential contraceptive guidance for all households; 2) providers received same & management of side effects Condom pictorial instructions: partial acceptance and use; religious leaders key

Main message Wait 2 years after childbirth before trying to become pregnant again, achieving 3 years birth spacing Effective contraceptive method needed for 18+ months, starting about 2 months after delivery – (many Afghan women supplement breastfeeding early) 3 years birth spacing important for child and maternal health

Teachings of Islam and Rationale for Healthy Timing and Spacing of Pregnancy (HTSP) “The Prophet Mohammed taught the importance of birth spacing 1400 years before science documented the health benefits for women and children” Pashtoon Mullah, Farza, Kabul Pr.* * Discussion in Farza when explaining improved health outcomes with 3+ year birth intervals-D. Huber, 2005 * Discussion in Farza when explaining improved health outcomes with 3+ year birth intervals-D. Huber, 2005

Contraceptive prevalence from community maps

Midwife providing Injection of DMPA (Depo-Provera) Mullah (also a CHW) demonstrating injectable contraception

Religious Leader Support for Afghan Birth Spacing Project Approval of each innovation crucial for new birth spacing initiative in community RL needed correct information on methods— of 37 mullahs in areas, none disapproved RL educated communities for 3+ year birth intervals and need for contraception Advocated for contraceptive use on national television

Lessons learned Change agents: Minister of Public Health, Afghan NGOs, MSH, Donors—USAID, Wld Bk, EU, Islamic leaders Ministry of Health endorsed project as a “best practice” for national scale-up Dissemination: Afghan TV (Minister), WHO Bulletin, conferences, print media (Associated Press), BBC/The World, internet/Google

The “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 A global interfaith Network of faith organizations advocating for family health and wellbeing-- maternal and child health, reproductive health, & family planning F2A calls on governments & other partners to collaborate Network recognises the importance of access to information and quality services on family planning to enable families to plan the timing and spacing of pregnancies consistent with their faith.