Patooni Basir is a counselor at the Family Planning Unit of Malalai Maternity Hospital in Kabul. Every day she talks to approximately 160 women about birth spacing. "Some of them have eight children with a very short period between the births. This is not healthy for the infant and the mother", she explains.
In Afghanistan, 90 percent of married women know about at least one type of contraception, but only 22 percent uses modern family planning methods. This is because of lack of comprehensive information, inadequate counseling skills among health service providers, limited access to contraceptives, fear of side effects among users and misinterpretation of religious doctrine regarding birth spacing. Also some cultural factors play a crucial role such as son preference and tendency of having large families", explains Dr Abdul Malik Faize, Reproductive Health Officer at UNFPA Afghanistan.
""Most of the patients know about the existence of modern contraceptives, but they don't dare to use it", explains Basir. She was trained on family planning methods by Afghan Family Guidance Association with the technical support of the United Nations Population Fund. UNFPA supplies the Family Planning Unit at Malalai Hospital with modern contraceptives.
Family Planning units inside hospitals play a crucial role on providing information about birth spacing, sometimes involving both partners. This is the case of Malalai Maternity Hospital, the only hospital in Kabul which has a special unit for male counseling.
"We often get questions from men about family planning. Most of them think it's harmful for their wives to use contraceptives or that they are against Islamic values", says Basir. "In that case I sit together with the couple and explain them the benefits of birth spacing and family planning, sometimes using verses from Islamic literature and verses from the Holy Quran to assist them."
In Afghanistan, most women still need permission from their husbands and mother in laws to use family planning methods. When men seek advice from male health service providers they are often dissuaded. This is a major constraint in promoting the use of contraceptives. To address this, UNFPA and the Ministry of Public Health trained in 2015 almost 800 health service providers, 350 of them men, on family planning to improve male involvement. Further to update the knowledge and skills of health service providers, UNFPA translated and adapted global and national guidelines and tools such as the Medical Eligibility Wheel and the Global Family Planning Handbook for Providers.
UNFPA works with the Ministry of Public Health to provide couples and women the knowledge and means to space their children's births which is essential to reduce the high maternal and infant mortality rates in Afghanistan and also to empower Afghan women and to improve their socio economic position in the society.
In response to the Ministry's request, UNFPA also provides contraceptives to government health facilities which are not otherwise supported by donors.