Management Sciences for Health

This Management Sciences for Health (MSH) Occasional Paper presents a culturally sensitive approach to family planning in Afghanistan that is reported to yield results through the "Accelerating Contraceptive Use" project. According to the paper, MSH achieved increases of 24–27 percentage points in the contraceptive prevalence rate in three rural areas of Afghanistan from 2004 to 2006. Although cultural factors and misconceptions about family planning presented obstacles, it was found that religion in Afghanistan, which is 99% Muslim, is not a barrier to expanding family planning services. Strategies found to support rapid scale-up of contraceptive use include: emphasising the use of birth spacing to protect the health of mothers and children, engaging clinicians and communities in culturally sensitive ways, increasing the number of female community health workers, and providing activities to empower women, including a health-oriented literacy programme.


The project in Afghanistan, funded by the William and Flora Hewlett Foundation, built on the work of United States Agency for International Development (USAID)-funded Rural Expansion of Afghanistan’s Community-based Healthcare (REACH) programme, to provide family planning services at the community level in post-Taliban Afghanistan, where contraceptive services had been banned between 1996 and 2001. This paper provides an overview of family planning in Afghanistan in its sociocultural and religious context and explores what constitutes culturally sensitive family planning services in Afghanistan. Key elements of success cited in the document include:

Recommendations from the document include:

1. "Provide family planning services to help reduce maternal deaths where there are gaps in maternal health services.
2. Emphasize the health of mothers and children in family planning and birth spacing messages. REACH information, education, and communication materials and messages conveyed the viewpoint that a smaller family makes a better economic life for all. While this message is well accepted by many Afghans, traditional Afghan communities with no family planning services may accept the importance of maternal/child health more readily than the economic benefits of family planning. In this setting, the birth spacing aspect of family planning should be emphasized.
3. Do not assume that local NGOs understand or support community-based health care... NGOs that establish rapport and build trust with their communities are more likely to have successful family planning programs in Afghanistan regardless of the nationality of the organization and its staff.
4. Question unproven assumptions that narrow the potential for success...Those who implement family planning projects should not assume that family planning is a taboo subject even in the most traditional communities. They should start working with the community (both men and women) through community members and structures, and design activities that are feasible and acceptable to the community."

Email from Ryan Pierce to The Communication Intiative on November 19 2007.