Family Planning to Prevent High Risk Pregnancies

Introduction of Jadelle in Afghanistan

April 2, 2014

BACKGROUND
FERTILITY RATES TFR: 5.1 Rural: 5.2 Urban: 4.7 Age: Higher rural fertility rate particularly evident in 15-24 year olds 40-49 year olds
Source: Afghanistan Mortality Survey 2010

BACKGROUND
MATERNAL MORTALITY No national vital registration system in Afghanistan Afghanistan Mortality Survey 2010: Pregnancy Related Mortality Ratio (PRMR): 327 deaths/100,000 live births Risk of Pregnancy Related Mortality highest in younger (15-19 years) and older (35-49 years) Rural vs. Urban (417 vs. 95 with 79% population rural) Lower than previous estimates Higher than Bangladesh, Nepal, Pakistan

BACKGROUND
CONTRACEPTIVE USE
Current use of contraception by married women ages 15-49 years Modern Methods: 20% (Urban: 31.7%; Rural: 17.2%) Injectables: 7.2% Pills: 6.0% LAM: 4.0% Condoms: 2.0% IUD: 1.4% Implants: 0.0%
Source: Afghanistan Mortality Survey 2010

ISLAM AND BIRTH SPACING

Islam and Birth Spacing/Family Planning National Conference 2012 RESOLUTION

Temporary birth spacing by withdrawal and using medications such as tablets, capsules, injections and subcutaneous implants, intrauterine device insertion and use of condom is allowed Permanent sterilization of a man or woman is not allowed, as sterilization is permanent contraception.

BACKGROUND FOR INTRODUCTION OF JADELLE

Ministry of Public Health collaboration with UNFPA, Marie Stopes International, Afghan Family Guidance Association 3 year advocacy effort to get contraceptive implants on the National Essential Drug List Challenges of this effort Previous provider trainings by MSI, but no product available UNFPA donated 5000 units of Jadelle to the MOPH Pathfinder International program: introduction of Jadelle

PROJECT OBJECTIVES
Collaborative Stakeholder Meeting: Review, revision, finalization of training and clinical guidelines IEC/BCC Materials - development and translation Stakeholders, providers, clients Demand creation Training of the trainers 5 master trainers Training Resource Package (TRP) for implants Training and translation Training of provincial trainers 15 provincial providers Trainers returned to their home provinces with supply of Jadelle and necessary supplies

IEC/BCC MATERIALS

JADELLE TRAINING

Training Resource Package (TRP) for Implants (WHO, UNFPA, USAID) Classroom Curriculum Clinical Curriculum Comprehensive checklist

TRANSLATION OF THE TRP

TRAINING RESULTS
Training of Trainers Five obstetrician gynecologists and one midwife 31 clients received Jadelle during training Training of Provincial Trainers 16 provincial providers 106 clients received Jadelle during training

LIMITED DEMOGRAPHIC DATA : CLIENTS SERVED

Age distribution of clients served/Jadelle acceptors: 15-24 years: 14% 25-39 years: 80% 40-49 years: 6%
Average parity by client age: 15-24 years: 2.2 children 25-39 years: 5.3 children 40-49 years: 7.8 children

SUMMARY
In Afghanistan, a Muslim country which recognizes the importance of birth spacing, but prohibits abortion and birth limiting by sterilization, long acting reversible methods such as contraceptive implants can be important in addressing unmet need and reducing maternal mortality throughout the reproductive life course of women.

This limited program suggests that 1) there is demand for long acting reversible contraception amongst Afghan women of all reproductive ages (often supported by their husbands), and 2) contraceptive implants can be an acceptable and desirable method in such settings.

OPPORTUNITIES In a Muslim country, such as Afghanistan, with high maternal mortality, high unmet need, and a large underserved rural population, long acting reversible contraception can potentially serve many women through out their reproductive life course.

CHALLENGES Commodity supply Provider/work force shortage in less accessible regions Continued conflict

For more information contact Linda Suttenfield Lsuttenfield@pathfinder.org twitter.com/PathfinderInt facebook.com/PathfinderInternational Youtube/user/PathfinderInt