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A new study out of Afghanistan indicates that enlisting the help of Afghan mullahs can dramatically increase the use of birth control in rural villages. The World’s Jeb Sharp reports.

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MARCO WERMAN:  I’m Marco Werman, and this is The World, the co-production of the BBC World Service, PRI, and WGBH in Boston.  A new study out of Afghanistan suggests that enlisting the help of local mullahs can dramatically increase the use of birth control in rural villages.  The study appears in the latest edition of the Bulletin of the World Health Organization.  Experts say the findings are critical in a country with one of the world’s highest rates of maternal mortality.  The World’s Jeb Sharp has details.

JEB SHARP: There’s a lot at stake in Afghanistan when it comes to family planning.  Afghan women have a, quote, “astronomic” risk of dying in pregnancy, according to Douglas Huber, the lead author of the study. (He conducted the study for U.S.-based nonprofit Management Sciences for Health.)

DOUGLAS HUBER: In Afghanistan, after 23 years of warfare and no health services, the studies were showing that women in Afghanistan have one of the highest, if not the highest, lifetime risk of dying in pregnancy – about one in seven women.

SHARP: With that in mind, Huber and his colleagues set out in 2005 and 2006 to see if they could help increase the use of birth control in three ethnically diverse communities.  They worked with local families, health workers and community leaders.  The result, they say, was a substantial increase in the use of contraceptives.  This, in a country generally assumed to be conservative and slow to change.

HUBER: It was really extraordinary.  I think none of us knew what to expect, but what we found was that the problems or the barriers, were not religious or cultural or even men, as is often presumed, but really misconceptions about family planning methods.

SHARP: And especially the safety of those methods.  One common misconception was that injectable contraceptives made women infertile.  Huber says part of the project was simply explaining how contraceptives work and the changes they cause in women’s bodies.  They didn’t just talk to women, they talked to their husbands and to local health workers and religious leaders.  Huber says these conversations included scientific information, but also some traditional teachings from the Koran.

HUBER: I was explaining through an interpreter to one senior Pashtun mullah, the importance of the data and the evidence now that we are finding of how important good birth spacing is for child health outcomes.  And he sort of gently interrupted me and said, “Yes, and the Prophet Mohammed knew this 1400 years before science came along and identified this as a [SOUNDS LIKE] portent health outcome.”  And so I was sitting there on the floor with him and others, and I found myself just nodding and saying, “Well, yes.”

SHARP: Huber has worked in several Muslim countries over the course of a thirty year career.  He says there’s no reason to believe Islam and family planning are incompatible.  Still, he’s careful to point out that this study was not conducted in areas held by the Taliban.  It’s quite possible, he says, that Taliban mullahs would paint such family planning initiatives as a Western idea that goes against the teaching of Islam.  But the study certainly indicates that Afghan culture is not impermeable to change.  Mary Lyn Gaffield, a family planning expert with the World Health Organization, says to the contrary, it suggests there’s a considerable opportunity for change.

MARY LYN GAFFIELD: We don’t realize how much we need to go where we haven’t been before, and that we need to recognize the importance of continually advocating, sending appropriate messages, clarifying misconceptions, always highlighting how family planning plays such a critical role in reducing maternal mortality and improving health of women of reproductive ages and eventually the health in communities.

SHARP: Gaffield says the study is striking for its comprehensive approach, and shows you can accomplish a lot without fancy resources, so long as you’re willing to work with local leaders and figure out what a community needs.  Still, she cautions that the study was short in duration and that the challenge with family planning is often sustaining it over a longer period.

GAFFIELD: There’s no quick fix, and the human resources and dedication that is required to achieve positive results needs to be continually worked upon and continually supported.

SHARP: As a result of the study’s success, there are plans to expand the program nationwide.  For The World, I’m Jeb Sharp.

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