The family planning conundrum in Afghanistan.

Introduction In Afghanistan, despite the high awareness levels of contraceptive methods, the contraceptive prevalence is low and short birth spacing is common. The aim of this study was to understand the perception about family planning and contraceptive utilization among reproductive-aged married women, their husbands, their mothers-in-law, religious leaders and healthcare providers. Methods Focus group discussions and semi-structured interviews were conducted among married women of reproductive age (n = 482), their husbands (n = 133), their mothers-in-law (n = 194), their religious leaders (n = 16), and healthcare providers (n = 36) in rural and urban areas in five provinces. Results Bigger family size was generally considered as desirable for emotional, economic and social well-being. The majority endorsed contraception. However, some religious scholars and their followers argued that contraception is a sinful act in Islam by interpreting contraception as equivalent to infanticide and suppression of the increase of the Muslim population. Healthcare providers attempted to disseminate health benefits of modern contraception on a family basis. However, fear of various side effects and doubts about their effectiveness due to irregular supply were prevalent in communities. Discussion It is important to increase awareness on the health benefits of appropriate birth spacing at community level. Public health campaigns supported by Islamic religious scholars and a system that ensures appropriate counselling and a steady supply of contraceptives are likely to increase contraceptive utilization.