Afghanistan is a collective society, which means discussing many issues is kind of a taboo. For example, there's not an open space to talk about sexual education including contraceptive methods, in families and societies.
Apart from being taboo, there is a real lack of knowledge. This, coupled with a radical mindset complicates things even further. People (especially in rural areas) don't have access to basic health services like proper vaccination or check-ups to deliver their babies in the clinics.
Using contraceptive methods is one of the things that people are not aware of due to a lack of access, the silencing of women on the subject and their lack of power to ensure their male partners use it.
Habiba is 60 years old and mother to 13 children, from the Sayed Karam district of Paktia. She was very young when she got engaged, and then married when she was 17 or 18. After marrying she moved to a rural village and was working on the wheat farms.
“When I was young, we could not even have access to sufficient hygiene materials like soap let alone contraceptive materials - we didn't even know about them, that’s why I have so many children.” Her husband was the only child of the family, and her mother-in-law was saying they should have more kids to widen the family population.
“I didn't know that so many pregnancies weren't good for my health - apart from poverty and illiteracy the services were not available. I'm happy that my sister-in-law knows and utilizes it (contraception)."
Habiba was not only mum to 12 living children (one died as a baby), she was also going to the mountains to collect firewood, working on the farm, milking cows, and taking care of the household. “If I hadn't been through so many pregnancies, I would feel younger than I do now.”
Habiba's fate is unfortunately not uncommon. Farahnaz is 49 years old and a mother to seven children - she moved from Kabul to the southern province of Ghazni when she got married. After two babies, she tried an injection as a contraceptive in the provincial hospital in their city, but she was in bed for one year and bleeding.
After that, she and her husband realised the injection wasn't working, and she proceeded to fall pregnant five more times.
“There was only a provincial hospital in the city and the influx of people was quite high. We did not know about more than the injection and some neighbours tried home pharmacology from some Sikh community available in the city which makes them sterile, and I was afraid of that and did not try it.”
On the other side of the parental coin, Akbarbai is 58 years old and Dad to nine kids in the Badakhshan province of Afghanistan. He's a farmer and believes using contraception is something for Western culture and is haram in Islam.“When God gives us, the kids give their sustenance as well. I did not know about these methods before but now I heard from someone, and I think these methods are brought by westerners in our country and want to reduce the population of Muslims.”
Mahrukh has four kids and studied till intermediary school before she got married and moved from Jalalabad to Kabul. She lives in the Dehsabz area of Kabul together with her in-laws in a big house.“There are some organizations that are surveying and distributing contraceptive materials based on the ages of the women. I get condoms every time their doctors come to our village but it’s very difficult to convince my husband to use them," Mahrukh says.
Thankfully, not all men are as hard to convince. Mukhtar a business owner and father of six tells me he uses condoms whenever he and his wife have sex. “For our parents it wasn't accessible to buy, or they did not know about it but for my generation it’s easy to buy and use it because it will help to have a better family planning.”
Mukhtar also mentioned that he buys the materials easily from pharmacists in the city. Unfortunately, not all pharmacies find it that easy. Pharmacist Mohammad Zahir says his business can’t sell condoms freely except to their reliable clients because the Taliban fighters interrupt them and remind them it’s Haram in Islam. “There are some people who are looking for condoms or pills, but we can’t sell them except the medical prescriptions, or we know them and make sure they won’t create problems for us," said Mohammad Zahir
In recent months, the Guardian published an article that the Taliban had banned the selling of contraceptive materials in the market. I tried to reach out to the Ministry of Public Health of the Taliban (the de facto regime) but they did not answer my calls.
Dr. Anas works as a health officer for one of the organizations which supports over 50 clinics across the country. Based on his experience working in very rural areas of Afghanistan, education about contraceptives is very low.
“In some parts of the country people believe using condoms is only for relations out of marriage that’s why it’s a taboo and shame and in some parts of the country people are not even aware of such methods.”
At the same time Dr. Farangis Karimi who is a gynaecologist working in one of the hospitals in Kabul says apart from lack of access or knowledge people count and believe it is a sin to use contraceptive methods. Only 5 - 7 percent of people know or use these methods in the whole country.
Dr. Farangis and Dr. Anas both confirmed people are interested in using tablets to prevent pregnancy and that women's need for suspension or break between pregnancies is often frowned upon because of community cultural sensitivity standards.
“If I have 100 patients in a week, only 10 of them may look for contraceptive methods. At the same time, lack of a break between pregnancies may cause death, mental and physical health problems not to mention negatively impacting the infant's access to nutrition," Dr Farangis says.
Dr. Anas believes education and health for families are very important. Lack of family planning creates a lot of problems like lack of nutrition for children, plus negative impacts on their education and health “If the education level of people is lower their knowledge about their health and wellbeing is lower and they are dependent on an old mindset,” added Dr. Anas
In the last 20 years, the World Health Organization, together with many health organizations have been working in support of Afghanistan's Ministry of Public Health to raise awareness, provide health services in the rural and urban areas to change the mindset of the people and provide access to them but it is a long-term path to get to this objective because the community is quite conservative and the lack knowledge is high. Apart from the knowledge, they're fighting against a culture of having so many kids and seeing the kids as a source of investment for your adulthood or senescence.
In Afghanistan where there are not welfare services, families are looking to their kids as a source of income and care for elders - that’s why families believe if they have more, they have preserved more energy for their future without considering the women’s health or the economical impact for rearing so many children. We hope this changes soon.