W children Figure 6.5, as compared with the

104 • Family Planning

7.1 C

ONTRACEPTIVE K NOWLEDGE AND U SE Knowledge of contraceptive methods is high in Afghanistan, with 95 of currently married women and 92 of married men knowing at least one method of contraception. Pills, injectables, and male condoms are the most widely known methods among both women and men. For more information on contraceptive knowledge by method, see Table 7.1 and Figure 7.1. Awareness of contraceptive methods is very poor among currently married women and men in Nooristan relative to those in other provinces, with only 32 of women and 59 of men having ever heard of any modern methods Table 7.2. Contraceptive prevalence rate Percentage who use any contraceptive method. Sample: Currently married women age 15-49 Table 7.3.shows the percent distribution of currently married women by the contraceptive method they currently use. Overall, 23 of currently married women use a method of family planning, with 20 using a modern method and 3 using a traditional method Figure 7.2. Figure 7.1 Knowledge of contraceptive methods Figure 7.2 Contraceptive use 95 94 89 87 65 49 23 62 32 48 15 50 92 91 84 79 72 53 34 33 22 34 17 65 Any method Any modern method Pill Injectables Male condom Female sterilization Male sterilization IUD Implants LAM Emergency contraception Traditional method Percentage of currently married women and men age 15-49 who have heard of specific contraceptive methods Women Men 23 20 7 5 3 2 1 1 3 Any method Any modern method Pill Injectables Male condom Female sterilization IUD Implants Traditional method Percentage of currently married women age 15-49 currently using a contraceptive method Family Planning • 105 Modern methods Include male and female sterilization, injectables, intrauterine devices IUDs, contraceptive pills, implants, male condoms, and the lactational amenorrhea method LAM. Among currently married women, the most popular methods are the pill 7, injectables 5, and the male condom 3. Patterns by background characteristics  The contraceptive prevalence rate CPR among married women age 15-49 is higher among those living in urban areas than among those living in rural areas 35 versus 19 Table 7.4.  Modern contraceptive use increases with increasing education. Women age 15-49 who have more than a secondary education 30 are more likely to use modern methods of contraception than those with no education 19 Figure 7.3.  Wealth is directly related to use of modern contraception. For instance, women in the highest wealth quintile are twice as likely to use modern contraception as those in the lowest quintile 31 versus 15.  Use of modern contraceptive methods varies by province, from a high of 58 in Herat to a low of 1 in Nooristan Figure 7.4. Figure 7.3 Use of modern methods by education 19 22 26 30 20 No education Primary Secondary More than secondary Total Percentage of currently married women age 15-49 currently using a modern contraceptive method 106 • Family Planning Figure 7.4 Modern contraceptive use by province Percentage of currently married women age 15-49 currently using a modern contraceptive method

7.2 S

OURCE OF M ODERN C ONTRACEPTIVE M ETHODS Source of modern contraceptives Place where the modern method currently being used was obtained the last time it was acquired. Sample: Women age 15-49 currently using a modern contraceptive method excluding LAM The public and private health sectors are equally popular as sources of contraception in Afghanistan Figure 7.5. Most current users obtain pills 59 and condoms 55 from the private medical sector, while the public sector is more often the source for female sterilization 68, IUDs 59, and injectables 62 Table 7.6.  Female sterilization: Sterilized women were much more likely to have had the procedure at a government hospital 67 than at a private hospital 18.  Male condoms: Private pharmacies are the predominant sources for male condoms 50, followed by government hospitals 13. Figure 7.5 Source of modern contraceptive methods Public sector, 47 Private medical sector, 47 Non- government sector, 1 Other source, 4 Percent distribution of current users of modern methods by most recent source of method Family Planning • 107  Pills: The most commonly used method, the pill, is also widely obtained through private pharmacies 45, although one-third of pill users obtain the method from government sources. A large majority of pill users say they use brands that are socially marketed Table 7.7.

7.3 I

NFORMED C HOICE Informed choice Informed choice consists of women being informed at the time they started the current episode of method use about side effects of the method, what to do if they experience side effects, and other methods they could use. Sample: Women age 15-49 who are currently using selected modern contraceptive methods and who started the most recent episode of use within the 5 years before the survey More than half of all ever-married women using modern contraceptives were informed about side effects or other problems with the method they used 53 and what to do if they experienced side effects 42. Sixty-four percent of women were informed of other methods they could use Table 7.8. Women receiving services from a public sector source are more likely to be informed about the possible side effects of the method 60, what to do if they experienced side effects 51, and other methods that they could use 70 than those receiving services from a source in the private medical sector 41, 30, and 55, respectively.

7.4 D

ISCONTINUATION OF C ONTRACEPTIVES Contraceptive discontinuation rate Percentage of contraceptive initiation episodes discontinued within 12 months. Sample: Episodes of contraceptive use initiated in the 5 years before the survey for women who are currently age 15-49 One out of every four times 26 that women began using a contraceptive method in the 5 years before the survey, they discontinued the method in less than 12 months. Discontinuation rates were highest for the pill, withdrawal, and condoms Table 7.9. The most common reason reported for discontinuation was the desire to become pregnant, followed by method-related side effects and health concerns Table 7.10. Method-related concerns were reported mostly for injectables 28, IUDs 24, and the pill 14. Knowledge of the Fertile Period The survey also collected information on women and men’s knowledge of the fertile period. Only 8 of ever-married women and 7 of ever-married men know that a woman is most likely to conceive halfway between two periods Table 7.11. 108 • Family Planning

7.5 D

EMAND FOR F AMILY P LANNING Unmet need for family planning Proportion of women who 1 are not pregnant and not postpartum amenorrheic and are considered fecund and want to postpone their next birth for 2 or more years or stop childbearing altogether but are not using a contraceptive method, or 2 have a mistimed or unwanted current pregnancy, or 3 are postpartum amenorrheic and their most recent birth in the last 2 years was mistimed or unwanted. Sample: Currently married and ever-married women age 15-49 Demand for family planning: Unmet need for family planning + current contraceptive use any method Proportion of demand satisfied: Current contraceptive use any method Unmet need + current contraceptive use any method Proportion of demand satisfied by modern methods: Current contraceptive use any modern method Unmet need + current contraceptive use any method Overall, 25 of currently married women have an unmet need for family planning, 18 for spacing and 7 for limiting Figure 7.6. Twenty-three percent of women have a met need for family planning or are using a contraceptive method. If all currently married women who say they want to space or limit their children were to use a family planning method, the contraceptive prevalence rate would increase to 47 total demand. Of the total demand for family planning methods, 48 is met through use of any method and 42 through use of modern methods Table 7.12.1. Patterns by background characteristics  Unmet need for family planning is lower among women with more than a secondary education 16 than among women with no education 25.  Twenty-seven percent of married women in the lowest wealth quintile have an unmet need for family planning, as compared with 21 in the wealthiest quintile.  Unmet need for family planning is lowest in Herat 6 and highest in Badakhshan 39 Figure 7.7.  Total demand for family planning methods is 26 in Nooristan, while the percentage of demand satisified by modern methods is only 2, the lowest among all provinces Table 7.12.1. Figure 7.6 Demand for family planning Unmet need for spacing 18 Unmet need for limiting 7 Met need for spacing 11 Met need for limiting 11 No need for family planning 53 Percent distribution of currently married women age 15-49 by need for family planning Family Planning • 109 Figure 7.7 Unmet need for family planning by province Percentage of currently married women age 15-49 by unmet need for family planning Future Use of Contraception The survey also collected information on nonusers’ intentions to use contraception in the future. Twenty- two percent of currently married women age 15-49 who were not using contraception at the time of the survey said that they intended to use family planning in the future, while 42 said that they did not intend to do so Table 7.13. Exposure to Family Planning Messages in the Media Table 7.14.1 offers information on women’s exposure to family planning messages in the media. About one in five ever-married women age 15-49 reported hearing a family planning message in the past few months on the radio 22. Similarly, 29 of women heard a message on television, while only 2 read a family planning message in a newspaper or magazine. Overall, 61 of women had no exposure to family planning messages in any of the three main mass media radio, television, or newspapermagazine. Other sources play important roles in Afghanistan with respect to providing knowledge on family planning, with health professionals 21 and local community leaders 25 being prominent sources. Two in five women are not exposed to family planning messages from any source including media. Patterns by background characteristics  Women in urban areas are more likely to be exposed to family planning messages through the media than those in rural areas. For instance, while 38 of urban women had no exposure to messages on the radio, on television, or in newspapersmagazines, 68 of rural women had no such exposure Table 7.14.1. 110 • Family Planning  Women in rural areas are more likely than urban women to be exposed to family planning messages through local community leaders 27 versus 18.  Education and wealth are strongly related to increased exposure to family planning messages through the various sources among women.  Table 7.14.2 offers similar information on men’s exposure to family planning messages. About one in three ever-married men age 15-49 reported hearing or seeing a family planning message in the past few months on radio 35 and television 34. Exposure to family planning messages through newspapers and magazines 9 is less common. Overall, men are more exposed to family planning messages than women.

7.6 C

ONTACT OF N ONUSERS WITH F AMILY P LANNING P ROVIDERS Contact of nonusers with family planning providers Respondent discussed family planning in the 12 months before the survey with a community health worker or during a visit to a health facility. Sample: Ever-married women age 15-49 who are not currently using any contraceptive methods The vast majority 82 of women age 15-49 who were not using a contraceptive method said they had not discussed family planning with a community health worker or health facility staff member in the 12 months before the survey Table 7.15. Fifteen percent reported discussing family planning with a community health worker and 10 with a provider at a health facility. Patterns by background characteristics  Among nonusers, those who are age 20-39 are more likely to have discussed family planning during a visit with a community health worker than younger age 15-19 or older age 40-49 women Table 7.15.  Women with no education are less likely to have discussed family planning while visiting a health facility 9 than women with more than a secondary education 19.  Women in Bamyan 29, Logar 27, and Faryab 27 are most likely to have discussed family planning while visiting a health facility, while women in Nooristan are least likely to have done so. L IST OF T ABLES For more information on family planning, see the following tables:  Table 7.1 Knowledge of contraceptive methods  Table 7.2 Knowledge of contraceptive methods by background characteristics  Table 7.3 Current use of contraception by age  Table 7.4 Current use of contraception by background characteristics  Table 7.5 Timing of sterilization  Table 7.6 Source of modern contraception methods  Table 7.7 Use of social marketing brand pills and condoms  Table 7.8 Informed choice  Table 7.9 Twelve-month contraceptive discontinuation rates  Table 7.10 Reasons for discontinuation Family Planning • 111  Table 7.11 Knowledge of fertile period  Table 7.12.1 Need and demand for family planning among currently married women  Table 7.12.2 Need and demand for family planning among ever-married women  Table 7.13 Future use of contraception  Table 7.14.1 Exposure to family planning messages: Women  Table 7.14.2 Exposure to family planning messages: Men  Table 7.15 Contact of nonusers with family planning providers 112 • Family Planning Table 7.1 Knowledge of contraceptive methods Percentage of ever-married respondents and currently married respondents age 15-49 who have heard of any contraceptive method, by specific method, Afghanistan 2015 Women Men Method Ever-married women Currently married women Ever-married men Currently married men Any method 94.5 94.5 92.1 92.1 Any modern method 94.2 94.2 91.0 91.0 Female sterilization 49.4 49.4 53.3 53.3 Male sterilization 22.7 22.7 33.8 33.8 Pill 89.1 89.1 84.4 84.4 IUD 61.3 61.5 33.2 33.2 Injectables 87.2 87.3 79.1 79.1 Implants 32.1 32.0 22.2 22.2 Condom 64.5 64.6 72.4 72.4 Lactational amenorrhea method LAM 47.7 47.7 34.2 34.2 Emergency contraception 14.8 14.7 16.6 16.5 Any traditional method 50.4 50.3 64.8 64.8 Rhythm 19.5 19.5 22.9 22.9 Withdrawal 45.9 45.9 60.9 61.0 Other 1.4 1.5 0.4 0.4 Mean number of methods known by respondents age 15- 49 5.4 5.4 5.1 5.1 Number of respondents 29,461 28,671 10,760 10,679 Family Planning • 113 Table 7.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and currently married men age 15-49 who have heard of at least one contraceptive method and who have heard of at least one modern method, by background characteristics, Afghanistan 2015 Women Men Background characteristic Heard of any method Heard of any modern method 1 Number Heard of any method Heard of any modern method 1 Number Age 15-19 92.1 91.4 1,812 93.8 93.8 142 20-24 93.0 92.7 6,028 91.7 89.4 1,160 25-29 95.3 95.0 6,193 90.1 88.1 2,410 30-34 95.2 94.9 4,226 91.9 91.5 1,992 35-39 95.6 95.3 4,375 94.1 93.7 1,925 40-44 94.2 94.0 2,977 92.1 91.2 1,385 45-49 95.4 94.8 3,060 93.1 92.2 1,664 Residence Urban 95.6 95.3 6,673 89.7 89.6 2,452 Rural 94.2 93.8 21,998 92.9 91.4 8,227 Province 2 Kabul 92.3 91.8 3,571 83.7 83.0 1,332 Kapisa 92.9 92.9 197 99.4 99.4 63 Parwan 99.5 99.4 592 100.0 99.6 218 Wardak 91.8 91.8 378 65.5 65.5 170 Logar 97.6 96.8 465 94.6 91.9 203 Nangarhar 99.2 97.2 769 89.8 89.8 272 Laghman 99.6 99.5 567 99.7 99.7 226 Panjsher 68.6 68.6 53 91.1 89.5 18 Baghlan 97.4 97.1 835 93.8 85.6 281 Bamyan 95.4 95.4 295 77.8 76.9 93 Ghazni 78.3 77.9 1,319 98.5 97.2 617 Paktika 86.8 86.3 779 78.8 78.1 318 Paktya 97.7 97.1 529 99.4 99.4 202 Khost 99.8 99.7 845 100.0 100.0 334 Kunarha 97.2 97.2 549 83.4 83.0 149 Nooristan 32.4 32.3 209 60.7 59.2 66 Badakhshan 82.3 81.8 968 76.9 74.9 311 Takhar 95.6 94.6 1,070 86.3 86.3 296 Kunduz 93.3 93.3 1,214 79.9 78.6 472 Samangan 86.8 82.2 319 87.0 87.0 125 Balkh 97.1 97.1 1,742 97.1 96.3 613 Sar-E-Pul 94.6 94.3 644 82.5 82.3 192 Ghor 99.7 99.7 708 99.9 99.8 315 Daykundi 78.8 78.8 319 72.3 72.3 77 Urozgan 83.2 83.2 229 99.4 99.4 92 Kandahar 99.8 99.8 2,193 99.7 94.7 870 Jawzjan 99.0 98.9 603 93.6 93.6 218 Faryab 98.3 98.3 2,030 98.6 98.6 704 Helmand 100.0 100.0 874 95.2 95.2 355 Badghis 99.6 99.6 640 99.8 99.7 230 Herat 100.0 100.0 2,166 100.0 100.0 852 Farah 96.7 94.3 717 95.6 94.0 294 Nimroz 98.7 98.7 264 96.0 94.2 93 Education No education 94.1 93.7 23,921 90.6 88.7 5,411 Primary 96.9 96.8 2,257 93.5 93.0 1,969 Secondary 96.1 95.9 1,951 93.5 93.3 2,615 More than secondary 97.2 97.2 542 94.9 94.8 685 Wealth quintile Lowest 94.3 93.9 5,757 90.1 88.2 2,018 Second 92.7 92.0 5,823 91.5 90.1 2,211 Middle 94.1 93.9 5,736 93.9 92.1 2,145 Fourth 95.5 95.2 5,846 94.6 93.9 2,253 Highest 96.2 96.0 5,509 90.3 90.3 2,052 Total 94.5 94.2 28,671 92.1 91.0 10,679 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, condom, lactational amenorrhea method LAM, emergency contraception, and other modern methods 2 Estimates for Zabul are not presented separately due to sample coverage issues; however, they are included in the total national estimates. 114 • Family Planning Table 7.3 Current use of contraception by age Percent distribution of ever-married women and currently married women age 15-49 by contraceptive method currently used, according to age, Afghanistan 2015