Several women in Afghanistan say that within their marriages, they face decisions and circumstances regarding pregnancy prevention that are not always in line with their own wishes and choices, and that they are sometimes pressured by their husbands or families. They say that in some households, men agree with the idea of preventing pregnancy but leave the responsibility for prevention to their wives. Under such circumstances, women turn to methods such as pills, injections, contraceptive implants, and intrauterine devices (IUDs) to avoid unwanted pregnancy.
Ziba, a 32-year-old woman, told the Hasht-e Subh Daily that she had a contraceptive implant inserted to prevent pregnancy. She said that after using this method, her weight increased significantly and she noticed changes in her body.
Ziba said: “I got the implant so I wouldn’t get pregnant again for a few years. But after using it, I gained a lot of weight and started noticing other changes in my body. My husband was fine with preventing pregnancy, but he wasn’t willing to use any method himself; he just told me it was up to me to figure something out. Now I’m caught between two fears: not wanting to get pregnant again, and worrying about the side effects of these methods.”
An obstetrician and gynecologist, who did not want her name mentioned in the report, said that women’s bodies do not react to prevention methods in the same way, and that the choice of method should be based on each woman’s health condition.
This doctor said: “A method that may be suitable for one woman may cause side effects for another. Before choosing a method, a woman’s health condition and medical history should be examined, and if a problem occurs, its cause should be diagnosed by a doctor.” According to her, any physical change following the use of a method cannot be attributed to that method without an examination.
Parisa, a 26-year-old woman, said she got married at the age of 16 and has tried various prevention methods since the early years of her married life. She said these methods were not compatible with her body, and that after using them, she felt changes in her physical condition.
This woman said: “The methods I used were not compatible with my body, and I felt that my hormones were disrupted. Later, a cyst developed in my breast. I am not saying that a doctor confirmed the cyst was caused by the prevention method, but because I saw these changes after using the methods, I am now afraid to use them again.”
These women’s experiences come as several others also criticize the role their husbands play in decisions about family planning. According to them, some men agree with preventing pregnancy but are not willing to use prevention methods themselves, and prefer that their wives use pills, injections, implants, or an IUD instead. In such households, the decision to prevent pregnancy may be a joint one, but the choice of method and the burden of its possible side effects fall mostly on the woman.
On the other hand, some women say their husbands are opposed to preventing pregnancy, and that they cannot independently decide on the spacing between their pregnancies.
According to Afghanistan’s Health Sector Transition Strategy for 2023 to 2025, about 80 percent of women said that their husbands decide about their use of family planning methods. This document also shows that 26 percent of users of family planning methods discontinued a new method within the first 12 months of use. These figures point to the role of family and health-related factors in decisions about family planning.
Data from the Family Planning 2030 program shows that in 2022, about 18.4 percent of women aged 15 to 49 in Afghanistan were using modern methods of contraception, and about 19.3 percent of them had an unmet need for modern family planning methods. Based on the same estimate, about 1.8 million women were using a modern method of prevention.
An example of the consequences of repeated pregnancies in Afghanistan is presented in a report by the United Nations Population Fund (UNFPA). According to this report, “Muska,” a pseudonym for an Afghan woman, became pregnant 12 times over 12 years of married life, two of which ended in miscarriage. During her twelfth pregnancy, she suffered from severe anemia, very low blood pressure, a rapid heart rate, and persistent headaches, and most of her deliveries took place at home without the help of a skilled midwife. UNFPA has emphasized the importance of spacing between pregnancies and women’s access to family planning services.
You can read the Persian version of this report here:
وقتی انتخاب با زن نیست؛ زنان افغانستان و بار سنگین پیشگیری از بارداری
