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Ensuring Afghan Women’s Access to Progestin-only Pills

In February 2020, USAID’s Abt-led SHOPS Plus project introduced Hernee, the first progestin-only pills available via the private sector in Afghanistan, from which 50 percent of women acquire their contraception. The new pills are distributed and promoted through the Afghan Social Marketing Organization (ASMO), using its national network of private pharmacies and trained obstetricians and gynecologists.

The project's objective in Afghanistan is to achieve, in partnership with ASMO, a sustained increase in the use of priority health products in family planning, maternal and child health, and nutrition. This is done by using evidence-based sustainable social marketing and social behavioral change strategies.

SHOPS Plus identified progestin-only pills as a priority for introduction based on an analysis of the 2015 Afghanistan Demographic and Health Survey and market assessments. Nearly 40 percent of women intending to use a contraceptive have already recently given birth. Combined oral contraceptive pills, the most popular family planning method in Afghanistan, are not recommended for post-partum women and those who cannot take estrogen. Breastfeeding women can safely use progestin-only pills, but SHOPS Plus’s rapid market assessment noted that they were not available in private pharmacies. Wide availability of progestin-only pills is particularly critical in countries such as Afghanistan, where women cannot easily access methods that require physical contact with a clinician, such as IUDs, implants, and injectable contraceptives.

The progestin-only pills were introduced right before the COVID-19 outbreak in Afghanistan. Despite this, the pills have quickly been established in the market.

“Inclusion of progestin-only pills expands contraceptive choice for the Afghan women and their families,” said Dr. Ghutai Sadeq Yaqubi, Acting Director, Directorate of Reproductive Maternal Neonatal Child and Adolescent Health, Ministry of Public Health. “Considering inconsistent access in the public sector, its availability in the private sector fills a critical gap in the country’s post-partum family planning program.”

SHOPS Plus has supported ASMO’s efforts to market a range of modern contraceptives, including Khoshi oral contraceptive pills and Khoshi injectables, and will introduce premium condoms at an affordable price soon.

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