An analysis of policy and social factors impacting the uptake of sexual and reproductive health services in Kabul, Afghanistan

Abstract

Research Question:
What factors at individual, health service provision and system levels are influencing sexual and reproductive health (SRH) service uptake?
Rationale:
In many Afghan ethnic groups, girls and women face heavier risks of disease and infection than men. Their diminished economic and social status compromises their ability to select healthier life strategies and access to sexual reproductive health (SRH) services. The Afghan government estimates a high maternal mortality ratio (327/100,000 live births) in Afghanistan. However, due to inadequate reliability of data, the true maternal mortality and morbidity ratio remain unknown. A deeper understanding of the policy and social factors that impact on poor SRH service uptake would help the development of applicable and successful SRH Policy and frame applicable and appropriate approaches for sustainable SRH service uptake in Afghanistan.
Method:
It is a qualitative policy analysis using the ‘Broader Framework of Thinking’ by Walt and Gilson (1994) and a variety of data collection methods. Data was collected from 450 participants (Patients 223, Family members 72, Health service providers 63, Governmental staff 31, Coordinating organisation staff 17, Religious leaders 11, Health-promoters 13, Psychosocial counsellors 20) by conducting interviews, focus group discussions, participant observation, life narratives, document reviews and an audit of medical records.
Findings:
My results show the key factors underlying women’s poor health were a lack of knowledge about SRH, poor communication, and a lack of honour and trust both between individuals and within the health system. In addition, research findings highlighted that depression, multi-pregnancies, childbirth complications, anemia, malnutrition, sexually transmitted infections and interpersonal violence were routine for women. It clearly shows gaps within SRH Policy design and implementation and health service provision. These gaps are associated with social factors, which negatively impact on access and utilisation of proper SRH services
Conclusions and Recommendations:
This research analysed national reproductive health Policy (NRHP) and explored the impact of multifaceted social factors on SRH service uptake. In complex health systems recommending solutions require distinguishing between types of problems and a specific time-scale to improve SRH service uptake.