Most Married Women at Kabul Maternity Hospital Know and Use Contraception, Study Finds

Most married women attending a major maternity hospital in Kabul know about family planning, view it positively, and are currently using contraception, according to a cross-sectional study conducted at Rabia Balkhi Maternity Hospital between October 2024 and March 2025. Among 356 married women aged 15 to 49 recruited through convenience sampling and interviewed face to face with a structured questionnaire, 86.2 percent had heard of family planning methods, 77.8 percent demonstrated good knowledge, 84.3 percent held positive attitudes, and 72.5 percent were using a contraceptive method at the time of the survey. The study, published in the journal Contraception and Reproductive Medicine, also identified the social and economic forces that predict who actually uses contraception in this urban, hospital-based population.

The survey team, led by Mohammad Reza Hussainzada and Fazel Ahmad Muhammadi, calculated their target sample with a single population proportion formula and then applied a finite population correction to the roughly 4,800 eligible women seen monthly at the hospital, arriving at 356 participants. The researchers acknowledge an important caveat: the formula assumes random sampling, but they used convenience sampling, and a design effect of 1.5 would ideally have raised the required sample to 518. Knowledge was scored across 20 knowledge points and split at the median of 13 correct responses, so women scoring at or above 13 were classified as having good knowledge. Attitudes were measured with eight items on a five-point Likert scale and yes, no, or unsure formats, with five or more positive responses counting as a positive attitude. Practice was scored across nine practice points, with four or more appropriate behaviors, such as ever-use, current use of an effective modern method, and not discontinuing for preventable reasons, classified as good practice.

The knowledge picture was detailed. When asked whether family planning could improve maternal and child health, 68.5 percent of women answered yes, 12.4 percent said no, and 19.1 percent were not sure. Asked to identify specific advantages, 51.7 percent cited pregnancy prevention, 19.9 percent cited birth spacing, 15.7 percent cited improved maternal and child health, and 4.2 percent cited population control, while 8.4 percent could not name any advantage. Most women, 81.5 percent, knew where to access family planning services, and 83.1 percent reported having received information or counseling on the topic. Healthcare providers dominated as the information source at 75.0 percent, followed by family or friends at 46.1 percent, community health workers at 4.5 percent, and media at just 3.7 percent. Awareness of side effects was nearly universal, with 92.7 percent able to name at least one; irregular bleeding was the most frequently reported at 44.9 percent, followed by weight gain at 19.7 percent, headaches at 16.0 percent, and mood changes at 12.1 percent.

Attitudes leaned strongly favorable. A large majority, 86.5 percent, considered family planning important for family well-being, and 82.3 percent believed it could improve the health of mothers and children. On safety, 71.9 percent believed the methods were safe, 9.6 percent considered them unsafe, and 18.5 percent were unsure. Cultural and religious acceptability was affirmed by 76.4 percent, while 10.7 percent considered it unacceptable and 12.9 percent were unsure. Husbands emerged as a pivotal variable: 68.5 percent of women reported their husbands were supportive of family planning, 12.1 percent reported neutral attitudes, and 19.4 percent reported outright opposition. Communication patterns followed a similar gradient, with 73.3 percent comfortable discussing family planning with their spouse and 87.6 percent comfortable discussing it with healthcare providers.

Practice data showed high uptake with a distinct method mix. Ever-use of contraception was reported by 79.2 percent of women, and current use by 72.5 percent. Among ever-users, combined oral contraceptives accounted for 21.5 percent and the depot medroxyprogesterone acetate intramuscular injectable, known as DMPA-IM, for 21.4 percent, followed by male condoms at 20.9 percent, intrauterine devices at 11.5 percent, progestin-only pills at 6.9 percent, implants at 6.2 percent, natural methods at 5.0 percent, DMPA-SC at 2.8 percent, sterilization at 2.5 percent, and emergency contraception at 1.3 percent. No women reported vasectomy use. Among current users, the DMPA-IM injectable led at 26 percent, followed by combined oral contraceptives at 13 percent, male condoms at 17 percent, IUDs at 12 percent, and implants at 12 percent, a pattern the authors describe as a preference for short-term and reversible methods over long-acting options.

The reasons women gave for not using or for stopping contraception mapped closely onto the barriers the study was designed to probe. Among the 74 women who had never used family planning, husband disapproval was the most cited reason at 9.6 percent, followed by desire for more children at 6.7 percent, lack of knowledge at 5.3 percent, and religious or cultural beliefs at 4.8 percent, with multiple reasons permitted. Discontinuation was reported by 31.7 percent of all participants, and among those who stopped, the desire to become pregnant led at 25.8 percent, side effects followed at 17.1 percent, lack of spousal support at 10.1 percent, and method failure at 1.7 percent. Access problems were also real but less widespread: 33.4 percent of women reported having experienced challenges obtaining services, with distance to the health facility cited by 16.6 percent, cost by 5.3 percent, negative attitudes of healthcare providers by 4.8 percent, stockouts of methods by 3.1 percent, and lack of privacy or confidentiality by 2.2 percent.

The statistical heart of the paper lies in the associations between the three domains. Women with poor knowledge were substantially more likely to hold negative attitudes toward family planning, at 64.6 percent, compared with only 1.8 percent of women with good knowledge, a difference the authors report as chi-square 187.3 with one degree of freedom and p less than .001. Poor knowledge was associated with poor practice in 67.1 percent of cases, while good knowledge corresponded to good practice in 95.7 percent of cases, with chi-square 176.8 and p less than .001. The attitude and practice link was similarly pronounced: women with negative attitudes exhibited poor practices 71.4 percent of the time, whereas those with positive attitudes demonstrated good practices in 91.7 percent of cases, with chi-square 148.2 and p less than .001. The authors interpret these patterns as evidence that knowledge, attitude, and practice are strongly interconnected, while noting that the small share of women with good knowledge but negative attitudes or poor practices suggests that cultural norms, spousal dynamics, and access barriers mediate the pathway from information to behavior.

Multivariate logistic regression sharpened the picture of who uses contraception after adjusting for confounders. Women with secondary education or higher had 3.42 times higher odds of current contraceptive use compared with illiterate women, with an adjusted odds ratio of 3.42 and a 95 percent confidence interval of 1.87 to 6.25 and p less than .001. Women whose husbands were supportive had 2.89 times higher odds of use compared with those whose husbands were opposed, with a confidence interval of 1.65 to 5.06 and p less than .001. Higher monthly household income, defined as 15,000 Afghan afghanis or more, was associated with 2.31 times higher odds of use, with a confidence interval of 1.34 to 3.98 and p equal to .002. Women with two to three children had 1.98 times higher odds compared with those with one child or fewer, with a confidence interval of 1.12 to 3.51 and p equal to .019. Age, husband’s education, and urban or rural residence were not significant independent predictors once other factors were accounted for.

The study also examined how education interacts with spousal negotiation. Among participants with secondary or higher education, 84.2 percent felt comfortable discussing family planning with their husbands, compared with 58.3 percent of illiterate participants, a difference the authors report as chi-square 18.7 with p less than .001. Educated participants were also more likely to use contraception even when their husbands were opposed, with an adjusted odds ratio of 2.43 and a 95 percent confidence interval of 1.34 to 4.41 and p equal to .003, which the authors read as evidence that education enhances reproductive decision-making autonomy. They situate their findings in a broader context: the current use rate of 72.5 percent exceeds the national Afghan average of approximately 25 percent and rates reported from Herat, reflecting the urban, hospital-based sample, yet the authors argue it still indicates substantial unmet need. They also note that the study was conducted after the political changes of August 2021, when shifts in international funding and new policies on women’s mobility occurred, and that restrictions on women traveling without a male companion may have created additional barriers for women in rural areas, a population their hospital-based sample cannot fully represent.

The authors are explicit about the limits of their evidence. Because participants were drawn from a single tertiary referral hospital that receives patients from all provinces, the findings cannot be generalized to all married women in Afghanistan, particularly those who never access healthcare services, although the hospital’s referral role means the sample includes a diverse group of healthcare-engaged women rather than only family planning seekers. The study relied exclusively on quantitative data and cannot explain why the observed patterns exist, and the authors call for mixed-methods research, including in-depth interviews and focus group discussions, as well as future work on how mobility policies affect family planning access in remote and rural provinces. Within those boundaries, their recommendations are directed at the health system rather than at individual women: strengthening provider counseling, expanding media and community-based education given that only 3.7 percent currently receive information from media, engaging religious leaders and husbands, improving supply chains, and targeting outreach to older, less educated, and poorer women, the groups in which the knowledge gaps concentrated.

Subject of Research: Knowledge, attitudes, and contraceptive use among married women attending a maternity hospital in Kabul, Afghanistan

Article Title: Knowledge, attitude, and contraceptive use among married women attending a maternity hospital in Kabul, Afghanistan: a cross-sectional study

Article References: Hussainzada, M. R., & Muhammadi, F. A. (2026). Knowledge, attitude, and contraceptive use among married women attending a maternity hospital in Kabul, Afghanistan: a cross-sectional study. Contraception and Reproductive Medicine, 11(1), Article 50. https://doi.org/10.1186/s40834-026-00464-w

Image Credits: AI Generated

DOI: 10.1186/s40834-026-00464-w

Keywords: contraception, family planning, Afghanistan, Kabul, maternal health, cross-sectional study, reproductive health, women's health, contraceptive use, health knowledge, spousal support, KAP study