I began my work in international health in 1999 when I conducted a study among one of the most marginalized groups in the region—nomadic Kurdish tribes in the mountains of Kurdistan in western Iran. The goal of the study was to learn whether these Kurdish communities were utilizing local health services and the extent to which they used modern versus traditional medicine. I was invited to set up my own tent and to live as a member of the nomadic community. I walked to the stream for water and endured with them the elements, including extreme heat and dust, sandstorms, and encounters with wolves. My research concluded that tribal members would choose modern medicine over traditional medicine if health services were made readily available to members of the community.
I also found that women had access to family planning methods and used birth control to regulate their fertility. I was pleasantly surprised that when I asked a woman in a neighboring tent about her opinion of birth control methods and whether she was using any particular method, she walked to a pile of folded blankets and pulled out a pack of oral contraceptives. This experience led me to pursue further research into family planning policy and program implementation in Iran, a country that has experienced one of the most dramatic fertility transitions in history.
I came to appreciate the success of family planning programs in Iran when I lived in Egypt. Despite the devotion of significant resources to family planning, Egypt has been unable to establish a viable national family planning program. This failure was especially evident in rural areas. My observations inspired me to consider how best to learn from Iran's experience and how to incorporate its most important elements into programs for other countries in the region.
After the fall of the Taliban and the influx of international organizations into Afghanistan to begin reconstruction, I considered whether, because of my Iranian cultural heritage, knowledge of the local language and religion, education in the field of reproductive health, and past experience in the region, I might be able to make a contribution to the improvement of reproductive health in that country. I also wondered if some of the successes and strategies used in the family planning program in Iran could be applied in the Afghan context. Afghanistan's maternal mortality rate has ranked second only to that of Sierra Leone, which, like Afghanistan, had experienced many years of horrific warfare. A successful family planning program could significantly reduce the high maternal mortality rates in the country because the use of contraceptives helps to prevent unwanted pregnancies and provides for birth spacing—a major factor in reducing maternal deaths.
I began my work in Afghanistan in 2003 as a consultant for a number of local NGOs. While there, I observed the general devastation of the health care system, the lack of practical training and clinical knowledge among family planning providers, and I learned that the population was overwhelmingly uninformed about family planning.
In January of 2005, I founded the Family Health Alliance to respond to the clear unmet need for family planning in resource poor environments around the world. Our first project was a family planning training program for female midwives and doctors which focused on clinical training with a specific emphasis on intrauterine device (IUD) insertion methods as a long term means of birth control. We started the program in two clinics in Kabul and expanded a year later to other areas of the country.
I am fortunate to work with a skillful and dedicated team of professionals who have made these programs a success. Each summer health professionals and student interns volunteer to travel with the FHA team to assist with the further implementation of the programs.
Among the strengths of these family planning programs is the fact that they are pursued in a highly collaborative effort. FHA has enjoyed the support of the Ministry of Public Health and several local NGOs who provide assistance and logistical support for our medical teams.
Since early 2005 the scope of FHA's work has grown. We have expanded family planning training programs for women to include the detection and prevention of sexually transmitted infections and HIV/AIDS. Moreover, we also recognized the need for greater male involvement in reproductive health and developed family planning training programs for male providers. More recently we have expanded our outreach services to Africa, where high maternal and infant mortality rates, a lack of family planning resources, and poorly trained health care providers combine to pose a serious threat to the lives and health of individuals and communities.
The empowerment of women through bolstering their sense of agency is another unique and important part of our programming. Women in the countries where I have worked are traditionally disempowered and lack control over decisions that directly affect their lives and the welfare of their children. Our programs are developed and conducted within a women's empowerment framework—an approach that has largely been overlooked by both international and local organizations. For example, we deliberately provide our female trainees with professional Muslim women as role models to demonstrate that women can play an important role in society and that they can be agents of change.
Policy planning and program development is conducted in our Los Angeles office where our staff and volunteers coordinate regularly with contacts on the ground in the countries where we maintain operations. We are proud, however, that our use of local resources and reliance on local logistical support has made our programs very cost-effective. Because of our teams' professionalism and cost efficiency we are continually asked by the ministries of health and health institutions in the countries where we work to return to develop additional programs.
The provision of health services, especially those which can engage embedded religious and cultural traditions, is a constantly challenging task. Our teams routinely overcome obstacles like frequent power outages and the unavailability of basic supplies; some clinics lack sinks and running water. We strive every day to provide innovative, culturally sensitive services and to make a difference in the lives of the people we touch. Our current program goal is to expand our small but powerful organization to develop and improve family planning services in the Middle East, West Asia, and Africa and, by so doing, to save and enhance the lives of individuals and their communities.
Throughout my work in the field of international health, I have learned valuable life lessons from some of the most forgotten women in the world and their presence in my life continues to enrich my spirit. I am an optimist and I believe that, as individual human beings, we all have the capacity to contribute to our global community. It is simply not enough to understand the problems of others and to feel empathy for their suffering. We can each do something. To learn more, please visit our Donation and Volunteer pages.
Taraneh R. Salke,
Executive Director
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