Afghanistan had the second-highest maternal mortality rate in the world in the early 2000s as a result of years of conflict, extreme poverty, a lack of access to health care, and childbirth without the assistance of medical personnel. 

The establishment of an efficient healthcare system was given top priority by the Afghan government and international donors in late 2001, following the overthrow of the Taliban administration.

Significant improvements (1) have resulted from these initiatives, such as

• A drop in maternal mortality from 1450 in 2000 to 638 in 2017.

• The percentage of births attended by experts climbed from 12 percent in 2000 to 58 percent in 2018.

• From 2003 to 2015, more people have access to contemporary family planning services: from 10% to 22%, and according to estimates from the UN, the maternal mortality rate fell by 64% from 1100 per 100 000 live births in 2000 to 396 per 100 000 live births in 2015.

• From 2003 to 2018, the neonatal death rate decreased from 53 to 23 per 1,000 live births.

• More than 2,800 health institutions were in operation in 2018 compared to 496 in 2002, an increase of over five times.

• Between 2006 and 2018, the under-5 death rate decreased from 191 to 50 per 1,000 live births.

• Between 2002 and 2018, the proportion of children aged 12-23 months in the lowest income quintile (20%) who received the PENTA 3 vaccine—doubled from 29% to 61%.

Condition now

After the Taliban takeover of the country in August 2021, things have taken a turn for the worse.

Though promising female education and freedom initially, the Taliban quickly changed its colors.

Imposing strict restrictions on female social mobility and education, the Taliban of post-2021 is treading the same path as the Taliban in the 1996-2001 regime.

Banning of Contraceptives

According to a report (2), even before the Taliban takeover, women and girls struggle to access even the most basic information about health and family planning. The report further said that,

• there was an unmet need for modern forms of contraception

• prenatal and postnatal care was often unavailable

• specialty care, such as modern cancer and fertility treatment, was largely nonexistent

• routine preventative care such as Pap smears and mammograms were almost unheard of

• a large proportion of births were still unattended by a professional.

With an already poor state of women's reproductive health in the pre-Taliban takeover, the ban on contraceptives is a new blow. Termed as ‘Western propaganda to control the Muslim population’, the Taliban is strictly enforcing this ban across cities.

With already meager reproductive health facilities available, and 1 in 14 Afghan women dying in often unwanted childbirth (3), the situation is bound to turn worse, with this ban.

Gender-Based Violence (GBV)

According to statistics from the United Nations Population Fund, 62% of women in Afghanistan are subjected to several forms of violence, including physical, sexual, and psychological damages, and 87% of women in Afghanistan experience GBV in some capacity throughout their lifetimes. (4)

This in turn has a huge toll on the women's mental health, which is already worse considering the war-like situation and food crisis going on in the country.

Mental health

The UN estimates that one in two people, mostly women, in Afghanistan's fundamentally patriarchal society, which has been battered by four decades of conflict, had psychological suffering even before the Taliban took power in 2021.

However, according to analysts, the Taliban government's restrictions on women's rights and the nation's economic difficulties have made matters worse than they have ever been.

Two-thirds of Afghan teenagers reported having depressive symptoms, according to a survey conducted in the province of Herat and published in March of this year by the Afghanistan Centre for Epidemiological Studies. (5)

Though no official reports could be found, it is expected that female suicides have increased under the Taliban regime.

Poisoning cases

Over 80 elementary school children, predominantly females, were poisoned in the northern Sar-e-Pul province in Afghanistan in June 2023. They were rushed to the hospital, with 14 children in critical condition. Local health officials attributed the crimes to radicals who were against women's education. (6)

Cases like this were reported in the previous Taliban regime and Iran. The motive generally ascertained was to scare people off, and somehow prevent parents from letting their girls attend school.

Women in Healthcare

The Taliban encouraged women in healthcare to return to work in August 2021 after originally discouraging it.

WHO reports that there was a severe scarcity of medical personnel in Afghanistan even before the Taliban seized power. According to WHO research from 2018, the nation had 4.6 medical physicians, nurses, and midwives per 10,000 inhabitants, which is below the acute shortage threshold of 23 professionals per 10,000 people. (7)

Many healthcare professionals left the country before the Taliban takeover, and many fear returning to work, leading to a healthcare crisis all over the country.

Women may find it difficult or even impossible to commute to and from work because they need to be accompanied by a male guardian.

Adding to the general population's woes, female healthcare workers were told to stop seeing male patients. This further reduced the availability of doctors all across the country.

International Aid

The aid has declined after the Taliban takeover, and considering that almost the entire healthcare system was running under foreign aid, it is on the verge of collapsing.

But gradually, the International Organisations are stepping up to provide aid to the ailing population of Afghanistan.

The UN launched the largest-ever appeal for a single country for humanitarian assistance for Afghanistan in January 2022 amounting to over $5 billion, considering more than 2/3rd of the population requires humanitarian assistance. (8)

In order to expand the provision of sexual and reproductive health services, again, for women, by women, even in rural places, UNFPA has increased its presence throughout Afghanistan and is collaborating with national partners. 

The organization provided period hygiene products to countless women and girls as well as crucial medicines and hospital supplies to more than 4.3 million individuals in 2022. (9)

Way forward

Since Afghanistan is a country largely dependent on foreign aid, international organizations and donors through selective funding can promote women’s health and education.

• Donors should recognize their leverage and affirm that women have the right to engage in any occupation in accordance with Afghanistan's commitments under international human rights law.

• The Security Council's 2002 creation of the UNAMA mission came with a broad mandate to monitor and defend women's rights. UNAMA's responsibilities include a core component of monitoring women's and girls' rights and that any concessions the Taliban asks for from the international community should be tied to UN findings on how they are treating women.

• Approximately 75% of the government budget and 49% of education spending were funded by foreign donors prior to the Taliban takeover. Hence, this provides leverage to demand more rights for women.

• Donors should not support any educational system that excludes girls. Instead, selective funding should be done to institutes that provide education to both girls and boys.

• Without recognizing the Taliban administration, efforts might be made to lessen the economic and financial disaster the Afghan people are currently experiencing. The UN Security Council Resolution 2615 (2021), which lifts sanctions for humanitarian aid, is a positive step in this direction.

• The international world needs to exert pressure on the Taliban to fulfill its promises in the areas of health, education, and finance, notably by opening schools and allowing women to fully participate in society.

• International organizations ought to support communities that are already pressuring the Taliban to allow females to attend school.

• The Solutions Strategy for Afghan Refugees to Support Voluntary Repatriation, Sustainable Reintegration and Assistance to Host Countries (SSAR), which was developed in 2012 by Afghanistan, Iran, and Pakistan with assistance from UNHCR, is a cornerstone of the effort to find solutions for Afghan refugees. The plan encourages a regional focus on finding solutions and encourages regional and international burden and responsibility sharing for refugees. (10)

• The EU can redraw a new strategy to assist women by cooperating with their allies in Afghan civil society and surrounding nations, including India and the future Central Asian Alliance, that are already working to find solutions, send humanitarian aid, and create pathways for international protection and asylum requests.

Conclusion

Afghanistan is facing a total breakdown of its health system currently. The healthcare statistics in the country had improved considerably from 2001 to 2020, but all that progress in health outcomes may be lost in the future.

Though there is a gradual revival of International Aid in the health sector, a lot more needs to be done. Sustained  International pressure has to be kept on the Taliban, so as to facilitate decisions that help in improving the overall status of women.

Till then, Afghanistan's healthcare system for women remains in a precarious position.

References:

1. “Delivering Strong and Sustained Health Gains in Afghanistan: The Sehatmandi Project.” World Bank, www.worldbank.org/en/results/2020/10/23/delivering-strong-and-sustained-health-gains-in-afghanistan-the-sehatmandi-project.

2. Human Rights Watch. “World Report 2021: Rights Trends in Afghanistan.” Human Rights Watch, 23 Nov. 2020, www.hrw.org/world-report/2021/country-chapters/afghanistan.

3. Afghanistan - maternal mortality ratio [Internet]. [cited https://knoema.com/atlas/Afghanistan/Maternal-mortality-ratio (2022 Jun 15)]

4. Saboor, Lamba, et al. “The Bleak Future of Afghan Women’s Health under the Taliban.” The Lancet, Feb. 2022, https://doi.org/10.1016/s0140-6736(22)00283-5.

5. “Afghan Women in Mental Health Crisis over Bleak Future | International Center for Transitional Justice.” www.ictj.org, www.ictj.org/latest-news/afghan-women-mental-health-crisis-over-bleak-future. Accessed 15 June 2023.

6. Press, Associated. “Nearly 80 Primary Schoolgirls Believed Poisoned in Afghanistan.” The Guardian, 5 June 2023, www.theguardian.com/world/2023/jun/05/nearly-80-primary-schoolgirls-believed-poisoned-in-afghanistan.

7. emhj. “Addressing Health Workforce Shortages and Maldistribution in Afghanistan.” World Health Organization - Regional Office for the Eastern Mediterranean, www.emro.who.int/emhj-volume-24-2018/volume-24-issue-9/addressing-health-workforce-shortages-and-maldistribution-in-afghanistan.html#:~:text=Afghanistan%20has%20the%20second%20lowest%20health%20worker%20density. Accessed 15 June 2023.

8. Afghanistan: UN launches largest single country aid appeal ever | UN News [Internet]. news.un.org. 2022 [cited 2023 Jun 27]. Available from: https://news.un.org/en/story/2022/01/1109492#:~:text=The%20UN%20and%20partners%20launched%20a%20more%20than

9. UN agencies recommitment to women, girls in Afghanistan one year after Taliban takeover | UN News [Internet]. news.un.org. 2022 [cited 2023 Jun 27]. Available from: https://news.un.org/en/story/2022/08/1124662#:~:text=The%20agency%20reached%20more%20than%204.3%20million%20people

10. Solutions Strategy for Afghan Refugees to Support Voluntary Repatriation%2C Sustainable Reintegration and Assistance to Host Countries (SSAR) [Internet]. Bing. [cited 2023 Jun 27]. Available from: https://www.bing.com/search?q=Solutions+Strategy+for+Afghan+Refugees+to+Support+Voluntary+Repatriation%2C+Sustainable+Reintegration+and+Assistance+to+Host+Countries+(SSAR)&cvid=0335275bf4d445488dfb143d8f384b74&aqs=edge..69i57.534j0j4&FORM=ANAB01&PC=LCTS

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