By Haaniya Frotan
Sara* is one of only a few female midwives in northern Sar-e-Pol province. Each morning, the 24-year-old walks for 1.5 hours to her job at a health clinic where hundreds of women and children seek care.
Although her job description is meant to only provide care to women and babies around pregnancy and childbirth matters, Sara says staff shortages means she provides many other services.
“I’m not only a midwife at the clinic. People even come to me for treatment of their colds and ask for all sorts of help,” she says.
Her hours are long and her duties are stretched, a massive job for the US$250 she makes per month.
“Despite doing most of the work at the clinic in these critical conditions, my wages are meager, and I cannot support my family,” she says.
It’s been nearly four years since Sara started working at the clinic. Originally her salary was around 24,000 to 25,000 afghanis (US$350) per month, but a recent move by the Taliban to reduce government salaries has cut it to 18,000 afghanis (US$250).
The love of her work – and the fact of having a job at all – keeps Sara returning each day. But her role as a midwife is threatened more than ever as the healthcare sector in Afghanistan struggles to meet demand.
It’s a reality not unique to Afghanistan. The United Nations said on May 5th International Day of the Midwife that the world is facing a shortage of 900,000 midwives that will impact preventable maternal and child deaths.
The World Health Organization said on the day that a shortage of midwives directly contributes to an increase in maternal and child mortality.
Taliban chaperone requirement squeezes staff and families
For Sara, one of the threats to her work as a midwife is the challenges placed by the Taliban’s restrictions. Among these are a strict dress code, complete separation from male colleagues, and the requirement to have a male relative accompany her on her commute.
“My brother has been deprived of his studies because I must bring him with me to the clinic as my male chaperone. The Taliban do not allow me to leave the house without a male companion,” Sara says.
Answering these questions over the phone, Sara is hurried as she has patients to attend to at the clinic.
Down the telephone line, the sound of people clamouring in the background at times drowns out her voice, and eventually, without even time to say goodbye, she hangs up the call.
On the other side of the country, in Afghanistan’s western province of Herat, Mina* also struggles with the Taliban’s male chaperone requirement.
She’s been working as a midwife for six years, travelling from the Jibril area to Herat city for work every day. She says needing to be escorted to work has added a burden to her family.
“We require the work of two people instead of one, in one household,” Mina says.
Emerging impact of education and exam bans
Countrywide, the number of female doctors and health workers is dwindling. The Taliban’s ban on formal education for girls and other crackdowns on women’s freedom is only driving that further.
Five months ago, the Taliban minister of public health Qalandar Ebad said the country faces a severe shortage of female doctors, and in some southern provinces, there are none at all.
With girls banned from high school education and from sitting exams for tertiary education, training of female doctors and health professionals has plummeted.
Fatima, 22, volunteers as a midwife assistant in a government hospital in Kabul. She completed the theoretical part of her training at a private institute in Kabul nearly two years ago, but the exam ban meant she could not get her qualification recognized.
“I had completed my studies over two years, but the Taliban did not allow me to take the entrance exam for public health. So because I haven’t taken the official exam, no organization will hire me without a certificate.”
Health system – and its workers – overburdened
Maryam, 27, is a midwife in a Kabul city government hospital. She says the weak economy and inadequacy of health facilities in the districts and other provinces has lead to floods of patients coming to the government hospitals in the capital.
“People come in groups to hospitals with the expectation of free services, and we often run out of beds. That’s why we try to discharge patients as soon as possible,” she says.
Maryam has worked there for nearly three years. Her starting salary was 18,000 afghanis (US$250) per month, but for the past six months, her salary has been reduced to 8,000 afghanis (US$111).
The salary cuts are sometimes too great for women to continue the job.
Zakira* is the only midwife in the remote district of Waras in central Bamyan province.
She says that the Taliban salary cuts have forced some midwives to give up their jobs as its no longer feasible for them to dedicate the time to this work.
A massive challenge is also the lack of adequate health facilities and equipment, as well as the long distances to Bamyan’s central hospital.
“The road is both rough and long. We’ve had cases where women [in need of more specialist care] are forced to give birth on the way to the hospital,” Zakira says.
In December 2023, United Nations Secretary-General spokesperson Stephane Dujarric stated that the statistics for Afghanistan show deaths during childbirth are among the highest in the world, “with one woman dying every two hours”.
The World Health Organization reported in 2023 that Afghanistan ranked among the top ten countries with the highest maternal and infant mortality rates in 2020 with 95 maternal and infant deaths per 1000 live births.
It’s estimated that this number has increased to more than 100 infant deaths per live birth in 2023, but exact figures from the Taliban’s Ministry of Health are not available.
