By Ziba Balkhi
A rising number of Afghan women are using strong sedatives and seeking psychological support despite the financial burden, health professionals say.
Psychologist Nasima Mohammadi*, who has practiced in northern Balkh province for six years, has seen a steep increase in women self-medicating with sleeping pills and seeking psychological support and medication for stress.
Ms Mohammadi said many of them are financially worse off due to the economic situation or because they can no longer earn an income. Still more women are paying for her services, with at least five women or girls coming in person every day and the rest seeing her online.
Ms Mohammadi links the increased demand to women and girls not coping with the restrictions that the Taliban authorities have imposed on their lives.
“And the use of sedatives and sleeping pills has increased,” she said. “There are many women who unfortunately resort to sleeping pills.”
Ms Mohammadi is concerned about most of her patients using sedatives in some form.
“I’d say that around 90 percent of girls and women I see are either going to doctors or to pharmacies at least [for medication]. They all use a type of sedation – hypnotic or sedative medicines, all of which have sleep-inducing properties.”
Pharmacists in Balkh confirmed that more women are purchasing sleeping pills and sedative drugs.
Mazar-e-Sharif pharmacist Mateen* has been operating his pharmacy for four years.
He is visited by an average of ten women a day who are trying to get sedatives.
“Some of them have a doctor’s prescription, which the doctor prescribes because the person has high blood pressure, but most of the women who come to us do not have a prescription and they ask us to give them a good sleep medicine that will work fast,” he said.
Mateen said many women ask for higher doses of the medicine they’re receiving, which to him is a sign they’re using it frequently.
“We don’t have the right to sell sleeping pills without a prescription,” he said. “But when we don’t, they just go and buy from other pharmaceutical shops.”
“I can’t sleep for an hour without sleeping pills”
Frozan*, 22, was a student in her second semester of a Bachelor of Law and Political Science at Balkh University when the Taliban banned women from universities last year. Since then, Frozan has been stuck at home with nothing to do.
The situation has driven her into a deep depression and acute anxiety. She uses sedatives to cope.
“I couldn’t sleep for even an hour at night because of the anxiety of what was in store for my future. Always anxious. I had to use sleeping pills to get rid of anxiety and worry and to get rid of a persistent headache. For now, I use sleeping pills at night secretly,” Frozan said.
The medicine helps with insomnia in the short term, but doctors are concerned because they are addictive, and in some cases people can develop a reliance where they can no longer sleep without it.
Frozan said she has been using the sleeping medicine Phenobarbital for nearly a year. She has tried many times to sleep without it, but it has proven ineffective.
When she first started, she’s take half a tablet each night, but with time, her sensitivity has decreased and she needs more for the same effect.
“Using sleeping pills has become a habit for me and I can’t stop using them anymore. I know that I’ve become addicted to them because I can’t sleep without it, and if there is no medicine, I stay up all night until morning.”
Frozan said she wants to stop using the pills and so she has sought the support of online counselling from a psychologist.
Benazir*, 42, was an employee in a government office in Balkh province. She lost her job because of a Taliban decree banning women from working in government offices. Over time the Taliban restrictions on women have increased.
Benazir’s two daughters in grade seven and grade ten are also homebound with the Taliban banning girls from receiving a high school education.
Benazir said their situation and having all three of them at home is a challenging environment. She has resorted to taking the sleeping medicine Alprazolam for the past five months to sleep at night. She was able to obtain it from a local pharmacy without a doctor’s prescription.
“At night, when I was sleeping in bed, my mind was very busy and I couldn’t fall asleep because of this worry and anxiety, I decided to use sleeping pills for just a few nights, and then stop.
“But no, when I used it for three or four nights and saw that I could sleep well with it, I continued and am still using it. But it does not have the effect of the first days.”
She said she has noticed that she is finding it hard to focus and take an interest in things. It’s a sort of “boredom” that leaves her unable to carry out her daily activities properly.
“I have decided to stop slowly because it has become a habit, and it is bad for me. For now, I use it every second night, but I haven’t been able to quit it permanently. The night I don’t use it, I feel terrible and I can’t fall sleep until morning.”
Temporary peace with harmful consequences
Ms Mohammadi said that dependence, decreased energy during the day, drowsiness, lethargy, decreased level of alertness, and depression in the long term are all possible consequences of using sleeping pills.
“Women get bored. They are not in the mood for talking and social interactions, and if they have tasks that require high attention, they are very damaged, because sleeping pills lower their level of alertness,” she said.
Rezwana, 26, a psychologist in Balkh province, has also noticed the rise in the use of sleeping pills. At least 40% of her clients are women who have insomnia.
“Since the [Taliban] restrictions were increased, most of my clients complain of insomnia and a large number of them use sleeping pills,” she said. “As psychologists, we do not recommend sleeping medicine to patients, instead, it is a series of activities that we teach them to do before going to sleep so that they can sleep comfortably, but some mental and neurological doctors may prescribe this medicine for those who suffer from acute insomnia.”
Ms Rezwana said that the use of sleeping pills can also lower natural immunity and have a negative effect on the nervous system as the body builds up a tolerance.
“When they face a problem and there is a need to use the medicine, that’s when the sleeping medicine eventually has no effect on them,” she said.
A joint report from three UN agencies released in September found that mental health problems have increased dramatically among Afghan women.
The report was based on interviews with 592 women in 22 provinces of the country. It found that 69 percent of Afghan women feel anxious, isolated, and depressed – an increase of 57 percent from the previous survey only months earlier.
*Note: Interviewees’ names have been chosen as pseudonyms for security reasons.
