By Baran Yousfi
In the bustling corridors of Malalai Hospital, the screams of women in labor and cries of newborn babies reveal an overwhelming number of patients. It’s ten o’clock in the morning, and medical staff are scrambling to tend to them as best they can. Many of these patients have traveled from remote parts of Afghanistan, unable to access medical services in their hometowns.
Gulmina*, 17, is one such patient. Eight months pregnant, she has journeyed from Khost province to Kabul for the birth of her second child. One of eight patients sharing a room at Malalai Hospital, her family brought her from Tanai district, Khost, seeking better care. Gulmina says that local clinics and Khost province’s central hospital failed to treat her, citing a lack of medicine, doctors, and health equipment. “The doctors said, Your condition is serious and you should go to Kabul for treatment,” she recalls.
Gulmina married at 14 and gave birth a year later. Now, during her second pregnancy, she experiences bouts of pain and swelling from low blood pressure. She has already spent three days in hospital when she speaks with Rukhshana Media. Describing health services in Khost province, she paints a grim picture: “There’s 12 or 13 pregnant women were admitted to a small room. Some of them sleep on the floor as there are only a few tables and beds. There were few midwives, and they could not take care of all the patients. It was difficult to find medicine.”
Traveling between health centers during her pregnancy was an arduous task. “It took me two hours to get from home to the clinic, and from home to the central hospital is almost four hours, because the roads are mud,” she says.
The lack of health centers, hospitals, professional doctors, midwives, facilities, and equipment in rural and remote areas of Afghanistan has long posed challenges for pregnant women. The situation has only worsened with the Taliban’s implementation of discriminatory policies and gender segregation plans.
A recent study by the medical NGO Medicines Sans Frontieres (MSF) has highlighted Afghanistan’s ineffective health system, widespread poverty, and Taliban-imposed restrictions on women’s lives as factors exacerbating the country’s humanitarian crisis.
Philip Ribeiro, MSF’s representative in Afghanistan, says, “One of the main problems in Afghanistan is that peripheral health facilities are neither well-equipped, adequately resourced, nor properly staffed. This means people in rural areas need to travel vast distances for quality treatment, even though they often cannot afford such journeys without plunging themselves into debt.”
Zainab*, 37, traveled to Kabul from Yakawlang district of Bamyan province, due to health complications during her six-month pregnancy. She suffers from high blood pressure, anemia, and heart disease. “That’s why the doctors at Bamyan Central Hospital told me that I should go to Kabul to give birth,” she says. Zainab’s two previous children were born at home.
In Yakawlang district’s clinic, Zainab says only one female midwife and one male doctor work, hampered by limited facilities and unable to treat all patients properly. She’s been hospitalized at Rabia Balkhi Hospital in Kabul for four days. “In Bamyan Central Hospital, although the facilities were better than in the clinic, the doctors of that hospital recognized that my health problems are serious and sent me with a letter that I should go to government hospitals in Kabul.”
Pain and fatigue are evident on Zainab’s face as she struggles to get up from her bed and walk without assistance. She recalls her harrowing journey to Kabul: “It took me four hours to reach the district center from the village. I went from home to the clinic with a donkey because there is no road, and the path is not smooth for cars and other vehicles. I was in severe pain on the way. Sometimes I thought that I might die on the road and not reach the clinic. We traveled eight hours by car from the district to Kabul. On the way, I felt heartburn and pain many times.”
In August last year, the International Committee of the Red Cross reported that pregnant women in Afghanistan receive inadequate treatment due to a lack of medicine and medical equipment. The organization’s statistics indicate that, for every 100,000 births in Afghanistan, 638 mothers die.
Some doctors also attribute the high maternal death rate in Afghanistan to the lack of midwives, low-quality medicine, and insufficient facilities and equipment. Najm al-Sama Shafajo, a 35-year-old obstetrician, says that Afghan hospitals, even those in the capital, do not provide regular, quality services to pregnant women. “In Kabul hospitals, sometimes two to three patients are admitted in one bed,” she says. “When the situation is like this in Kabul, the situation in remote areas is many times worse.”
Poverty, harmful traditions, and challenging roads further impede pregnant women’s access to health services. According to a World Health Organization report published in February, Afghanistan has a higher maternal mortality rate than the combined total of its six neighboring countries.
Farahnaz*, 21, a resident of Silaba village, Khajaghar district of Takhar province, tells the story of her uncle’s wife, who died during childbirth. “My uncle’s wife was 20 years old and a year after they married, she died during her first delivery,” she says. “Because the distance was far and my uncle’s economic situation was not good, he could not take her to a clinic or hospital. Still, in our village, traditional midwives help women to give birth.”
Although pregnant women’s lack of access to health services has been an issue in remote parts of the country for the past 20 years, the International Committee of the Red Cross states that the situation has worsened since the Taliban came to power.
The Taliban’s Ministry of Public Health claims that 37,000 midwives are working in public and private sectors across the country. Sharaf Zaman, the ministry’s spokesperson, says the Taliban is working on mechanisms to improve health services, including “increasing the capacity of midwives”, but does not provide any details.
After regaining power, the Taliban imposed numerous restrictions on women, such as prohibiting travel without a male escort and implementing gender segregation in public places, including hospitals and health facilities. The Office of the Special Inspector General of the United States for the Reconstruction of Afghanistan (SIGAR) reports that these restrictions have significantly decreased women’s and girls’ access to health services.
*Note: Names of the interviewed women have been chosen as pseudonyms at their request.
