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Afghanistan's future looks uncertain as US troops prepare to leave the country before September 11, 2021.
In the years after the US-led military invasion and the defeat of the Taliban government in late 2001, the Afghan government and international donors gave priority to developing an effective health system, including extending access to basic health care to all parts of the country.
This led to significant improvements for women’s health. But even with two decades of effort and hundreds of millions of dollars spent, delivery of health services for women and girls remains far below international standards.
Dr. Najmusama Shefajo, Head of Afghanistan Ob/Gyn Society
Our maternal mortality rate nowadays is 638 per 100,000 live births. It is a shocking number.
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In the last several years, donor support to Afghanistan has been falling. Services that were already inadequate are further deteriorating.
Women and girls often struggle to access even the most basic care. Access to contraception. Access to prenatal care. Access to safe birthing services. The cost for transportation, as well as medications and the supplies patients are obliged to pay for because government hospitals no longer have enough funding, keeps women from receiving care, with sometimes deadly consequences.
Insecurity and fighting due to the war in Afghanistan also create major barriers to women and girls accessing health care. Health facilities and workers are often caught in the middle of the conflict or even targeted themselves, making it almost impossible at times to provide services.
In May 2020, attackers killed 24 people including mothers, children, and a midwife in a hospital maternity ward operated by MSF.
Shaharzad Akbar, Afghanistan Independent Human Rights Commission
With the conflict and the uncertainty about the outcome of the peace process, donors are more hesitant about committing funding to NGOs or Afghan governments. In the midst of uncertainty, it’s the most vulnerable, it’s the women, the children, the displaced communities, who are losing out.
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Over 75% of the Afghan government’s budget comes from international donors. Afghanistan cannot afford decent health services without help.
Donor countries should fully appreciate how deep and urgent are Afghanistan’s humanitarian needs, including for women’s health care. They should not use the withdrawal of foreign troops as a justification for disengaging when the need for international assistance is greater than ever.
(New York) – Falling donor support for essential services in Afghanistan is reducing women’s access to essential health care, Human Rights Watch said in a report released today. More cuts are likely in coming months following the announcement by United States President Joe Biden that the US will withdraw all its forces from Afghanistan by September 11, 2021.
The 39-page report, “‘I Would Like Four Kids—If We Stay Alive’: Women’s Access to Health Care in Afghanistan,” documents barriers to Afghan women and girls obtaining health care and the healthcare system’s deterioration due to declining international support. The drop in international donor funding has already had a harmful—and life-threatening—impact on the lives of many women and girls, as it affects access to and quality of health care.
“International donors are locked in a waiting game to see whether the withdrawal of foreign troops will result in the Taliban gaining greater control of the country,” said Heather Barr, interim co-director of women’s rights at Human Rights Watch. “But this is no excuse for cutting funds for essential services that aid groups have managed to deliver in insecure and Taliban-controlled areas.”
For the report, Human Rights Watch interviewed 56 people in Afghanistan in March and April, including 34 women about their experiences obtaining health care, and 18 Afghans working in the health sector, including the public health minister.
Over the past two decades, the Afghan government has depended on international donor support to fund essential services like health care. But this donor support has been falling for years and will likely continue to do so--perhaps precipitously, Human Rights Watch said. In 2013, member countries of the Organisation for Economic Co-operation and Development's (OECD) Development Assistance Committee contributed US$141 million to health and population assistance in Afghanistan. By 2019, this figure had dropped 26 percent to $105 million.
The Afghan government has little ability in the short term to move toward self-sufficiency. Over 75 percent of its budget comes from international donors. In 2020, the country’s sustainable domestic revenues fell 2.8 percent compared with 2019, due in large part to the economic downturn from the Covid-19 pandemic.
As hospitals run out of funds to pay for basic medical supplies, they are charging for supplies that previously were free. Many patients cannot pay or even afford transportation to a health facility, which may be far away. Progress on some key indicators, such as accessing prenatal care and skilled birth attendance, is stagnating, or even reversing.
“It’s Taliban-controlled—people are poor, there are no jobs,” said a doctor from Kapisa province, northeast of Kabul. “Clinics are far from where they live, so often [women giving birth] die or the baby dies…. People don’t even have money for transport to the center, to a government hospital, and you still have to pay for medicines at the government hospital.”
Women and girls struggle to get even the most basic information about health and family planning. There is an unmet need for modern forms of contraception, and prenatal and postnatal care is often unavailable. Modern cancer and fertility treatment and mental health care are largely unavailable. Routine preventive care such as pap smears and mammograms are almost unheard of; and a large proportion of births are still unattended by a professional.
Women often have more children than they want because of lack of access to modern contraception; face risky pregnancies because of lack of care; and undergo procedures that could be done more safely with more modern techniques. Maternal and infant mortality remain very high.
In addition to the announced US withdrawal, other NATO member countries plan to withdraw their forces alongside the US. Afghans interviewed expressed fears that the Taliban would obtain increasing control over their lives or that the already-high level of violence in the country would escalate. Both growing Taliban control and rising levels of violence have implications for donor support to Afghanistan, including for women’s health.
It is crucial for donors to prioritize meeting the urgent needs of Afghans—including those of women and girls for health care, Human Rights Watch said. The US and other troop-deploying countries in Afghanistan should assess the need for aid and their commitment to providing it seperately rom the decision to withdraw their forces. They should fully appreciate the depth and urgency of the needs in Afghanistan, and not use political and security developments to justify disengaging when the need for international assistance is greater than ever.
“This critical moment is no time to abandon Afghan women, who often face a brutal choice between feeding their families or caring for their health,” Barr said. “International funding for the health system is a life-and-death issue—and whenever cuts are made women will die.”
