12.2007 - Source: UN High Commissioner for Refugees

Health situation and access to healthcare in Afghanistan in a bad state, particularly in rural areas; maternal and infant mortality rates are among the highest in the world ("UNHCR's Eligibility Guidelines for Assessing the International Protection Needs of Afghan Asylum-Seekers") [ID 22745]

"The average life expectancy in Afghanistan for both men and women is 42 years which is among the lowest in the world. Maternal and infant mortality rates are among the highest in the world and stand at 1600 for 100,000 births and at 210 for 1000 live births, respectively. In 2000, per 100,000 births, 1900 women died from complications in pregnancy and childbirth. Less than 15 percent of deliveries are attended by trained health workers.  A report published in September 2006 concludes that there have been some improvements in maternal health indicators but the disparity between rural and urban areas remains significant.

In terms of access to healthcare, Afghanistan’s poor healthcare system has a very strong urban bias in its existing infrastructure. Overall, there are only 210 health facilities with beds to hospitalize patients. With the exception of four provinces, the current ratio of doctors per patient stands at one doctor per 10,000 patients."

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30.03.2007 - Source: ReliefWeb

One in 9 Afghan women dies during or shortly after pregnancy, and only 11 per cent of deliveries take place in a health facility ("UNICEF and partners come together to help reduce maternal mortality in Afghanistan"), Autor: United Nations Children's Fund (UNICEF) [ID 19603]

Document(s): Open document

12.12.2005 - Source: ReliefWeb

Report focused on women (social change, women's health) ("Women of Afghanistan (ActionAid)") [#40469],  [ID 1250]

Document(s): Open document

12.12.2005 - Source: ReliefWeb

Report focused on women (social change, women's health) ("Women of Afghanistan (ActionAid)") [#40469],  [ID 1370]

Document(s): Open document

19.12.2003 - Source: UN Human Rights Council (formerly UN Commission on Human Rights)

Health situation of women and girls in Afghanistan continues to reflect the consequences of the long-term conflict; second highest maternal mortality rate in the world ("Report of the Secretary-General: The situation of women and girls in Afghanistan (E/CN.6/2004/5)") [#18829],  [ID 1371]

"51. Despite positive developments since the installment of the Afghan Transitional Administration, the health situation of women and girls in Afghanistan continues to reflect the consequences of the long-term conflict, displacement, shortage of female health personnel and difficult as well as limited access to health care services in many communities in Afghanistan.
52. The recent studies by the United States Centers for Disease Control and UNICEF confirmed that Afghanistan has the second highest maternal mortality rate in the world with a maternal mortality ratio of 1,600 per 100,000 live births at the national level and 6,500 per 100,000 live births in certain deprived areas of the country. Maternal mortality would be alleviated with increased access to essential obstetric care and increased training of female health personnel. An increase in the population’s awareness concerning the issues of women’s health would also greatly facilitate improved maternal and infant health. Currently, across Afghanistan, only 15 per cent of deliveries are attended by trained health personnel.
53. Utilization of health services in facilities where only male health personnel are available is very low; the few female health personnel need retraining in basic health care provision. Traditions in Afghanistan make treatment of women by male nurses or doctors difficult and serve as a constraint for women seeking health care. Increasing female representation in the health care sector is a priority in order to address this constraint."

Document(s): Open document

03.11.2003 - Source: International Federation of Red Cross and Red Crescent Societies

IFRC: Maternal mortality - 1,600 maternal deaths per 100,000 live births - is among the leading causes of death in Afghanistan ("Delivering midwifery skills to Afghanistan’s remote east") [#30521],  [ID 1372]

"The Dar-i-Noor valley is only some 50 km from Jalalabad, the capital of Afghanistan’s eastern province of Nangarhar. But, lying deep in the Hindu Kush mountains, many of its villages cling to its precipitous slopes that are inaccessible, even by donkey.

“When a woman from one of the isolated hamlets needs medical help, her husband or brother has to carry her on his back down the narrow paths,” says Salma, a 30-year-old midwife from Jalalabad who has been helping to deliver babies and train traditional birth attendants in the remote valley for the past two years.


“A few days ago a mother died in childbirth because her husband would not allow her to leave the house,” Salma remarks.

“There are three main problems facing women in Dar-i-Noor. The first is ignorance, the second is transport and the third is poverty,” she adds.

Most families in the valley are subsistence farmers. Others earn a pittance cutting wood and selling it locally. All are poor. They can neither afford transport to take them to the hospital in Jalalabad when they fall ill, nor pay for medical treatment should they be lucky enough to find some way of getting there.

It is for this reason that the ARCS clinic in Bamba Kot, although offering only basic outpatient services, plays a crucial role in the life of the valley, for all the treatment and medicines are free.

It means that the health education sessions Salma runs are vital too. She teaches family planning, monitors the growth of children and advises women on pre- and postnatal care. During her two years in Bamba Kot, she has trained 29 traditional birth attendants, and supervises their work.

Their work is essential, since maternal mortality - 1,600 maternal deaths per 100,000 live births - is among the leading causes of death in Afghanistan. The UN Children’s Fund, UNICEF, says that more than 40 per cent of deaths among women of child-bearing age are caused by complications in pregnancy that are preventable.

Last June, as part of a ‘safe motherhood’ initiative, Salma attended a month-long training at the local Ministry of Health-run hospital in Jalalabad on how to set up a basic emergency obstetrics centre (EOC). Her training was funded by the International Federation.

Afterwards, UNICEF provided each participant with a basic EOC kit containing forceps, a fetoscope, a ventouse suction cap, instruments for minor surgery and other essentials."

Document(s): Open document

25.08.2003 - Source: ReliefWeb

Two years after the fall of the Taliban regime, women still face restrictions; no free education, poor healthcare situation ("For Afghan women: new regime, centuries-old barriers") [#15581],  [ID 1373]

Document(s): Open document

05.03.2003 - Source: Medica Mondiale

Lack of reliable forensic evidence is a particular concern in crimes where a woman is accused, especially in ‘morality’ crimes ("Trapped by Tradition - Women & Girls in Detention in Kabul Welayat") [#14380],  [ID 1374]

"The lack of reliable forensic evidence is a particular concern in crimes where a woman is accused, as they tend to be ‘morality’ crimes, which necessitate some kind of medical examination to determine sexual activity. Currently most if not all women who are detained undergo some kind of vaginal exam, which is either carried out by the ‘only expert’ in the Department (a man), or ‘if the woman objects’ by a female medical professional from Malalai Maternity Hospital. Such forensic evidence is then dependent on interpretation by legal professionals. In some cases, such as one of alleged incest with off-spring, simple forensics could prove the case, but are not available."

Document(s): Open document

27.10.2002 - Source: New York Times

Women Suffer Most in Afghan Health Crisis, Experts Say ("Women Suffer Most in Afghan Health Crisis, Experts say") [#12289],  [ID 1375]

"The most comprehensive surveys of medical facilities and maternal deaths ever conducted in Afghanistan show that the country's 25 million people have among the world's worst health and greatest needs, according to Afghan officials and foreign health experts.

Particularly hard hit by Afghanistan's 23 years of war, civil strife and Taliban misrule are Afghan women, who are experiencing what health officials call "catastrophic" death rates associated with pregnancy and childbirth — the world's worst, doctors believe.

Many Afghans in the most remote rural areas have never even seen a doctor, nurse or paramedic. Many rural clinics have no electricity or running water, and lack basic medical instruments. Medical schools in Kabul and Jalalabad have no textbooks, teaching slides or anatomical charts — the Taliban often burned them because of their graphic depictions of the human body. Some hospitals in the capital and other major cities lack microscopes and operating tables.
[...]
The bleak assessment of Afghanistan's health care comes mainly from twin surveys conducted this past spring and summer — an inventory of hospitals, clinics and medical workers in all Afghan provinces, and a study of the maternal health of 100,000 women in four far-flung Afghan provinces — urban Kabul; Laghman, which is semirural; and the rural provinces of Kandahar and Badakhshan. Preliminary results of both surveys are scheduled to be discussed with the Afghan cabinet on Oct. 28.
[...]
Data from the four-month maternal health survey are still being analyzed and will be final in early November, health officials said. Previous studies, including by United Nations agencies, have shown Afghanistan's maternal mortality rate to be among the highest in the world.

Preliminary data from the maternal health study show that from 1998 to 2002, about half of the women of childbearing age who died succumbed to complications associated with their pregnancies or childbirth.

In Badakhshan, the most remote province in northeastern Afghanistan, 64 percent of women of reproductive age who died reportedly succumbed to problems associated with pregnancy.

"Maternal mortality in Afghanistan is at catastrophic levels," said Peter Salama, the chief of health and nutrition for Unicef's office in Afghanistan, which conducted the maternal health care study from April to August with the Centers for Disease Control and Prevention in Atlanta.

Mr. Salama said the studies were done at the Health Ministry's request to help shape the country's medical priorities and health care strategies.
[...]
Linda Bartlett, a Canadian physician and researcher who supervised the analysis for the C.D.C. and conducted many of the interviews, compared conditions in remote Badakhshan in northern Afghanistan to those of "biblical times, some 2000 years ago." She said some villagers she interviewed had little sense of even the most basic hygiene. Many villages, for instance, had no latrines, so human and animal feces were found near food sources. Few villagers had ever seen a health care worker, much less a doctor; almost no one was vaccinated against any disease; women delivered babies at home, with only a relative present.
[...]
The maternal study found that only 4 percent of the women who died were literate, as were only 26 percent of their husbands. As troubling, only 30 percent of the people interviewed had access to a radio. Because many large, poor countries often use radio to help disseminate the basic principles of health and hygiene, the low access rate means that Afghanistan's government will have difficulty getting essential health information to many Afghans in the 37,000 villages, where more than 85 percent of the population lives.

In its inventory of Afghan health facilities, Management Sciences, the Boston nonprofit group, found roughly 1,038 health care facilities for Afghanistan's 25 million people, or one for every 24,000 Afghans. The rate is comparable to that of sub-Saharan Africa, public health officials said.

Only half the health care facilities have safe drinking water; 27 percent have electricity; and 37 percent have no toilets for staff or patients. Of even greater concern, 40 percent have no female health workers, which means those facilities are virtually off limits to women holding traditional values, who are not permitted to mingle with men.

Not surprisingly, both the inventory and the maternal health care studies found an enormous discrepancy between health care available to urban and rural residents. For instance, Kabul, which has 12 percent of the country's population, has nearly half of all the country's hospital beds."

Document(s): Open document

26.09.2002 - Source: Washington Post

Safe Childbirth Not Yet One Of Afghan Women's Rights ("Safe Childbirth Not Yet One Of Afghan Women's Rights") [#12286],  [ID 1376]

"But in 2002, Afghanistan remains one of the planet's riskiest places to have a baby. According to UNICEF, more Afghan women die during pregnancy and childbirth -- 1,700 per 100,000 -- than in any other country except Sierra Leone. The infant mortality rate of 165 per 1,000 live births is the third highest in the world, and one in four children die before they reach age 5.

The vast majority of Afghan women receive no prenatal care and deliver their babies with no help except from female relatives and untrained, traditional birth assistants known as dayas. As the country moves slowly toward modernization, entrenched rural poverty -- and the conservative attitudes that accompany it -- have left many pregnant women and infants trapped in helpless isolation.

"Most deliveries still occur at home, and when I ask women why, they say their male family members don't give them permission to go out," said Noor Khanum, a doctor who runs a midwife service in Kabul for a Swiss charity called Terre des Hommes. "The political situation has changed, but the mind of the people has not."

To a certain extent, the blame lies with the Taliban, the ultra-conservative Islamic movement that ruled most of Afghanistan from 1996 until last year. Placing women's "honor" above their health, the Taliban banned women from traveling -- even in emergencies -- unless a male relative accompanied them. Authorities also made it difficult for women to study medicine and shut down hundreds of clinics to prevent men and women from coming into contact.

But the Taliban's rule only compounded problems that have long afflicted Afghan women and remain stubbornly resistant to change. More than 70 percent of women live in rural provinces, where health care has always been scarce and transportation primitive. They marry as teenagers, bear an average of seven children, rarely attend school and live in male-dominated households where women's rights is an unknown, threatening concept.

Many rural women are anemic or malnourished, making them especially susceptible to complications of childbearing. Sometimes, according to doctors here, a husband will prefer that his wife die in childbirth than be exposed to male doctors. And even women with more liberal families often wait until they are seriously ill before trying to reach professional help.

"In most cases, they are already too sick to walk and certainly could not withstand a donkey ride for hours in the hot sun or freezing cold," said Chadija, a female obstetrician at a provincial hospital who was interviewed for a recent study by Physicians for Human Rights. "Once they get here, we have to send their relative to the bazaar to buy the drugs they need, [and] more time goes by."

The study, conducted in the western province of Herat by the Boston-based medical advocacy group, found that 97 percent of women there delivered at home with no skilled help and that maternal health care facilities and providers were "virtually nonexistent." Only 11 percent of women received prenatal care, and 593 died in childbirth for every 100,000 live births.

In Kabul, a teeming city of 2 million, there are a half-dozen public hospitals with maternity wards where health care is theoretically free, as well as 30 community clinics that have reopened since the Taliban was ousted from power last year. But the city has been inundated with impoverished returning refugees in the last nine months, overwhelming medical facilities, and staff members said they lack medicine and essential equipment for safe deliveries.

In the maternity wing of the city's military hospital, the rooms are spotless and cheerfully painted, but doctors said they had virtually no painkillers, plasma or antibiotics on hand. Some patients, recovering last week from the complications of unattended pregnancies or home births, slumped exhausted from their ordeals.
[...]
With poverty and prejudice preventing most Afghan women from seeking professional care, the vast majority of babies are delivered by local dayas. Unlike midwives, dayas have no formal training and little knowledge of how to prevent or treat such common -- and potentially fatal -- delivery problems as infection and hemorrhaging.

During the Taliban's rule, the enforced isolation of women increased their reliance on dayas, while many doctors fled the country and training for female nurses was sharply curtailed. Today, in a country of 26 million people, there are still only 7,000 doctors and an equal number of midwives, mostly located in cities or towns.

To bridge the gap, foreign aid organizations including UNICEF, the World Health Organization, the International Medical Corps and HealthNet International have begun a number of maternal health projects across the country, including two that teach dayas basic hygiene and delivery care. Their ultimate goal is to replace them with more skilled providers, but that may take several years of training.

"The dayas are a big problem, because they have no knowledge and they may endanger their patients' lives," said Shukria, 29, a veteran midwife in Kabul who trained dayas during the Taliban era. "There was a need for them at the time, but more clinics are open now and women can travel more easily. When I see dayas, I ask them not to practice, but people still come to them for help."

Agencies such as UNICEF are also trying to increase the number of midwives by funding crash courses for former students who were forced by the Taliban to suspend their studies. At the UNICEF program at Malalai Hospital for Women in Kabul, 25 re-enrolled midwifery students are learning to monitor fetal heartbeats, clamp umbilical cords and administer anti-bleeding drugs during labor.
[...]
Meanwhile, Khanum's team of 24 midwives struggles to keep up with the soaring demand for their services. Visiting 120 homes a day in Kabul's poorest neighborhoods, they provide checkups for thousands of mothers and babies, answer questions about family planning, discourage dangerous traditional practices -- such as packing the umbilical stump in mud -- and persuade reluctant husbands to send their seriously ill wives to the hospital.

"Some Afghans think if a woman dies giving birth, it is part of life," said Malalay Nazir, a physician and former director of the program. "Some think hemorrhaging or convulsions are a normal part of delivery. And some say if your wife is dying, don't be sad or spend your money on her; you can always get a new one.""

Document(s): Open document