On the Ground Supporting Women’s Health in Afghanistan
Over the past 18 months, life as a woman in Afghanistan has become unbearable. Every two hours, a woman dies from preventable pregnancy or childbirth complications. An estimated 95 percent of the population doesn’t know where their next meal will come from. And, woman and girls have been progressively excluded from public life and live under the constant threat of violence.
Recent events have only deteriorated the situation further and left women and girls in need of support more than ever before.
But, thanks to dedicated supporters like you, we are on the ground in Afghanistan supporting women and girls with critical sexual and reproductive health care.
Here are just some of the programs you have kept running and the women and girls you have reached:
Family health houses
UNFPA family health houses aim to increase access to care in underserved areas. A midwife from the community staffs each house and provides essential reproductive, maternal, newborn, and child health services.
Laila has run a family health house in her community for nearly a decade, but one day stands out in her memory. It was the day a 17-year-old girl, pregnant with her first child, arrived at Laila’s house in a wheelbarrow. She had been experiencing extreme labor pains, but her family didn’t have the money to pay for transportation to the clinic. By the time the girl arrived, it was too late. She had succumbed to a preventable childbirth complication.
Building a safer future
Laila resolved to do more for the women and girls of her community and prevent this tragedy from happening again. She worked with her community to make sure two cars were available at all times to transport women to the clinic. If needed, the cars can even travel to the nearest hospital – an hour away – to save a woman’s life.
These efforts have been successful. “We haven’t had maternal deaths here since that unfortunate day five years ago,” Laila said. “This clinic may be small but it has a big contribution on the health of women in this village.”
As word of the clinic’s services and success has spread, Laila has become much busier. Her family health house was intended to serve 300 patients per month. Today, she regularly sees more than double that amount —700 patients a month. And, Laila is on-call 24/7 for any emergency that may need her attention. “The zero maternal deaths represent the success of my work and this is an inspiration for me.” UNFPA currently supports over 220 family health houses for women and girls across Afghanistan and plans are in place to increase that number. These houses are a vital resource in a country where one woman dies every two hours from preventable pregnancy and childbirth complications.
Mobile health clinics
UNFPA mobile health clinics provide reproductive health care to communities on the move or those isolated from care. Shahpirai belongs to the latter. She is the sole provider for herself, her husband, and their three children. She’s been doing the best she can to support her family, but even so, her youngest became malnourished. “With my salary as a teacher, I could just afford to pay rent and buy food for my family, but not to seek treatment for my child,” Shahpirai explained.
When a UNFPA mobile health clinic came to her community providing free care to women and children, Shahpirai knew she needed to take her son. The clinic referred to a program with children with acute malnutrition and gave her medicine to give him at home. “I returned to the center regularly, and after three months the doctor said my son was doing better and no longer needed therapeutic feeding. I was also instructed on how to provide him with proper nutrition at home.”
Today, Shahpirai’s son is a healthy 15-month-old boy. But hunger and malnutrition are rampant in Afghanistan. An estimated 95 percent of the population is on the brink of starvation.
Minaz had just completed her midwifery training and was looking forward to supporting the health of women and girls in her community when a devastating earthquake hit Afghanistan’s Khost and Paktika provinces. Minaz jumped into action. “There was a woman who was nine months pregnant. She was injured and lost family members and relatives in the earthquake. She was in a state of shock and fear.” The woman went into early labor and Minaz delivered her first baby without the support of a mentor.
The birth went smoothly, but the mother needed mental health counseling to cope with the shock of the earthquake. Minaz remembered, “Other women, many of them pregnant, were also in shock with the sight of dead bodies – including those of their loved ones – being recovered from beneath the rubble.”
In life-changing moments like these, midwives are a lifeline for women and girls. But, midwives like Minaz also navigating difficult scenarios from the personal shock of losing loved ones or their home in a crisis, to having limited supplies to care for patients and managing rare complications.
Supporting midwives on the frontlines
Luckily, midwives on the frontlines of this essential work aren’t alone. They can call a UNFPA hotline that’s staffed around-the-clock with experienced OB/GYNs and midwives. The hotline provides critical advice and support during moments like the earthquake but also during complicated deliveries, like Firoza’s.
Firoza, a mother of five, was rushed to her local family health house. She was in labor with her sixth child but had developed complications and was in severe pain. At the house, Firoza received treatment and delivered her baby. But Amina, her midwife, noticed something different about this delivery: another baby. Amina knew Firoza couldn’t travel to another health center better equipped to provide her with care. She had to call the hotline for support.
A senior midwife on the hotline successfully guided Amina through the delivery of Firoza’s second baby — but their joy was cut short when Firoza began to hemorrhage. Still on the hotline, Amina quickly asked for advice to stop the bleeding. Amina was able to stabilize Firoza and keep her twins healthy until they could travel to a larger facility the next day.
“It was a difficult time for me, but I’m lucky that I was supported by the Family Health House. Now I’m feeling well and my twins are healthy,” Firoza said when she visited Amina’s family health house a week later for postpartum care.
Mental health services
Women and girls have been increasingly excluded from public life and are becoming distressed.
“Most of the problems of women and girls are invisible. You only learn about their suffering when you talk to them and they open up to you,” explained Fariha, a mental health counselor at a UNFPA safe space. She often sees more than 25 patients a day. “It is a privilege for me to have their trust that they can talk to me. I listen to them and provide them support to enhance their coping skills and improve their well-being” she said.
The mental health of girls
One girl who benefits from such support is Mursal. She was 17 when the government collapsed and forced to drop out of school and put her dreams of becoming a doctor on pause. “It is not right that they are deciding for us, ordering us to go with mahram [a male companion], that we should hide our faces, and stop going to school,” Mursal said. “I really miss my friends, my teachers, and my school. It was a great place but now I can’t go there.”
But, through the support of UNFPA, Mursal has found a new purpose. She has learned to cope with the changes in her life and has become a peer educator to help other girls like her navigate their new circumstances. Her advice for girls is to remain hopeful. “I hope that young girls will not give up. It is okay to be scared, it is okay to cry, but giving up is not an option. I hope they will continue learning in any way they can. Insha Allah [God willing], maybe someone will help us, or the schools will reopen. Our bright morning will come.”
The Path Forward
Thanks to the commitment of supporters like you, we have been on the ground delivering lifesaving health care to women and girls in Afghanistan. In the past 18 months, we have reached more than 4.3 million people through our family health houses, mobile clinics, and midwives. We have provided essential medicines and supplies to hospitals to ensure safe births and distributed menstrual products to hundreds of thousands of women and girls. We’ve responded to a major earthquake. Now during the winter season – and as needs continue to rise – we are providing cooking utensils and blankets to those in need. We stand ready to do more.
We are continuing to expand access to care for women and girls like Mursal, Firoza, Laila, Minza, Amina, Shahpirai, and Fariha. And we are only able to do this because of your support. Thank you so much for being with us during this time and for being with women and girls in Afghanistan, no matter what.
dignity of women and girls