After the fall of Afghanistan to the Taliban insurgency this year, there is great concern about the rights of women and girls across the country. Women have made many advancements in their pursuit of equality and human rights since the last Taliban government, that was overthrown in 2001. There are concerns that with the new change of power in Afghanistan many of these newly gained rights will be swept away, and instead extremely conservative and restrictive laws will be implemented in order to limit women’s roles in society.
WOMEN’S HEALTHCARE DURING THE FIRST TALIBAN GOVERNMENT (1996-2001)
From 1996 to 2001, the Taliban imposed a series of oppressive measures on women and girls. One of the most disturbing restrictions was on women’s access to healthcare. Female healthcare workers such as doctors, nurses, and pharmacists were barred from entering the Kabul hospitals where they worked, leaving 22 hospitals in the city critically short-staffed. For the most part, male doctors were unable to diagnose or effectively treat women, given they were not allowed to see their female patient’s bodies, as well as other prohibitions. Female patients in Kabul were also not allowed to go to men’s hospitals, forcing them to attend a segregated medical centre. Out of all the hospitals in Kabul, only one dealt with women’s needs and it was also the only centre where women could work as healthcare providers. Although these measures were eventually relaxed, other restrictions were imposed such as not allowing women out of their house without a male companion. This caused insurmountable difficulties for women who had no living male relatives. As a result, many women were not able to access medical facilities. These restrictions on women’s access to healthcare also gravely impacted children’s health, as often their mothers could not take them to the doctor or satisfy their medical needs.
The quality of healthcare available under the Taliban regime was equally insufficient. The single medical facility available to women in Kabul had only 35 beds, no oxygen, no surgical or diagnostic equipment, no electricity, or even clean water. One of the most concerning aspects of women’s healthcare in Afghanistan in the late 1990’s was access to maternal healthcare. Due to restrictions and poor quality of medical services, only 10% of women were able to access prenatal and maternal care, and only 6% of women had trained medical personnel at their births. Maternal mortality during this time was the highest in the world, at 1,450 per 100,000 live births. Equally as bad was the quality of mental health services available for women. At the time, 97% of women suffered from major depression, 86% suffered from severe anxiety and 42% reported having symptoms of post-traumatic stress disorder.
Finally, other restrictions the Taliban imposed on women indirectly contributed to declining health. Due to restrictions on women’s ability to work and to earn an income, many women were thrust into poverty. Combined with the difficulty females faced in simply leaving their house, and the Taliban’s interference with humanitarian aid programs, many families suffered from malnutrition and related illnesses.
WOMEN’S HEALTHCARE FROM 2001 ONWARDS
Since 2001, healthcare in Afghanistan has been funded mostly by international donors who, along with the Afghan government, prioritised providing primary health care to the entire country. In the years that followed, restrictions to women’s access to healthcare were lifted. Women were no longer segregated, they were able to be treated by male doctors, a male companion was no longer necessary for a woman to leave their house, and women could work and receive an income. One of the key areas of improvement was access to better maternity care. Where 6% of births during 1996 to 2001 were attended by medical personnel, 58.8% of births in 2018 were attended by a trained healthcare worker. Maternal mortality declined from 1,450 per 100,000 live births to 638 per 100,000 live births. While this is still a very high number, the improvement is quite significant.
However, there are still significant challenges for women accessing healthcare in Afghanistan. Insecurity, violence, gender inequity, family pressures, restricted autonomy, lack of information, distance to medical facilities, and cost of care severely impact the ability for females to access necessary healthcare. The cost of medical care is one of the most limiting factors. Even though care in government hospitals is free, as a result of underfunding, women are required to provide some medical equipment required for their own procedures to be carried out, such as gloves, gauze, scalpels, catheters, and sterilising fluid, as well as their own medication. Because of a lack of resources, blood tests and certain diagnostic tests sometimes have to be conducted outside hospitals and they must also be paid for by the patient. These costs can rapidly escalate if a patient needs surgery or treatment that cannot be provided at a government hospital. In this situation, a patient must seek private healthcare. Additionally, as, many women do not have a medical care centre nearby, there are also significant transportation costs. Corruption is still rife at all levels of society, so it is not uncommon that a bribe is also required in order to access the closest medical centre. For the many women in Afghanistan who struggle with poverty, these costs mean a visit to the doctor is often out of reach, thus leaving them without adequate care.
The quality of the healthcare system in Afghanistan is still far below international standards. As well as limited prenatal and postnatal care, there is a lack of information about general healthcare, family planning and modern contraception. Specialist care such as fertility and modern cancer treatments are largely unavailable, as is preventative care such as mammograms and pap smears. Hospitals are still critically understaffed. As at May 2021, Afghanistan had 4.6 doctors, nurses and midwives per 10,000 people. The threshold for critical shortage defined by the World Health Organisation is 23 medical professionals per 10,000 people. Due to the many barriers in the Afghan the healthcare system, those who can afford to travel often choose to seek medical care abroad, primarily in Pakistan or India.
THE FUTURE OF WOMEN’S HEALTHCARE UNDER THE CURRENT TALIBAN REGIME
With the Taliban taking control of Afghanistan in mid August 2021, it is uncertain what the impact will be for women and girls throughout the country. At the time of writing, some restrictions on women have already been put in place, most notably in education where women must be segregated. These measures have already caused significant disruption and they also have severe implications for the future of women’s health care. If universities refuse to or cannot financially justify separate classes for women, then women will not receive education in various areas. Without adequate medical education for women, there will not be trained female healthcare workers. Women currently working in healthcare have been given mixed messages, as they are told they will be allowed to work, but they have also been told to stay at home and not go to work (with the exception of public health workers). Working conditions for female medical staff are already difficult. In one hospital, patients and staff have been segregated [in French] based on gender. In Kabul, medical workers have been prevented from going to work if they cannot get there safely, and this insecurity particularly prevents female healthcare providers from choosing to risk going to work.
However, the main threat to health care under the current Taliban regime may actually be lack of funding from other governments. Up to 90% of health clinics in Afghanistan are funded by international donors, primarily western governments, who have now shown a reluctance in sending funds to a Taliban-led country. It is still unclear whether there will be more restrictions imposed on women and girls, and whether international donors will continue funding the Afghan healthcare system. So far the restrictions have not been as severe as some feared, and it is still possible that there will be no significant reductions in international aid funding. While it is clear that access to medical care is in jeopardy, the world is cautiously hopeful that the situation for millions of women and girls in Afghanistan will not get worse.
Laura is a pharmacy student at the University of Alcalá de Henares and is interested in pursuing a career in global health, humanitarian medical aid and human rights from a health perspective.