Human Rights Watch (HRW) in a report published on May 6 says that women and girls in Afghanistan struggle to access even the most basic information about health and family planning.
The report says that there is an unmet need for modern forms of contraception; prenatal and postnatal care is often unavailable; specialty care, such as modern cancer and fertility treatment, is largely nonexistent; routine preventative care such as pap smears and mammograms are almost unheard of; and a large proportion of births are still unattended by a professional.
Health facilities often lack sufficient staffing and essential supplies and equipment.
Afghanistan has 4.6 medical doctors, nurses, and midwives per 10,000 people, far below the threshold for critical shortage of 23 healthcare professionals per 10,000 people as defined by the World Health Organization, the report says.
Women often struggle to access care due to costs, including for transportation to a health facility, and for medications and supplies for which patients are obliged to pay, the watchdog says.
When they can obtain care, it is often of poor quality. Distance remains a problem for a significant proportion of the population; almost 10 percent of people cannot reach a health facility within 2 hours and 43 percent must travel more than half an hour, according to the report.
Lack of access to adequate care drives Afghans to spend $285 million a year on medical tourism, mostly to Pakistan and India, draining funds from the health sector, the watchdog sys.
Progress on some key indicators, such as accessing prenatal care and skilled birth attendance, is now stagnating, or even reversing, the report says.
According to the report, Corruption at all levels threatens the delivery of health services and demands for bribes drive people away from seeking care.
Human Rights Watch says in its report that it visited health facilities in Kabul, the capital, and interviewed 34 women about their experiences seeking and receiving health care, 18 people working in healthcare delivery, 4 donor entities, and additional experts including international and nongovernmental organizations (NGOs).
What emerged is a picture of a system that is increasingly unaffordable to the estimated 61 to 72 percent of Afghan women who live in poverty, and one in which 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 access to and capacity to use more modern techniques, the study finds.
People interviewed by Human Rights Watch expressed fears that the Taliban would obtain increasing control over the lives of Afghans or that the already-high level of violence in the country would escalate.
Both scenarios—growing Taliban control and rising levels of violence—have implications for donor support to Afghanistan, including for women’s health.
Donors and organizations delivering services described being locked in a waiting game, with donors unwilling to make firm commitments, and hedging on whether they will be able to fulfill existing commitments until there is greater clarity on the political and security situation. This uncertainty reflects the major challenges that already exist in delivering services in Afghanistan, the watchdog says.
It is crucial that donors prioritize meeting the urgent needs of Afghans—including those of women and girls for health care.
Human Rights Watch says it conducted research for this report in March and April 2021. The research included 56 in-person interviews in Afghanistan plus 7 additional interviews with experts via video conferencing.
The watchdog says that 34 interviews were with Afghan women about their experiences of seeking and receiving health care. 18 were with Afghans working in the health sector, ranging from the minister of public health to a hospital cleaner, and including doctors and people working in management, midwifery, nursing, and physiotherapy, most of whom we were able to interview during visits to health facilities.
The rest were with donor agency officials and with other experts on the health sector or women’s rights in Afghanistan.
The watchdog suggests the afghan government to continue prioritizing support and reform of the health system and include a strong focus on women’s health.
It also asks the government to increase monitoring and strengthen accountability measures, such as complaint mechanisms to reduce and end corruption in the health sector.
The government should develop and implement a plan to provide comprehensive sexuality education to all Afghans, including women and girls, and people who do not attend formal education, the watchdog says.
Expand access to psychosocial support and mental health services, including a focus on providing these services, in a gender-sensitive manner, to women and girls.
End the requirement that a husband must consent to his wife accessing contraception.
The HRW asks the Taliban to support provision of health services and reform of the health system and respect the right of everyone, including all women and girls, to have full access to all health services.
The watchdog also asks the Taliban to permit and facilitate education for girls and women to ensure literacy about family planning and health, and support training future female health workers.
It also asks the Taliban to allow “comprehensive sexuality education and full access to modern contraception.”