The Complex Presence Of Fathers: Birth Customs In Afghanistan

Afghanistan is a dangerous place to give birth, with thousands of women dying each year from pregnancy-related causes. The country has one of the highest infant mortality rates in the world, and the maternal mortality ratio is 638 per 100,000 live births. In the past, Afghanistan's healthcare system has been destroyed by conflict, leaving few trained health workers and little infrastructure. Although conditions are improving, with more children living past infancy, Afghanistan still faces significant challenges in providing adequate healthcare for mothers and newborns. The presence of men during birth in Afghanistan is influenced by cultural and religious factors, with male doctors treating women still largely considered taboo.

Afghanistan has one of the highest infant mortality rates in the world

In 2018, four out of ten Afghan children died before their first birthday. While this is a notable improvement since 1990, far too many families are losing their children during the neonatal period. Most of these deaths could be prevented with timely and adequate care, treatment, and healthy behaviours.

Afghanistan also has one of the highest maternal mortality ratios in the world, with 638 deaths per 100,000 live births. This is due to several factors, including the lack of access to healthcare facilities, financial barriers, geographical challenges, and cultural factors.

The country's healthcare system has been destroyed by years of conflict, resulting in a shortage of trained healthcare workers and infrastructure. Additionally, the distance to healthcare facilities poses a significant challenge, especially for women in remote areas who may need to travel for more than two weeks to access a skilled birth attendant.

Cultural factors also play a role, as male doctors treating women is still largely taboo in Afghanistan. The re-emergence of groups like the Taliban, which banned education and the free movement of women, could also negatively impact death rates.

Improving maternal and infant health in Afghanistan requires addressing financial, geographical, and cultural barriers to accessing skilled birth attendants and quality healthcare. Efforts by the Ministry of Public Health, UNICEF, and charities have made progress, but sustaining these improvements in the face of declining foreign aid and ongoing insecurity remains a challenge.

The country also has a high maternal mortality ratio

Afghanistan has a high maternal mortality ratio, with 638 maternal deaths per 100,000 live births as of 2020. This ratio has decreased over the years, with 1,400 maternal deaths per 100,000 live births in 2008, and 1,800 in 2000. Despite these improvements, Afghanistan remains one of the most dangerous places in the world to be a mother, with thousands of women dying every year from pregnancy-related causes, most of which are preventable.

The high maternal mortality ratio in Afghanistan is influenced by various factors, including:

• Healthcare Services: The availability and quality of healthcare services play a crucial role in maternal health. Afghanistan has been working to rebuild its healthcare system, with international organizations providing significant support. However, there is still a need for more skilled healthcare professionals, especially female doctors and midwives, as male doctors treating women is generally taboo. Additionally, the utilization of healthcare services among Afghan women is variable and inconsistent.
• Education: Education is a critical factor in improving maternal health. It empowers women, increases their healthcare utilization, and helps them make informed decisions about their reproductive health. However, Afghanistan has a low literacy rate, especially among women, which impacts their ability to recognize and seek appropriate healthcare.
• Socio-cultural Practices: Patriarchal societal practices, such as early marriage and the need for a husband's permission to access healthcare, negatively impact women's health. These practices are deeply rooted in Afghan society, where reproduction is still considered the predominant role for women.
• Employment and Income: There is a correlation between household income and women's healthcare utilization. Even a small fee for healthcare or drugs can be a barrier for low-income families. Additionally, women's formal employment and its impact on their health is challenging to determine due to the low employment level among women in Afghanistan.
• Food, Water, and Sanitation: Lack of access to nutritious food, clean water, and proper sanitation facilities contribute to poor hygiene and nutrition among pregnant women, increasing their risk of complications.

Addressing these factors and improving maternal health in Afghanistan requires a comprehensive approach involving various government sectors, such as education, labor, social services, and cultural organizations. It is also essential to recognize the impact of geographic and cultural differences, as maternal mortality rates vary significantly between urban and rural areas.

Most Afghans live in rural areas, far from health facilities

Afghanistan is a country where most people live in rural areas, far from health facilities. About 74% of Afghans live in rural areas, and the country has one of the highest infant mortality rates in the world. The country's difficult terrain and poor transportation infrastructure make it challenging for women in remote areas to access healthcare services.

Afghanistan has a high maternal mortality rate, and thousands of women die every year from pregnancy-related causes, many of which are preventable. The distance from health facilities poses a significant challenge, as both infant and maternal deaths have been found to increase with the distance from urban centers.

The lack of access to healthcare in rural areas is further exacerbated by cultural and socioeconomic factors. Literacy and socioeconomic status influence the utilization of skilled birth attendants, with women from wealthier quintiles having higher odds of utilizing these services. Additionally, patriarchal societal practices, such as early marriage and the need to obtain permission from male relatives to seek healthcare, impact women's health.

To address these challenges, organizations like UNICEF and NGOs like World Vision work to expand healthcare services in existing facilities and reach mothers and children in remote villages. They provide training and essential newborn care equipment and deploy mobile health outreach teams to isolated areas. Despite these efforts, the financial barriers faced by poor and uneducated women, as well as cultural and geographical obstacles, continue to pose significant challenges to improving maternal and neonatal health outcomes in Afghanistan.

Afghanistan's health care system has few trained health workers

Afghanistan's healthcare system has been struggling with a shortage of trained health workers for many years. The country has one of the highest infant mortality rates in the world, and thousands of women die every year from pregnancy-related causes, most of which are preventable.

In 2002, Afghanistan's healthcare system had few trained health workers and little remaining infrastructure due to 25 years of conflict. The lifetime risk of maternal death for women was 1 in 9, and 78% of maternal deaths were from causes that could have been prevented with adequate obstetrical care. Only 9% of women were assisted by a skilled birth attendant, and one-third of women were vaccinated against tetanus.

The shortage of trained health workers, particularly female health workers, is a significant barrier to accessing healthcare for many Afghans, especially in rural areas. Afghanistan has some of the worst health indices in the world, and infectious diseases, malnutrition, physical trauma, psychological trauma, and human rights abuses are prevalent. The lack of trained health workers, especially in emergency medicine, contributes to these issues.

The security situation in Afghanistan also affects the availability of trained health workers. Violence and insecurity have led to the closure of many health centers and the deaths of healthcare workers. In addition, the Taliban's restrictions on women's education and freedom of movement have further reduced the number of female health workers, which is particularly problematic since Afghan societal norms dictate that only women can provide medical care for other women.

Economic instability and a lack of funding for the healthcare system have also contributed to the shortage of trained health workers. External funding from organizations like the World Bank and USAID is crucial for Afghanistan's healthcare system, but it is unpredictable and can end without warning. Domestic health care spending is a low priority, with per capita spending on health care at only 0.6% of the country's gross domestic product (GDP).

The challenges of establishing a functional healthcare system in Afghanistan are complex and interconnected. They include those typical of a developing nation, a post-conflict nation, and a combat zone. A combination of specific goal-oriented projects, foreign aid, and domestic responsibility is needed to improve the situation.

Male doctors treating women is largely taboo in Afghanistan

Afghanistan has one of the highest infant mortality rates in the world, and thousands of Afghan women die every year from pregnancy-related causes, many of which are preventable. The country's maternal mortality ratio is 638 per 100,000 live births, and in 2008, the number of women who died giving birth was 1,400 per 100,000 live births.

The Taliban's strict interpretation of Sharia law and gender segregation has had a significant impact on women's access to healthcare and education. The Taliban has barred women from working in most professions, and girls from attending secondary school. In addition, the Taliban has issued decrees directing hospitals to ensure that male doctors do not treat female patients. This has led to fears among female medical professionals and students that women will die due to a lack of medical supervision.

Religious and cultural norms in Afghanistan mean that women rarely visit male doctors, especially for gynaecological issues. As a result, women's health issues often go untreated, which can have severe consequences. The lack of access to male doctors also affects women's ability to receive emergency medical care. In some cases, male doctors have been prevented from treating women, even when their lives are at risk.

The Taliban's policies have also had a negative impact on the number of female doctors and medical professionals in the country. Many female doctors have fled the country due to safety concerns or have been prevented from practising medicine due to restrictions on their movement and harassment from Taliban officials. In addition, the Taliban's restrictions on girls' education will likely result in a further reduction in the number of female doctors in the coming years.

The World Health Organization (WHO) and other international organizations have expressed concern over the Taliban's policies and their impact on women's access to healthcare. The United Nations Security Council has also urged the Taliban to "reopen schools and swiftly reverse these policies and practices, which represent an increasing erosion for the respect of human rights and fundamental freedoms."

Despite these concerns, the Taliban has continued to enforce its policies, and the situation for women in Afghanistan remains dire.

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