Maternity Care, Once a Sign of Hope in Afghanistan, Is Faltering Under the Taliban

Decades of progress in maternal and neonatal healthcare, once a flagship indicator of the West’s success in Afghanistan, are eroding due to hunger, fleeing hospital staff and curbs on women’s freedom, doctors and international organizations say.

At Kabul’s busiest maternity hospital, incubators and cribs hold up to three newborns at a time due to a shortage of space. The weakest patients die because of a lack of equipment and medication. Doctors say hunger is behind a rise in complications like premature delivery and low birthweight, and rates are expected to rise in the year ahead.

Dr. Atiqullah Halimi stood by an incubator in the Neonatal Intensive Care Unit, where a premature baby was being treated with oxygen. The infant was born nine weeks early and weighed just under a pound because his mother had gone hungry during the pregnancy. In the West, the baby might have lived, but in Kabul he had no chance of survival, the doctor said.

Afghanistan has long suffered some of the world’s highest maternal and neonatal mortality rates in the world, but billions invested by the U.S. and its allies in the health system brought improvements to the lives of mothers and babies during the 20-year war, despite the ravaging effects of the conflict that claimed thousands of civilian lives every year.

The U.N. estimates the neonatal mortality rate last year was almost 7% of all live births, and could rise to 10% without adequate funding—more than 20 times higher than in the U.S. Aid officials say that true figures are likely underreported because there hasn’t been a reliable survey in years and many women give birth at home.

Patient numbers at major centers like Malalai Maternity Hospital in Kabul are on the rise for a multitude of reasons linked to the West’s departure after the Taliban takeover of Afghanistan last summer. The end of the war has made it possible for rural women to travel long distances to access specialized care. Sanctions and the frozen banking system have limited public funding, forcing rural medical facilities to close and straining the already weak healthcare system as a whole. Meanwhile, the economic collapse in Afghanistan has left much of the country on the brink of starvation.

The United Nations and its partners in Afghanistan said in May that close to 20 million people, almost half the population, face acute hunger.

The Taliban’s spokesman Zabiullah Mujahid didn’t respond to a request for comment. He has previously said that poverty in Afghanistan was caused by 40 years of destructive wars. He has also described U.N. data as exaggerated.

Kabul’s Malalai Maternity Hospital also risked closure last year. Doctors and staff went unpaid for months until the International Committee of the Red Cross stepped in to cover the budget until the end of the year. The organization has propped up a total of 33 hospitals across the country, said ICRC spokeswoman Anita Dullard.

The U.N. and other agencies for months have been warning that the healthcare system is on the brink of collapse, and it is hoping to raise just over $250 million for reproductive health in Afghanistan in 2022, it said.

Midwives say dozens of staff have fled the country, and more plan to leave because of the Taliban’s ban on girls’ education and curbs on women’s freedoms. The Taliban have kept women home from work, prohibited women from traveling without a chaperone, and sometimes even barred them from accessing healthcare without a guardian.

“We are scared of going back in time,” the head midwife at Malalai Maternity Hospital said.

The Taliban’s leader, Mullah Haibatullah, made no mention of women in a rare statement this month despite pressure to reopen girls schools as promised earlier this year.

At a maternity hospital operated by Doctors Without Borders in eastern Khost province, doctors have similarly seen an increase in obstetric complications since last summer. The organization’s medical coordinator, Anna Cilliers, said they were unsure whether it was due to improved access now that the war was over, a lack of prenatal services, growing hunger, or a combination of all those factors.

Neonatal mortality rates at the Khost hospital, which lacked specialized equipment, was steady at around 8%, she said. Doctors Without Borders was also observing more complications in the south, where it operates a maternity ward at its general hospital in Helmand province.

 “We do not know what the real mortality rate is at the moment,” Ms. Cilliers said.

In central Wardak province, which experienced some of the worst fighting during the war, pregnant and breast-feeding mothers recently lined up for nutritional pouches at the main regional hospital. The midwives kept track of patients in a book that had logged 84 cases of malnutrition in the past two days, determined by measuring the circumference of the upper arm. The figure was about 10 times higher than in recent years, they said.

Meanwhile, neonatal unit doctors were hoping to save one baby from a set of twins born 13 days earlier. The mother, who wore a pink dress embroidered with beads, suffered from malnutrition and went into labor during her seventh month of pregnancy while she was carrying heavy buckets of water. Her surviving baby is a girl weighing just over 3 pounds, wrapped in a white cloth with purple flowers. The boy had died a few days ago.

“I’m so happy this one is still living,” she said.