Courtney Pendray
Women’s Health in Afghanistan
From: Secretary of Health, Afghanistan
To: Minister of Finance, Afghanistan
Introduction:
Women’s ill health is a serious problem in Afghanistan, with life expectancy at only 44
years of age and the maternal mortality ratio at 1,800 per 100,000 live births.i More than half of
Afghan women suffer from anxiety, depression, or post-traumatic stress disorder, as well as
gender violence as a result of oppressive Taliban policies.ii These issues affect all Afghan
women, but especially poor, uneducated women living in rural areas. Risk factors for ill health
include the high fertility rate, lack of access to health services, inadequate water and sanitation,
low educational levels, and social and legal oppression inflicted by the Taliban regime.
Addressing women’s ill health is essential to improving economic productivity as well as the
health and wellbeing of the future generations of our nation. These problems can be most
effectively addressed by increasing access to health services for women, improving water and
sanitation in rural areas, and improving rates of female education and literacy.
Nature and Magnitude of the Problem:
The state of women’s health in Afghanistan is appalling and needs to be addressed. At
only 44 years, female life expectancy in our country is among the lowest in the world and is 33
years lower than the global average.iii Additionally, females are only expected to live in good
health for 36 of these years.iv Maternal causes are the biggest contributor to women’s ill health,
with death as a result of post-partum hemorrhage, obstructed labor, infection, and eclampsia as
the main causes.v The maternal mortality ratio is 1,800 per 100,000 live births, also among the
highest in the world.vi
The increasingly poor status of women’s mental health in our country is of grave
concern. Afghan women suffer disproportionately from anxiety, depression, and post-traumatic
stress disorder, and are victims of gender violence. 73% of Afghan women show symptoms of
depression, 84% suffer from anxiety, and 48% from post-traumatic stress disorder.vii Of all
incidents of violence against women committed in Afghanistan, 30.7% were related to physical
violence, 30.1% to psychological violence, 25.2% to sexual violence, and 14% were a
combination of the three. Family members committed an alarming 82% of incidents.viii
Affected Populations:
Women’s health issues in Afghanistan affect mainly impoverished and uneducated
women living in rural areas. As 88% of our population lives in rural areas, these issues are of the
utmost importance.ix 36% of the total Afghan population lives below the poverty line, and the
unemployment rate is 35%, demonstrating the pervasive nature of poverty in our country.x
Uneducated females suffer increasingly from poor health conditions, and with a female literacy
rate of only 18%, women’s health among this population is a serious concern.xi
Risk Factors:
Risk factors for women’s ill health and premature death in Afghanistan are primarily the
high fertility rate, lack of access to health services, lack of adequate clean water and sanitation,
low rates of female education, and social oppression inflicted by the Taliban regime. The
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fertility rate is extremely high at 5.39 children per woman, putting women at high risk of
maternal causes of death.xii Only 16% of pregnant women in the country went to at least one
antenatal care visit, and this number drops to 8% in rural areas. Similarly, only 14% of births
nationwide are attended by a skilled health professional, and only 7% are attended in rural areas.
As the majority of women live in rural areas, access to health services is a significant issue.
Contraceptive use is extremely low at 21%, which contributes to the high fertility rates among
Afghan women.xiii There is a serious shortage of physicians, nurses and midwives in our
country, with only 2 physicians and 5 nurses and midwives per 10,000 citizens.
Inadequate water and sanitation are significant contributing factors to the high rates of
maternal infection and death. Only 12% of the total population and 8% of the rural population
enjoys access to adequate sanitation, and only 17% of the rural population uses improved
drinking water sources.xiv The lack of these basic necessities is a major risk factor for the spread
of disease, especially during pregnancy.
As the education level of a woman directly correlates to her health status, the low levels
of female literacy and school attendance in our country are alarming. The female youth literacy
rate is low at 18%. 84% of females are enrolled in primary school, but this number drops sharply
to 15% for female secondary school enrollment.xv
The political and social oppression enforced by the Taliban regime has had an immensely
negative impact on the health of Afghan women. Sanctioned gender violence has played a
significant role in the increase of mental health conditions in women.
Economic and Social Consequences:
The economic and social consequences of women’s ill health in Afghanistan are
significant due to the pervasive nature of the problem. Short life expectancy combined with risk
of maternal morbidity and mortality directly affects the young children of mothers who die in
childbirth, putting them at increased risk of malnutrition, infection, neglect, and death. Female
mental ill health has similar effects, but also contributes to the low rates of economic production
that the country is currently experiencing. Addressing women’s health concerns is necessary for
increasing the economic output of our economy as well as improving the social wellbeing of our
population.
Priority Action Steps:
In order to improve women’s health and prolong female life expectancy, we must address
the areas of diagnosis, transport, and treatment in regard to maternal health, as well as improve
women’s educational status. The approach to improving maternal health is threefold, involving
increasing birth attendance by skilled health workers, increasing the number of clinics in rural
areas, and improving treatment by providing access to emergency obstetric care. Increasing the
number of clinics will also increase access to contraceptives and antenatal care. This holistic
approach to improving maternal health will decrease maternal deaths by increasing availability
of health services. In order to implement these changes, increased funding and commitment is
needed from the Afghan government as well as outside sources such as the USAID initiatives
already in place.xvi Only 3.7% of all government expenditures are allocated to health, and an
increase in this percentage is necessary to improve the health status of women in our country.xvii
Increasing access to adequate water and sanitation sources in rural areas is another main
area of concern. Improving these resources will decrease incidence of infection as well as the
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spread of disease. This initiative will also require national as well as outside funding and
commitment.
Improving women’s educational status is the most effective means of lifting women out
of poverty, improving their physical and mental health status, and decreasing rates of gender
violence. Initiatives aimed at community and religious leaders will allow us to improve female
school attendance rates and increase female literacy. The biggest obstacle to success in this area
is the Taliban rule, but progress can be made by starting on a grassroots level. As women’s
health is essential to the health and productivity of future generations of our country, it is
essential that we address this issue immediately.
i
Afghanistan Summary. Population reference bureau. Retrieved April 13, 2011, from
http://www.prb.org/Datafinder/Geography/Summary.aspx?region=137&region_type=2
ii
Afghanistan: National Reconstruction and Poverty Reduction – The Role of Women in Afghanistan’s Future. The
world bank. Retrieved April 13, 2011, from
http://siteresources.worldbank.org/AFGHANISTANEXTN/Resources/AfghanistanGenderReport.pdf
iii
Afghanistan Summary. Population reference bureau.
iv
Afghanistan: Health Profile. (2004). World health organization. Retrieved April 13, 2011, from
http://www.who.int/gho/countries/afg.pdf
v
Fatimie, S. M. A. Minister of Health, Islamic Republic of Afghanistan, (2009). Overview of status of women’s
health in Afghanistan Washington, D.C.: Retrieved from
http://www.embassyofafghanistan.org/documents/WomensHealthinAfghanistan.pdf
vi
Afghanistan: Demography and Population. (2005). U.S. global health policy. Retrieved April 13, 2011, from
http://www.globalhealthfacts.org/country.jsp?c=12&cat=7
vii
Cardozo, B.L., Bilukha, O.O., Gotway, C.A., Wolfe, M.I., & Gerber, M.L. (2005). Report from the cdc: mental
health of women in postwar Afghanistan. Journal of Womens Health, 14(4), Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/15916500
viii
Unifem Afghanistan. (2010). Retrieved from
http://www.unifem.org/afghanistan/media/pubs/factsheet/10/violence.html
ix
Afghanistan Summary. Population reference bureau.
x
Afghanistan. (2011). Cia world factbook. Retrieved April 13, 2011, from
https://www.cia.gov/library/publications/the-world-factbook/geos/af.html
xi
Afghanistan Statistics. (2009). Unicef. Retrieved April 13, 2011, from
http://www.unicef.org.infobycountry/afghanistan_statistics.html
xii
Afghanistan. (2011). Cia world factbook. Retrieved April 13, 2011, from
https://www.cia.gov/library/publications/the-world-factbook/geos/af.html
xiii
Afghanistan Summary. Population reference bureau.
xiv
Afghanistan Summary. Population reference bureau.
xv
Afghanistan Statistics. (2009). Unicef. Retrieved April 13, 2011, from
http://www.unicef.org.infobycountry/afghanistan_statistics.html
xvi
Usaid Afghanistan. (2009). Retrieved from http://www.usaid.gov/locations/asia/countries/afghanistan/index.html
xvii
Afghanistan: Programs, Funding & Financing. (2005). U.S. global health policy. Retrieved April 13, 2011, from
http://www.globalhealthfacts.org/country.jsp?c=18&cat=5
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