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While many women in developing countries face childbirth complications that have been nearly eradicated in developed countries, maternal health in Afghanistan, a predominantly Islamic country, is particularly contentious for religious reasons. Although Afghanistan has always struggled with maternal mortality, a January 1997 Taliban decree that hospitals had to be segregated based on gender wiped out virtually all medical care for women. Women could only be examined by a female provider or a male provider if accompanied by an appropriate chaperone, and a 1998 survey published in the Physicians for Human Rights sponsored report The Taliban's War on Women: A Health and Human Rights Crisis in Afghanistan found that in Kabul, the nation's capital, there was only one hospital providing any type of obstetric care. The Taliban also severely restricted women's access to higher education and ability to work in health professions. Male physicians could not physically examine women and were not permitted to participate in deliveries or surgeries even in life-and-death cases. For this reason, many women died because they could not seek medical attention during labor and delivery. Taliban guards enforced the strict segregation of women and men by publicly beating and jailing non-adherents. Even today, many women will not see a male physician.

Since the U.S. invasion in 2001, the country has tried to gradually rebuild its health system, but as reported in the 2005 Lancet article "Reconstructing Afghanistan," the effort has been hampered by several factors, including a lack of trained health professionals, inadequate financing, and logistical concern. Despite the obstacles, Afghani women are coming together to improve conditions for mothers and children. Dr. P. Herberg's 2005 International Nursing Review article "Nursing, midwifery, and allied health educational programmes in Afghanistan" reported that local women are reaching out as skilled attendants at home births and as health educators. Available spaces in midwife educational programs have doubled since 2001. Students receive extensive clinical training at facilities in Kabul, and the curriculum emphasizes evidence-based practice. Many support services are in place to help women complete the curriculum successfully and return to practice in their home communities. In a culture where women are often leery of male providers or shy about their reproductive health needs, midwives and skilled birth attendants are truly advocates for women who otherwise would have no one to speak for them in cases of delivery complications.

Becoming a mother does not have to be unduly dangerous. A pregnant woman should be able to look forward to watching her baby grow rather than wondering if she might never see her child. The everyday successes of Afghani midwives are proof that women can make a difference for other women.

References for More Information
Herberg, PhD, RN, P. (2005) Nursing, midwifery, and allied health educational programmes in Afghanistan. International Nursing Review 52: 123-33.

Physicians for Human Rights. The Taliban's War on Women: A Health and Human Rights Crisis in Afghanistan. Washington, D.C.: Physicians for Human Rights, 1998. Accessed at on 5/10/2008.

(2005) Reconstructing Afghanistan's health system. The Lancet 366: 17/24/31.

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