“When we lost all three, they said it was God’s will,” said Sajida, 26, describing doctors’ reaction when three of her babies died, each within weeks of birth. “They were smaller than normal, weak, and had heart issues.”
No one had been able to tell her what was wrong or help ensure that the same thing would not happen again.
She was five months pregnant with her fourth child when I met her in March 2021 in Kabul, Afghanistan.
Afghanistan does not have a functioning healthcare system -- and it has never needed ongoing European Union support to essential services in the country more than it does now.
New research has found that cuts in aid by other international donors in recent years have already harmed women’s access to health care, costing lives.
Health services that once were free, no longer are, as hospitals run out of money to pay for basic supplies. These costs are passed to patients, many of whom cannot afford them, or even afford transportation to a health facility, as the COVID-19 pandemic dramatically increased the rate of poverty in Afghanistan from an already devastating 55 per cent in 2015 to an estimated 61 to 72 per cent in 2020.
Afghan women often have more children than they want because of a lack of access to modern contraception. They face risky pregnancies because of inadequate medical care. And they undergo procedures that could be done more safely with access to more modern techniques. Maternal and infant mortality remain very high. Progress on some key indicators, such as accessing prenatal care and skilled birth attendance, is stagnating or even reversing.
This is a terrifying moment for women in Afghanistan. The April 14 announcement that US troops will leave Afghanistan before September 11 has created a new level of fear in a country already devastated by 40 years of war. Other NATO countries plan to withdraw their forces in coordination with the US.
Violence could surge and the Taliban could dramatically expand their control. Either scenario would be devastating for women’s rights.
The EU has a crucial role to play in ensuring that the departure of troops does not send Afghan women and girls back to the conditions of 2001 when, under Taliban rule, they were systematically denied access to education, employment, and freedom of movement.
International aid to Afghanistan has been falling for years. The US, the country’s largest donor, has slashed aid and deep UK cuts to aid pose new threats.
The EU has been a staunch friend to Afghanistan, at times when other donors have disengaged, providing more than €4 billion in development aid since 2002. At the November 2020 Geneva donor conference, the EU pledged €1.2 billion for the next four years, matching its pledge for the previous four-year period, at a moment when overall pledges fell by some 20 per cent.
Today, donors and organisations delivering services in Afghanistan are in a waiting game, with donors unwilling to make firm commitments, and hedging on whether they will be able to fulfil existing commitments until there is greater clarity on the political and security situation. A crucial question is whether the EU and other donors will stand by the pledges they made, in Geneva and elsewhere if the security situation deteriorates significantly or the Taliban seize greater control.
The answer should be an emphatic “yes.” Donors should prioritise meeting the urgent needs of Afghans —including health care for women and girls.
Nongovernmental organisations and the Afghan government have learned hard but valuable lessons about delivering services amidst deep insecurity and in areas under Taliban control. They can deliver these services — if they have sufficient resources.
Donors to Afghanistan should assess the need for aid, and their commitment to providing it, separately from the withdrawal of forces. They should fully appreciate the depth and urgency of the needs in Afghanistan, and not use political and security developments to justify disengaging when the need for international assistance is greater than ever.
One of the women I interviewed in Afghanistan was Zarmina. At age 27, she was in labour with her fourth child. She had never received prenatal care during any of her pregnancies because her family could not afford the cost. That day she was afraid that she might need a caesarean section. “I already bought gloves and other things needed for today—it cost 2,000 Afghanis,” she said, about US$26. “If I need a C-section, I have no more money. I had 2,000 Afs and I spent it all.”
No woman should face this situation. The next chapter in the EU’s important work in Afghanistan should be taking the lead in ensuring uninterrupted funding to essential services like education and health care, especially for women and girls.
Heather Barr is the interim co-women’s right director at Human Rights Watch.