Last April, President Biden announced his plan to withdraw all remaining U.S. troops and personnel from Afghanistan by September 11, 2021, after nearly twenty years of influence in the nation. In correspondence with this proposal, other members of NATO have agreed to withdraw their forces from Afghanistan in a coordinated effort with the United States. Biden’s decision has been brought to question by many who believe that a sudden and complete withdrawal will allow the Taliban to quickly regain control of the country within an estimated two to three years following a U.S. withdrawal. The lack of U.S. influence in the nation and a subsequent takeover by the Taliban are expected to undo much of the progress made in Afghanistan within the last two decades, particularly in securing women’s rights to healthcare.
Afghan women face a unique disadvantage in acquiring access to healthcare, a phenomenon that began with the rise of the Taliban. Almost immediately after the group came into power in 1996, the Taliban violated many basic principles of international human rights law by forbidding women the right to education, mobility, work, and healthcare, while justifying their actions with an extreme interpretation of Islamic law. These standards are specified under the International Covenant on Civil and Political Rights and International Covenant on Economic, Social and Cultural Rights, treaties that the preceding government of Afghanistan both signed and ratified. Of the numerous human rights violations committed against Afghan women by the Taliban, denial of access to healthcare has had long-lasting impacts on women and their children. Under the Taliban rule, around 16 in 100 mothers died during childbirth, while 165 in 1000 babies died before the age of one.
Following the 2001 military intervention that defeated the Taliban government, the Afghan government, with the help of many international donors, worked to develop a healthcare system that extended basic access throughout the entire country. The initiative has made some progress in women’s healthcare, as maternal and infant mortality rates significantly declined. Yet, healthcare services for women are still lacking in comparison to international standards, despite the two decades of work and hundreds of millions of dollars in aid invested into improving the healthcare system. Women still face challenges in acquiring modern forms of contraception, prenatal and postnatal care, modern cancer and fertility treatment, and even routine treatments like pap smears and mammograms.
Improvement of female healthcare services seems to be constrained by economic, political, and cultural factors. For one, healthcare is too expensive. Even services at governmental hospitals require the payment of fees, which is a luxury in a country where poverty rates are on the rise. Additionally, Afghan healthcare facilities and medical personnel are frequently victims of violent attacks. A 2018 report found that in that year alone, 140 healthcare facilities that had served two million Afghans closed due to attacks by armed groups. These attacks force women to choose between their immediate safety and their health. Large amounts of aid provided by international donors to advance women’s healthcare services have also been lost to corruption.
Finally, Afghanistan’s cultural norms dictate that women are only able to receive medical service from other women. However, high illiteracy rates━prompted by decades of war and conflict with the Taliban━have significantly limited the pool of female doctors available to treat women. This issue is even more severe in areas still controlled by the Taliban today, as women continue to be forbidden from receiving education. Furthermore, male doctors and nurses may only touch female patients above their burqas, which has dangerous consequences for cases that require more invasive examinations. Although international medical institutions like the Red Cross have been granted permission to work in the Taliban-controlled areas, they are still required to adhere to the Taliban’s rules, and thus are unable to perform procedures for women that conflict with the Taliban’s beliefs.
The limited achievements that have been seen in women’s healthcare in Afghanistan are still contingent on support from international donors. However, aid provided to the Afghan healthcare system has been declining in recent years. In 2013, countries in the Organisation for Economic Co-operation and Development’s Development Assistance Committee provided Afghanistan with $141 million to support its healthcare system. However, by 2019, aid had decreased by 26 percent to $105 million. Moreover, with the exit of the U.S. from Afghanistan, aid is further suspected to decrease. Although the withdrawal of troops does not require any conditions to be met, it will have a large impact on many international donors that distribute aid to governments on the condition that they uphold human rights, especially women’s rights. This requirement will be difficult to fulfill considering the predicted rise of the Taliban.
With the ongoing COVID-19 pandemic, any further loss in foreign aid will almost certainly overburden the already struggling healthcare system. Currently, the pandemic has exacerbated preexisting issues for the Afghan healthcare system, including a lack of efficient emergency services, an insufficient number of experienced staff, low testing capacity, scarce PPE, and high rates of violence against healthcare workers and facilities.
In the current circumstances of the pandemic, women are even less likely to receive the necessary medical assistance. The combination of limited medical resources, ever-growing rates of poverty due to economic downturn, and a fear of contracting illness have deterred many women from going to the hospital, despite being in life-threatening situations. In one instance, an Afghan midwife quarantined in a tent outside of her home after contracting COVID-19 because she lacked the resources to go anywhere else.
To make matters worse, India’s ongoing second wave of COVID-19 is expected to have incredible effects on Afghanistan’s healthcare system. Many new cases that have surfaced in Afghanistan have been credited to relaxed travel restrictions, which have allowed foreign arrivals to enter the country without being screened for COVID-19. The government has yet to ban direct flights between Kabul and New Delhi. With the approaching withdrawal of U.S. troops and the underprepared healthcare system, the effects of India’s second wave are almost certainly going to devastate Afghanistan’s ability to overcome the COVID-19 pandemic alongside any security developments in the region. In this environment, ensuring healthcare access for women is in serious danger.
Now more than ever, healthcare for women is imperative for their wellbeing and prosperity. Yet, with the U.S. withdrawal, there is an impending threat that the little progress that has been made in women’s health will not only revert back to the status that existed under the Taliban, but will likely worsen as a result of COVID-19. In this state, the U.S. and international donors cannot end their support of the Afghan healthcare system and developments in women’s health. In fact, a renewed emphasis must be placed on revitalizing the healthcare system and increasing its accessibility to women. More specifically, this plan must ramp up efforts to decrease the cost of receiving medical care, advance the medical treatments available for women, and educate women in order to increase the number of experienced female doctors. Furthermore, ongoing violence and political developments in the region must be considered to ensure that these efforts are effective.