Afghanistan’s maternal mortality rate was already among the ten highest in the world, but it has come under further pressure. The United States’ decision to entirely cut aid to Afghanistan earlier this year has led to the closure of over 400 health facilities and that is likely to have particularly affected women during the most precarious events in their lives — pregnancy and childbirth. Coupled with that, there is a shortage of female doctors and midwives, likely to worsen as midwifery and female nurses’ training are now banned, along with all higher education for girls, including as doctors. Jelena Bjelica and AAN’s team have been trying to get a clearer sense of Afghanistan’s maternal mortality rate. They found quantitative data was scarce, but midwives, doctors and health officials in different provinces said they think the rate is increasing. They also heard from one Afghan who described how his family lost a female family member in childbirth due to poor healthcare. It was nine o’clock in the morning when we took her to the clinic in our village. It was her fourth pregnancy. Her husband is my relative. He doesn’t have a car, so he called me to come to his house and help him take her to the clinic. … When we got there, the midwife was present. My relative’s wife went into labour, but the baby was stillborn. The midwife told us to wait a while for her to check my relative’s wife. …
When she finally gave us permission to leave, the women in our group noticed that my relative’s wife was still bleeding. We asked the midwife if we should take her to the Bost Hospital in Lashkargah city. The midwife said there wasn’t a problem, that it was normal to bleed after childbirth. … After we got her home, the bleeding increased. By the late afternoon, she grew weaker. We finally took her to Bost Hospital, but the doctor told us she had already lost a lot of blood and that the midwife couldn’t have been properly trained because the placenta had not been entirely removed. The doctor said we had got her to hospital too late. We donated blood, but on the third day, late in the afternoon, she passed away in the hospital.
This incident occurred in Marja district of Helmand province in June 2025.
In an earlier AAN report on rural women’s access to health (published in March 2025, based on 22 interviews conducted in 19 provinces between September and November 2024), we found that the picture was already bleak: women spoke about the prohibitive cost of travel, when household incomes had fallen, the difficulty of independent travel following Emirate restrictions and declining standards in the facilities themselves. For this report, we wanted to really scrutinise the situation of pregnant women and those who have recently delivered and, in particular, try to get a clearer picture about the current maternal mortality rate in Afghanistan. We interviewed nine Afghan health professionals or health officials from eight provinces – Takhar, Jawzjan, Samangan, Balkh, Badghis, Paktika, Zabul and Kabul – as well as one international health expert, regarding the state of maternity care in the country. They also discussed the underlying causes for the apparent rise in maternal mortality, mentioning a decline in foreign support to health care, shortages of medicine, worsening poverty and Emirate restrictions on women’s professional medical training.
What is maternal mortality?
Maternal mortality, also known as maternal death, is defined as when a woman dies due to complications during pregnancy or childbirth or within six weeks of the end of her pregnancy, from any cause related to or aggravated by the pregnancy or its management (WHO). The most significant causes of maternal mortality are: severe bleeding, infections, pre-eclampsia and eclampsia, delivery complications and unsafe abortions.
The rate of maternal mortality is measured as the number of maternal deaths per 100,000 live births. Afghanistan saw a huge reduction in maternal mortality between 2000 and 2023, from 1,372 to 521 deaths per 100,000 live births (World Bank). However, to give a sense of just how high even the 2023 figure is by global standards, some other countries’ rates are: Pakistan 155 deaths of mothers per 100,000 live births; Bangladesh 115; India 80; Uzbekistan 26; US 17; Iran 16; Tajikistan 14; France 7; Norway 1.
There have been no recent surveys on maternal mortality. A government official with the Ministry of Public Health, who wished to remain anonymous, told AAN that due to the US cutting all aid, a health survey had not been completed. He said the whole-country survey had been indirectly funded by USAID and added that 85 per cent of the survey had been finished when Trump issued his order to stop aid. Some of the healthcare professionals we spoke to also pointed to the lack of data, but all thought maternal mortality was rising.
One tiny statistical indication of an increase in the rate came from Deputy Representative of the World Health Organisation (WHO) for Afghanistan, Makta Sharma, who told Salam Watandar on 7 April 2025 that there were currently 620 maternal deaths per 100,000 live births. If correct, that is much higher than the 2023 rate of 521 deaths per 100,000. Apart from that one figure, one is left to anecdotal evidence, which, however, all points to maternal mortality being on the increase. One forecast, from the leading UN agency for sexual and reproductive health, the United Nations Population Fund (UNFPA), was also stark. The closure of health facilities caused by the end of US funding, it said in February 2025, would “likely result in 1,200 additional maternal deaths and 109,000 additional unintended pregnancies” between 2025 and 2028 (UN News).
Maternal health in the provinces: eyewitness accounts
Our interviewees all agreed that the deterioration in the healthcare system in their provinces was driving an increase in maternal mortality. The medical professionals cited several reasons for that deterioration, with the most prominent being the shortage of professional staff and the lack of health facilities in remote areas of the country due to funding shortfalls. Some also spoke about poverty making it impossible for families to pay for medicine or even getting transport for a woman in difficult labour to the nearest clinic. Poverty also means women are weak or malnourished during pregnancy or have to engage in hard labour during it, both factors adding to the risk of maternal death. The dire economic outlook in Afghanistan since 2021 is part of the story of increasing maternal mortality. Some of our interviewees also drove home how dire they believed the situation had become by relaying instances of women dying in childbirth.
In Takhar province, the head midwife of a clinic said that many pregnant women were dying due to a lack of prenatal and postnatal care, because there were no facilities providing these services, or there was a shortage of medicine, money for transport, or the means to pay staff. Healthcare facilities had closed, she said, and a significant number of midwives and doctors had left Afghanistan.
Women continue to die from high blood pressure, heavy blood loss, and lack of medical attention. One of my close friends gave birth in a hospital. She was discharged too soon due to the overwhelming pressure on doctors and staff. They couldn’t attend to her after delivery, so as soon as she delivered, she was discharged. On the way home, she started bleeding heavily. She was brought to our clinic from the provincial hospital, but despite our best efforts, we couldn’t save her. She died from a heart attack due to the massive blood loss, leaving behind three children. She died and left three children. She was my close friend.
Such deaths were preventable, she said and should have been avoided.
Tragically, half of the women die on the way to hospital or to a clinic. Staff shortages exacerbate the situation. For example, a healthcare worker may see up to 300 patients in a single day and will just not have the capacity to see the 301st patient. It makes it impossible to treat the patients properly. I’ve also seen patients die because they could not afford medicine or get blood.
The head midwife also said that amr bil-maruf officials, tasked with enforcing the law promoting virtue and preventing vice, sometimes make the situation worse. “They sometimes enter delivery rooms during labour, forcing us to leave while they ‘inspect’ the room, claiming we might be hiding our corruption,” she said. “On one occasion, they were physically present in the delivery room when we were actually delivering the baby.”
Another midwife, also in Takhar, said she had left her hospital job after the fall of the Republic because of declining standards in hygiene and management, as many of her colleagues had left the country and others had lost their jobs. However, she said former colleagues told her things had got even worse this year:
The closure of the institutes that trained girls to become midwives and the cut in aid following Trump’s order has severely affected health service delivery. The Taliban have employed their relatives and other people they know. Most of the midwives in the hospital where I used to work are those acquainted with the Taliban. However, they haven’t yet graduated, nor completed their training and education as midwives. There’s been an increase not only in maternal mortality rate but also in children’s mortality rate because of the lack of qualified doctors, nurses and midwives over the past three to four years.
Another midwife, this time from Jawzjan, who lost her job after the takeover, echoed these points. Her old colleagues had described to her a severe shortage of midwives and doctors, as well as of medicine and medical supplies in clinics. She said the difficulties in healthcare had reached a new high, and that all the problems were contributing to an increase in “the number of maternal deaths and the loss of infants and prematurely born babies.” She recounted a maternal death she had recently witnessed and explained the reasons behind such deaths:
Just a few days ago, I witnessed a death myself while I was in the hospital with a family member of mine who was giving birth. I saw a pregnant woman die during delivery. Also, another woman was in desperate need of a blood transfusion, and her family struggled in vain to find the right blood type for her. Without blood, she too was at risk of losing her life. … These deaths occur because mothers do not receive proper care during pregnancy. Many suffer from malnutrition, anaemia and weakness due to poverty and lack of resources. Without prenatal care, adequate nutrition and medical guidance, both mothers and their babies face risks. Even if the mother survives, newborns often do not. I’ve personally seen babies born prematurely at six months, and doctors explained this was due to the mother’s lack of prenatal care and the heavy physical labour they have to do in the villages. There are no instructions for these women in rural areas on prenatal care.
In Samangan province, a gynaecologist said that maternal and child healthcare in provincial centres had already begun to deteriorate after the fall of the Islamic Republic because many health workers left their posts, and the morale of those who remained plummeted because salaries were significantly lower than before the takeover. But now, she said, after the closure of midwifery schools and the end of USAID funding, “the health services women rely on are crumbling.” She pointed to cases of women dying of complications during delivery, including excessive bleeding. “Due to a shortage of staff and low salaries,” she said, “the quality of health services at provincial health centres just isn’t good.”
A graduate midwife from Balkh province said that women in her province, particularly pregnant women, must often travel long distances to the city for treatment because of the lack of services in remote areas. “Many women have lost their lives because of this,” she said. She believes the closure of midwifery programmes has directly contributed to an increase in the maternal mortality rate in the rural areas of Balkh.
A recent report on maternal mortality in Badakhshan province by the BBC’s Yogita Limaye heard multiple concerns at the provincial hospital there. The budget had been cut by almost two-thirds, 300 patients were being treated in a hospital with 120 beds, and maternal mortality had gone up: by August 2025, she reported, “there had been as many maternal deaths recorded [in the provincial hospital] as there were for the whole of last year.” At that rate, “maternal mortality could increase by as much as 50% [compared to] last year.” Deaths of newborn babies were also up by a third. The hospital’s head midwife, Razia Hanifi, was exhausted. “I have been working for the past 20 years,” she said, “This year is the toughest, because of the overcrowding, the shortage of resources and the shortage of trained staff.”
In Zabul, a local health official said maternal mortality had definitely increased in his province. He said they had only recently begun recording maternal mortality data, so could provide no statistics, but his strong sense was that considerably more women were now dying in pregnancy or childbirth. He gave some recent examples of deaths:
Two weeks ago, we received information about two maternal deaths in a remote village. Neither patient’s family had the money to take the pregnant woman to the hospital, nor was there an ambulance in the area. We also received news of another complicated case in the same district. In that case, we sought help from UNICEF; they arranged for an ambulance, but unfortunately, the area was very remote and, by the time the ambulance arrived, the mother had lost her life.
The problem with access to maternal health care in remote areas was also mentioned by an international health expert, Dr Kweku Ackom, who works with the UK’s foreign and development ministry, who said their implementing partners were relaying anecdotal accounts about women dying at home in hard-to-reach areas. However, as with the Afghan health officials we spoke to, he said there was no systematic data to give a clear idea of the extent of the problem.
A health official in Badghis also mentioned the lack of data. The situation in his province, he said, had anyway been dire. He was aware of the maternal deaths in areas where health facilities did exist, but also said there were large parts of Badghis with no health services at all. People living there were poor and unable to take their women to distant hospitals. “God knows how many pregnant women die there,” he said.
The issue of underreported maternal mortality was also raised by a health official in Paktika province, although for a different reason.
Maternal mortality is more than twice the reported figure. It has definitely increased significantly. The NGOs implementing health projects in my province are not providing accurate data because they attempt to portray their efforts and services as highly successful.
The head midwife from Takhar also said that in her hospital, maternal deaths were underreported to avoid raising questions:
Maternal mortality rates are extremely high; officially, [in my clinic] three out of every 100 patients die, but the real number is far higher. Many deaths are not reported at all; deaths at home or on the way are not reported at all. And even hospital deaths, the ones that are registered, are sometimes hidden or incorrectly recorded to avoid raising questions.
The response of the Islamic Emirate
Although the evidence of a rise in maternal mortality is anecdotal, it strongly suggests that all the reasons for pessimism are correct. The Afghan government, however, wants to tell a different story, shown in its response to comments made by UNFPA’s Deputy Executive Director, Andrew Saberton, who visited Afghanistan in May. He spoke about the funding cuts and the end of the ‘pipeline’ for new midwives, given the ban on midwifery training and on girls’ education beyond 6th grade. He also said that every two hours, an Afghan mother died “from preventable pregnancy and childbirth complications” (Tolo News).
That statistic, said spokesperson for the Ministry of Public Health Sharafat Zaman Amarkhel, was “unfair, unrealistic and incorrect.” He insisted that since regaining power, the Islamic Emirate of Afghanistan (IEA) had paid special attention tothe health of children and mothers. “Our request to all international organizations,” he said, “is that if they want to publish figures, they should do so in coordination with the Ministry of Public Health to prevent the spread of fear and misinformation among the public” (Tolo News).
Despite the government’s apparent attempt to control the narrative on maternal mortality, our interviews show why the rate is likely going up. In the following sections, we give a little more background on three of the causes mentioned: cuts in aid; scarcities of medicine and the end of midwifery training.
The reduction in aid and access to healthcare
The difficulties facing pregnant women can be placed in the context of a wider problem with healthcare. At its peak in the late 2010s, Afghanistan’s health system consisted of more than 3,000 health facilities. By 2024, this figure had been reduced by half, with just over 1,500 still operational. As a direct result of the end of US aid, said the WHO Health Cluster Bulletin, by July 2025, the number of health facilities had fallen even further, to 817. Only 297 of the approximately 400 districts in Afghanistan’s 34 provinces now have health facilities.
The funding situation is stark. The United States was the largest single donor to Afghanistan, providing 40 per cent of all aid in 2024. It cut all of it, suddenly and with no, or almost no, warning (for more detail on this, see AAN’s May 2025 report, The End of US Aid to Afghanistan: What will it mean for families, services and the economy?). Healthcare was particularly vulnerable, as it was very dependent on foreign financial support. This reliance was crucial during the Republic era, and nothing changed after the Emirate came to power. Although foreign aid to the health sector declined significantly, the new government allocated a minimal budget to it, prioritising other sectors, especially security. Already, in relation to the much smaller decline in aid seen in 2024, ie before the US completely stopped aid, the World Bank had concluded, in its April 2025 Development Update, that the reduction in aid posed “a serious risk to the continuity of essential service delivery programs, particularly those implemented through the UN and funded via humanitarian channels.” It explained:
Key sectors such as healthcare, education, and social protection which have historically relied on international aid, may face severe disruptions, disproportionately affecting marginalized populations, including women, children, and displaced communities. The contraction in aid may also limit emergency response capabilities, further straining public services and slowing economic recovery efforts.
The decline in general healthcare provision is evident in the quantitative data. The March 2025 Humanitarian Needs Survey assessed the ‘health needs conditions’ in Afghanistan’s 401 districts, and classified as conditions in 373 were severe (234 districts), extreme (134), or catastrophic (5). Just 28 districts in the whole of Afghanistan were classified as being in the ‘better’ categories, in a ‘stress phase’ or with ‘none to minimal health needs’. The assessment was based on: whether households had access to adequate healthcare; the availability of a health centre providing maternity services; and the average time it takes to reach the nearest functional health facility.
The Humanitarian Situation Monitoring, also published in March 2025 by the same group, which assessed 12,015 settlements across 401 districts and 34 provinces, found that residents in 10 per cent of them had no health facility at their disposal, 45 per cent reported that their medical facilities were not adequately staffed, 78 per cent said their medical facilities lacked medicine or equipment, while 28 per cent reported physical difficulties in accessing health services due to damaged roads, no transportation, flooding etc. On the national level, 13 per cent of respondents said the majority of households in their settlement currently had no access to adequate healthcare when they needed it. The worst-affected provinces were Ghor (where a majority of households in 52 per cent of settlements had no access to adequate healthcare), Takhar (37 per cent) and Kunduz (28 per cent). Additionally, the report found that 16 per cent of healthcare facilities were structurally damaged.
The Humanitarian Situation Monitoring also found that women and girls faced particular restrictions limiting their access to healthcare, with 49 per cent of their sample reporting that women were allowed access only when accompanied by a male relative, or a female relative or friend. In December 2021, the Emirate forbade women from travelling long distances (72 kilometres) without a mahram (a close male relative). However, Emirate officials often interpret this as meaning that women need a mahram whenever they leave the house.
Particularly important for expectant mothers have been the cuts to the UNFPA-run Family Health Houses (FHH), which provide reproductive, maternal, neonatal, child and adolescent health services in the country’s remotest areas. In 2025, the UNFPA lost approximately USD 330 million in US funding worldwide, of which about a third, or USD 102 million, directly affected its work in Afghanistan (UN News). In 2024, UNFPA had supported 533 midwife-led Family Health Houses, serving about four million people, almost 80 per cent of them women, in the most remote areas of 26 provinces (UNFPA). It was also running 263 mobile health teams and 28 clinics and health centres. The UNFPA said in a tweet on 21 May 2025 that, because of the funding cuts, more than six million people were losing access to “essential health care, most of them women and girls, including lifesaving maternal health services” and that “hundreds of health centres operating in remote areas and mobile clinics are being forced to close.” The number of midwives that UNFPA is able to support in 2025 has also almost halved. Instead of the 974 midwives that the agency planned to support this year, it will be able to pay for only 565 (UNFPA).
Some midwives and doctors, such as the gynaecologist from Samangan whom we interviewed, have agreed to continue working for free. She told us that after USAID pulled its funding, UNFPA asked if she would volunteer and work without pay for several months.
I work in Hazrat-e Sultan, a very poor area where people have nothing. How could we abandon them? So, we agreed. We also knew we weren’t the only ones; colleagues across Samangan’s remote districts made the same choice, working unpaid because the need was so urgent.
The scarcity of medicine
Medication shortages have also gripped the current healthcare system in Afghanistan. With the decline of aid, medicines needed by health facilities in Afghanistan, including for women during childbirth, have also become scarcer, our interviewees reported. “The number of patients is overwhelming, yet resources and medicines are scarce,” the head midwife from Takhar province said:
Supplies intended to last three months often run out in just a month, leaving facilities empty-handed for the next two months. There has been a significant cut in funds and supplies are no longer as plentiful as before, which means a shortage of personnel, medicine and ambulances. Previously, I was part of a project that provided folic acid to pregnant women free of charge, but that programme has now been stopped. Pregnant women must now buy everything themselves, but most can’t afford it. The majority of women don’t even have money for medicine or transport. Many walk six to seven hours just to reach a clinic.
The health official in Badghis said there was a critical need for medicines for their patients, including women in labour. He said: “We don’t have enough essential medicines, nor do we have medicines which are needed in an emergency for a mother during her delivery.” The health official in Zabul said they lacked medicines for mothers, both prenatal and postnatal, while a health official in Paktika also reported similar issues regarding medicines for childbirth: “I’m running a health project and I can say that we don’t have any medicines for those who give birth in our clinics.”
One high-ranking health official working in the Ministry of Public Health told AAN that the clinics have some emergency medicines available to provide to mothers before and after delivery. However, he mentioned that the stock of medicines had decreased since the collapse of the Republic. This medicine shortage was also one of the main findings of a qualitative study on the factors hindering access and utilisation of maternal healthcare in Afghanistan, published in the Healthcare journal in April 2025. The study found that:
Medication shortages have also gripped the current healthcare system, especially in the public health sector and rural areas. Public hospitals have also run out of medications quickly because they have more patients than private hospitals. In rural regions, distance and weather conditions hinder access to medication, leaving patients stranded and without essential medications. A provider noted that “In rural areas, when hospitals run out of medicine in the winter… They cannot travel to the city to get them because the snow blocks the road for 6 months or more.”
The end of midwifery training
The latest trouble putting Afghanistan’s maternal health sector at risk is the IEA’s ban on all midwifery and nursing schools, effective from December 2024 (BBC, UNICEF). This ban, along with the earlier general prohibition on girls’ education beyond the first six grades, and on higher education, including training to become a doctor, will have long-term consequences. This ban is even more serious than it would be in many other countries because of the cultural taboo and legal prohibition on male medical staff attending female patients. Already in 2024, the UNFPA had estimated that Afghanistan urgently needed at least 18,000 additional midwives to meet basic maternal care needs. Without a steady stream of new midwives, the need for medically trained women to help their compatriots in childbirth will never be met. Indeed, the existing shortage in midwives will only worsen. Earlier this year, in March 2025, UNICEF warned that, as a direct consequence of the education bans, the country would experience a shortage of qualified female health workers. “With fewer female doctors and midwives,” it said, “girls and women will not receive the medical treatment and support they need. We are estimating an additional 1,600 maternal deaths and over 3,500 infant deaths [no time span given].”
We interviewed a young woman from a family of midwives in Balkh province, who had just graduated from the midwifery programme when the ban was announced. However, she was unable to obtain her diploma or take the exit exam. This left her unemployable.
A former head of the Afghan Midwives Association, Sabera Turkmani, argued that the midwifery ban had to be lifted, in an opinion piece published in December 2024 in the British Medical Journal:
The health workforce is in a state of crisis, with most healthcare facilities lacking female health providers, leaving many women living in rural and remote areas without access to skilled maternity care. … I have witnessed substantial progress while working with Afghan communities. … Afghan midwives play a pivotal role in advancing primary healthcare and provide a wide range of essential reproductive, maternal, newborn, child, and adolescent health interventions. … Midwifery services are indispensable for saving lives as cultural and religious norms in Afghanistan prohibit male healthcare providers from attending to women. … Skilled midwives can have a central role in reducing maternal and neonatal mortality. Beyond clinical skills, the ripple effects of midwifery are profound. Empowering midwives is not merely a cost-effective health intervention; it is a pathway to economic growth, community resilience, and peacebuilding.
The system, even as it is now, cannot provide quality healthcare services for mothers. But given that every year, female health professionals retire or leave the service for other reasons, without a steady stream of new female doctors, midwives and nurses, professional childbirth services in Afghanistan will likely not survive.
Looking ahead
It seems no exaggeration to say that Afghanistan’s maternal healthcare system is in crisis, under threat both from a dire shortage of funding and – especially with an eye to the future – the end of the education pipeline to ensure new female nurses, doctors and midwives are coming into the workforce to replace older women retiring or otherwise leaving their jobs. We may not have the exact numbers, but after two decades of fewer Afghan women dying in pregnancy and childbirth, the figures are surely now rising. Becoming a mother in Afghanistan, going through pregnancy and childbirth, was already riskier than in most other countries in the world, even during the relatively well-resourced Republic era. It has now become even more dangerous. As the midwife from Jawzjan put it: “Afghan women are among the most unfortunate in the world. … They lose their lives even while giving birth to new ones.”
Edited by Kate Clark
References
Afghanistan Peace Campaign
